CT Results

Well, it's not really any surprise that my CT showed that I still have cancer. My wildest fantasy would be to have one of these scans and really puzzle the doctors by having no visible tumours. This time it didn't happen but there will be more of these scans in my future so I'll keep hoping that someday my fantasy will come true.

Last week's scan showed, as I suspected, that the tumours in my lungs had grown. They range in size from 1-7mm and affect all lobes of both lungs. The radiologist who reviewed the scan did not comment on the number of tumours in my lungs or their specific locations or the relative growth of individual tumours relative to my last scan in May. I believe the scan then showed multiple tumours ranging in size from 1-5mm. If I put my post secondary math skills into action I can arrive at the conclusion that the largest tumour grew by 2mm between scans.

The real question, for which there is no clear answer at this point, is this: Is the chemo working? One might infer from the growth of the spots that the chemo is ineffective but I don't believe you could draw that conclusion yet. Since my last scan in May I did no chemo in June, one round in July and one round in August. For September and October I was on chemo full time. So did the tumours grow in June, July and August when I was doing little or no chemo and then stay stagnant while I was on chemo in September and October? Did they grow for June, July and August and then shrink in September and October? Or is my cancer slow growing and has been growing slowly and steadily since my scan in May regardless of the fact I've been on chemo? The answer to those questions is not really clear at this point.

So, looking ahead there are 4 options.

1) Stop chemo altogether.

2) Stay the course and continue my modified FolFiri + bevicizumab protocol (no IV pump)

3) Go back to an unmodified FolFiri+bevacizumab protocol (with IV pump)

4) Take part in a phase 1 clinical trial.

Option 1 is appealing in the short term but may not yield the best results.

The main difference between option 2 and 3 is that right now I don't have to wear an IV pump home for two days after I get the rest of my chemo. This IV pump is set up to deliver a steady dose of chemo (5Fu) for 46 hours. The oncologist I visited at the Mayo clinic said I didn't need the 5Fu and that I could cut it out of my treatment here. I was game for that since having the extra chemo infused for two extra days prolongs the length of the side effects I have. The side effects aren't terrible but still, that's 2 days of my life I'll never get back. The problem with cutting the 5Fu out is that at the beginning of my treatment 2 years ago I did 5 weeks straight of radiation and 5Fu. I wore that damn bottle for what felt like an eternity and it made me feel like crap. When they did my liver resection my surgeon said he could see that the spots in my liver had been partially killed somehow (I forget the exact words he used). Since the radiation I had was focused on my colon (yup, it's as fun as it sounds) and not my liver, the only thing that could have messed up my liver tumours would be the 5Fu. So with that in mind, perhaps going back to the full dose of 5Fu might be worthwhile.

The 4th option is for me to take part in a phase one clinical trial. The first phase of a clinical trial is one step (small) removed from animal trials. This particular trial is for a drug that was designed for use in patients with advanced stage cancers that can't be treated with other protocols. It is non cancer specific, meaning they don't know exactly which cancers it will be effective in treating. While it might be exciting to be part of a trial, I'm not keen on abandoning ship on my FolFiri treatments just yet. Dr Lupichuck also hinted that there is another clinical trial coming to the Tom Baker Centre that is specific for colon cancer patients. She said it's a couple months away from being started and would likely be better suited to my cancer than the current clinical trial.

In the end we decided to go with option 3. This option means wearing the IV pump home for two days after treatment and possibly feeling a little more crapped out than my treatments over the past few months. So the plan is do option 3 for two months and get another CT scan. That scan should give a more conclusive answer as to whether or not this chemo protocol is working for me.

I forgot to mention the good part about my CT results today. The scan showed no visible cancer anywhere else in my body (yipee!). It also showed that my abscess (the one with the drain) has not enlarged over the past 5 or so months. This means the drain is doing its job and keeping the fluid from accumulating down there and causing an infection.

If you were me what would you do? Feel free to leave a comment.