The week started out busy with Marye's scans on Monday. She was scheduled for a CT scan, bone scan, and a brain MRI to follow-up on the punctates that were discovered in December. We had pretty much forgotten all about these since Dr. Riley and the radiation oncologist (hereinafter, radonc) were confident that they weren't cancerous. They just wanted to get another scan to make sure. On Tuesday, Dr. Riley called with the news that, yes, of course they are malignant, having grown to a maximum size of 3.5 mm and showing swelling of the brain tissue around them. Obviously, this was not the news we were expecting or hoping for. Dr. Riley asked about any symptoms that may be caused by brain tumors: loss of balance, slurred speech, etc. Everything was negative, so the lesions aren't causing any problems, yet. The only good news was that the CT and bone scans both showed improvement in the liver and bone lesions. There are still around 19 tumors in the liver, specifically, but they are shrinking (or stable) and showing signs of decreased central density. The explanation for this whole picture is that the Navelbine is actually effective, but since it cannot penetrate the blood-brain barrier, the metastasis in the brain will not be affected. The solution? Radiation. The consultation with the radonc was set up for Tuesday.
After a stressful evening of wondering about radiation to the brain, I decided that we just need to relax until we see the doctor and get our questions answered. (Tip: Don't use the internet for medical advice.) On Wednesday, we met Dr. Draygun down at the cancer center and learned about brain lesions and radiation. Marye has four lesions in her brain that the radonc wants to treat and at least two more punctates that are too small to treat right now. Essentially, there are two treatment options: whole-brain radiation and the CyberKnife. Apparently, this thing is the Egg McMuffin of radiation oncology. Instead of radiating the entire brain over a number of days, the cyberknife is a highly precise beam that hits the tumors without touching the surrounding tissue, so there should be very few side-effects. Good news, right? Yes. Even better is that since they are still so small, each lesion will need only one blast of radiation. The downside is that because the radiation beam hits only the tumors, the ones that haven't yet blossomed will need to be treated at some point in the future. If she were to have whole-brain radiation, all of the tumors would be treated at once. Of course, that wouldn't prevent further metastasis and so she may very well need more radiation in the future, anyway. But the side-effects of whole-brain treatment are much more profound over time.
Anyway, back to the CyberKnife. She needs to get another MRI for the procedure. This one is hyper-accurate so they can focus the beam exactly where it needs to be. They also need to make a mask of her head to immobilize it for the treatment. The preparation for this procedure takes a few days, while the treatment for each lesion will last about 15 minutes. Looking forward, Marye will have regular brain MRIs to monitor any more lesions, and she'll get treated for them as necessary. Based on how fast the punctates blossomed into lesions that are big enough to treat, I suspect that she'll be doing this again within the next six months.
Ok, that was Wednesday. The next step was to meet with Dr. Riley on Thursday to go over the other scans and also get the regularly scheduled chemotherapy. Having the worst news (brain lesions) behind us, and already hearing that the liver and bone scans looked better, we were looking forward to some good news. But, cancer had other ideas. Although the liver tumors do, in fact, look better, the CT scan revealed a few potential problems. There is some fluid in the pericardium that may indicate malignancy near the heart. The pericardium is the sac that encases the heart and is filled with fluid to lubricate and nourish the heart muscle. If there are malignant cells there, the fluid will increase and swell. So the CT scan has picked that up. Also, there was some change in the lymph nodes around the heart and lungs that may indicate malignancy. The lymph nodes are the filters of the immune system, and the lymphatic system acts as a conduit for cancer to metastasize throughout the body. During a lumpectomy or mastectomy, the surgeon will take lymph nodes from the armpit and biopsy them. The number of nodes that are "involved" indicates the potential for metastasis. Well, with some funny looking lymph nodes, combined with the fluid around Marye's heart (not to mention the brain lesions), Dr. Riley wants to do a few tests to see if the cancer has spread further. She took blood to check the tumor markers and wants to get an echo cardiogram of the heart. The implications of this are, obviously, that the chemo that we thought was working, might not be.
Again, this was not the news that we expected or hoped for. At this point, I can only deal with one catastrophe at a time, and we're not at all certain that the cancer has spread to her chest. So we'll take care of the brain radiation next week, then schedule the echo of the heart for the following week. By then, we'll know what the tumor markers are, and that will guide Dr. Riley on the next course for the chemo. If the tumor markers are down, she will likely keep Marye on Navelbine for a few more cycles, since she's only been taking it for about a month. It's possible that the drug is working, but it just needs time to catch up with some previous progression of the cancer. Or it could be effective on the liver tumors, but not the other tumors. In the meantime, we'll do the radiation, and Marye gets to take a week off of chemo, which should help her feel a little better. She did get treatment on Thursday, on top of everything. All in all, it's been a pretty tough week.
