My CO-1686: Something Old, Something New

Once with cancer, always with cancer.  When a scan report says Stable, all it means is No evidence of progression was found during that imaging session.  If the report says NED,  it’s No Evidence of Disease.  In both cases the nasties are there, surreptitiously floating around.  Those statements or some words to that effect were drilled into my head at the very beginning of my cancer journey.  The message: Be clear on that concept.  I got it.

Last month’s events would have freaked out worry-warts but not the self-proclaimed veteran of several medical battles.  However, the events gave me pause but only to allow my mind to explore positive steps to take if or when ugly news about the menacing tumor at the bottom of my left lung confronted me. After that, I moved on to matters over which I have control like trip planning, fine dining, and toenail clipping.

But first, my new primary care physician  (PCP), a gerontologist, a doctor specialized in medical issues of people waaaay past puberty, just had to double down the harrowing events.  He ordered me to get a mammogram! I protested tremendously.  I had already given up the mammogram thing three decades ago after the first one, plus in the CO-1686 clinical trial, I have been having thoracic and abdomen CTscans every nine weeks.  From my studies of the human anatomy at Google University (GU), I know the thoracic area definitely includes the breasts.

Dr PCP wouldn’t take no for an answer, adamant that a different imaging technology is used for the breasts.  I also did not want to push my luck and get thrown out of his patients list. At our initial doctor/patient fact-finding interview, after I had given him all the information about my ailments and those of my blood relatives dead and alive, my past and present medications and surgeries, he asked, Is there anything else about you that I should know?  I asked back, my inscrutable beady eyes a-glint with mischief, You really want to know? Yes, he responded with conviction. Okay, I said, if you really must know: I question doctors. His face cracked an enigmatic smile.

So off to my second mammogram screening in three decades I shuffled. At the breast clinic, I noticed that the mammogram motions had not changed in 30 years. As the female technician pulled the first breast and shoved it under the automatic-garage-door-like contraption, I wondered if in these days of unisex permissiveness, male mammogram technicians abound.  I did not ask the bubbly millennial who seemed to thoroughly enjoy her work. Soon the pulling and shoving were over.

One week later, the breast clinic summoned me with urgency to return for a mammogram diagnostic because the radiologist had seen psomething unusual about my right breast. I thought, That’s it. The lung cancer has not only risen from the dead, it has metastasized to the breast. I’ve become a two-cancer senior babe. When it rains it pours!

So, back to the clinic I surrendered the C-cups one more time. Ms Bubbles focused entirely on the right one. She said hopefully she would not have to do an ultrasound.  She pulled and shoved, took x-ray images and eyeballed them. Uh-oh, we do need an ultrasound, she declared, and led me to the ultrasound room.

I have always associated ultrasound with the determination of the gender of a fetus in mama’s womb. Are you looking for a baby? I asked, as she slid the mouse over every square centimeter of the breast.  She answered, If I find a baby up here, we’re in big trouble. And we laughed. In a minute, the job was done. I’ll show the result to the radiologist, she said and rushed out the door. In a moment, she returned, the female radiologist ahead of her.

You’re good! the radiologist beamed. See you next year. And the two left me unceremoniously.  Just as well because I found myself suddenly speechless.

Learn something new everyday is my mantra. Here’s what I learned from the mammogram experience. Women’s breasts are not only calipered, as in 34A or 44D, they are also density defined: normal, heterogeniously dense, and extremely dense. In some states, including CA, the law requires doctors to notify women with dense breasts. The intent is to make them more vigilant, which makes sense because a dense breast is like a rainforest. Cancer is difficult to see and requires extra technological maneuverings.

Two days later, I had the CTscan that would determine the fate  of the flying saucer at the bottom of my left lung. Five days later, I did the blood tests and Dr Brevity and I met to discuss the outcomes.

Dr Brevity is a straight shooter.  He said the flying saucer measurements increased a very tiny bit and still not considered progression by RECIST (Response Evaluation Criteria in Solid Tumors) rules. But there is something new in the CTscan report. It talks about a 2.5 cm tumor sitting on top of the right adrenal. Where is the adrenal? I asked. It’s a gland on top of the kidney. His turn to ask: Do you have any pains? How are you feeling in general?  I feel awesome. No pain, no fatigue, no shortness of breath. I have boundless energy, voracious appetite, and many more upbeat stuff I wanted to say but didn’t. I did not think overselling would knock the adrenal occupier off its perch. My turn to ask: What are we going to do about the tumor? His answer: Nothing, because you have no pain. What?! What a weird thing to hear – doing nothing to a nodule in someone with cancer because she suffers no pain.

Since progression has not been established, I continue to stay under the trial umbrella. Dr Brevity gave me a fresh supply of Poksceva for my 47th cycle on CO-1686. To determine what the mysterious adrenal occupier is and if there are other parts in my body that might light up like the night sky of July 4th, he ordered a PETscan and an MRI. He also ordered a liquid biopsy to get ahead of the treatment game if certain mutations are found lurking in the blood.  He also told me to ask Dr PCP to get my insurance company’s authorization for my continued participation at Club Med.  How can I not love back Dr Brev!

Meanwhile, I needed to get answers to my questions about tumors that suddenly pop up atop the adrenal. The GU scholar went to work, in hot pursuit of power through knowledge. If not me, who? If not now, when? I love that argument!

This I learned: Any one of two types of tumor can suddenly grow on top of anybody’s adrenal: (a) cancerous, called cortical carcinoma.  Or (b) benign, called benign (duh!) adenoma.  According to the American Cancer Society, a 5 cm to 6 cm tumor, about 2 to 2.5 inches, is considered cancer. That’s the length of an average jalapeno.  Imagine that object banging against the other organs near the kidney.  It would definitely inflict pain.  That’s why nothing is done to a measly 2.5cm tumor or anything under 4 cm.  It just sits there like a blob. Sometimes it resolves.  My body welcomes a blob as long as it stays measly. However, the possibility exists that the blob can grow as massive as a brick, bear down on my poor right kidney and bully the other organs around, sending me writhing in pain. That’s the time doctors will consider surgery to save the Drama Queen.  Okay. GU never expressed the tumor’s morphing in those terms.  Such description happens only when the blogger, an Investigation Discovery junkie, gets distracted by an occasional sci-fi movie.

Otherwise, everything else in the CTscan and blood reports is copacetic. But the Feisty Heifer’s hackles have sure been raised a bit!