At my oncologist assessment appointment on the 8th of May to get my latest scan results – I burst into tears. Why – because of bad news? No, because there was no official scan report from the radiologists. When you have psyched yourself up to deal with results, good or bad, getting no results is actually worse because you are left in a state of suspended anticipation, ‘ not knowing’ the ‘what ifs’ crowding your mind, which as I have said many times before, does my head in far more than knowing facts and figures even if the facts reveal bad news.
The Radiology department of Middlemore hospital ( the local hospital where I have to have my CT scans vs Auckland Hospital where I receive my cancer treatment) has some major issues around scheduling and reporting. While I can’t fault the technicians and nurses that actually facilitate the scans, I have always had issues getting the scans scheduled within the timeframes that my oncologist wants them and we have always had to wait longer than necessary for the official radiologist report. I do not think this is good enough when you are talking about people’s health.
To make it worse, at my oncology appointment I saw a new registrar Dr KN who didn’t know me at all and so could only go on what she had quickly read in my notes. It was a slightly weird consultation as we were discussing what options I had around continuing chemo without knowing what the scan results would ultimately show. She promised to ring me as soon as the scan report came through and let me know as well as posting a printout of the results out to me.
I got the phone call the next day. My larger tumour in segment 7 of my liver has now grown to be 9.4 cm x 7.1 cm up from 6.7 x 5.2 in my February scan.
Dr KN then went on to talk about the other tumour they had measured which now measured 1.1 cm. I think I surprised her by asking her what segment it was in. My second tumour, in segment 2, had been measuring 2.5 cm so I thought she was saying it had shrunk. But no… this is a third, new, tumour in segment 6. She went on to say that they had not been able to get an accurate measurement of the segment 2 tumour.
I decided not to do a blog post about this until I got the written report so I knew exactly what they said, and I also wanted to get my head around what the results might mean, which is part of the reason this blog post hasn’t been written before now.
I got the printout a couple of days after that. as well as the measurements I have reported above, it says that segment 2 is ‘difficult to define due to perfusional change in the left hepatic lobe’ ( meaning the way blood etc is flowing through that part of my liver is partially obscuring the definitive boundaries on that tumour) they also say ‘ there are other small foci which are indeterminate for liver metastases or focal fatty sparing’ – this means because I have got fatty infiltration of my liver that until tumours grow to be about 0.5- 1 cm it is hard to differentiate them from fatty globules. What this means is at the moment we know that I have 3 definite tumours but possibly quite a few more. We wont know until they start growing a bit more. We actually don’t know for certain where or how many ‘spawn of Gertrude’ there are
To put these measurements in perspective I investigated what an average liver’s dimensions were, – me being my usual investigative ‘facts and figures self’. I know my liver is slightly enlarged and that also my larger tumour is pushing out of my liver by a good couple of centimeters at the least so all of its dimension isn’t taking over within the liver itself but the average adult liver is 20-23 cm transversely and 15-17 vertically and 10-12 front to back. So especially the largest tumour is fairly significant in relation to the size of the liver as a whole.
That’s the bad news… the good news is that my tumour markers continue to fall, from 557 to 249 which reassures me there aren’t quite so many cancer cells circulating in my blood looking to ‘set up home’ elsewhere and my liver function tests remain stable.
What does this mean for carrying on treatment. I will discuss more in a following blog post some other factors that have come into play but in the discussion on the 8th and subsequent phone discussion with Dr KN we decided to carry on for at least this cycle and hopefully another couple and then scan again. as we don’t know how much of that growth between the scans on the 1st February and 2nd May happened in the month I was off chemo in February and how much has grown while I’ve been on the Taxol. At most the Taxol is keeping it stable, it isn’t shrinking it at all.