... Stay the course
In the past two months Jen's pain and discomfort has returned, to a minor extent. But her symptoms and ailments hasn't changed dramatically, nor has our outlook. Hence I haven't been updating the blog all that much. I know... my bad. It just didn't seem a great use of everyone's time continually bugging everyone just to say "Every thing's the same" over and over again.
We got more data this week. Jen had the had labs and scans performed on Monday October 22nd. We met with Dr. Santana and learned the results Weds the 24th.
The Short:
The tumors have remained constant in size and aspect. In cancer circles, this is considered a win because it means the cancer is being held at bay. By clinical definition, this means that the crizotinib treatment is still considered effective, and there are no changes to the overall treatment plan. So... we stay the course.
The Long:
This was the first set of labs and scans she's had done since the kids were in school so it was a little easier juggling the logistics of it all. However, regardless of the relative calm when it's just Jan and I, it's still difficult to sit in the radiology waiting room. Not knowing what the scans are going to reveal
Almost all the supporters I've talked to have admitted they go through the same range as they wait for their wife/husband/daughter to return from the magical CT machine...
... maybe it's all gone... hopefully the treatments have gotten rid of most of it... please don't find anything... I hope it hasn't grown... nah, stay positive, maybe it's all gone... come on, be realistic, it won't all be gone... yeah, hopefully the treatments have gotten rid of most of it... I hope it hasn't grown... please don't find anything... and over and over and OVER.
Then Jen comes out, the scan is all over, and I feel a temporary sense of relief. Even though all the heartless CT machine did was take pictures, you feel like some threshold or hurdle was overcome. What it's going to find, it's already found. Like it was some test that she either passed or didn't and you won't know until the next class. Yuck.
On Wednesday, the initial exam discussion was done with another Dr. Not Dr.Santana. Not sure why that was but from the very beginning, this visit seemed different. It took forever to get to the real answer we were there for. About 10 minutes in it was stated, almost anecdotally, that "there's no change in the size of the cancer". After that, he said he'd go get Dr Santana, and they'd return.
...and then it was just Jen and I alone in the room.
We both took this as a bit of a disappointment. After the two previous scans proving the tumors were decreasing, achieving "stability" seemed like a setback. When you objectively look at the situation, sure, it's a win. But it didn't seem that way in that sterile little room.
When the Dr came in, we briefly looked at the various tumors and measurements on the display. And there it was in greyscale. Nothing has changed. None of the tumor locations showed any material sign of increase or decrease. The minuscule differences between the August scans and these could just be differences in the angle or aspect the tumors were measured, not real growth or shrinkage.
They way to interpret this is the crizotinib is still working. If it weren't, there'd be growth in the tumors. It is entirely expected that the results from growth inhibitors such crizotinib are very "front loaded". There's an incredible initial reduction, followed by a steady decline in shrinkage rate. That's exactly what we're seeing here. But it doesn't necessarily signal the end of crizotinib's effectiveness. It's entirely possible that what is there is majority scar tissue, and not actively feeding cancer. So as the cancer is being killed off, the scar tissue remains but doesn't shrink beyond a certain size. So if you're basing your opinion on tumor size and aspect, you'd come to the wrong conclusion.
I'm a numbers and measurements guy so, naturally, I came to the wrong conclusion. I know better now.
So what's next?
The reasonable expectations of the next scan (Dec 19th) are these:
- The tumors are slightly reduced or remain stable
- There is measurable progression
If it's 1: we stay on the crizotinib horse and ride it as far as it goes
If it's 2: another biopsy will be ordered and we'll find out what we're up against... again. and we'll figure out how we're going to win... again.
Thanks to everybody who's offered support, encouragement, or just a smile throughout all of this. We're only in the initial steps, but knowing everybody's along for the journey means more than you could ever imagine.
