Optimistic

Today my dad and I made another trip to the other town to visit my other oncologists.  The driving conditions were perfect:  clear roads and overcast sky.  The highlight of the road trip entertainment was the electronic over-the-road sign that broadcasts traffic updates.  Today it read, "Hey bobblehead stop looking at your phone."  We crossed the state and passed under at least three of these electronic signs, all of which said the same thing.  That guy or gal has too much fun.

The purpose of this trip was to deliver disks of my recent PET scan and to get their opinions on my continued treatment plan.  We first saw Dr. Medical Oncologist.  She was thrilled with the clean PET scan result and agreed that it couldn't have been better.  She thinks that I should continue to have PET scans every 3-4 months for now, and that I should see her again in 6 months.  She also maintains that I should continue the Herceptin+Pertuzumab treatments indefinitely.  I asked her about side effects on my heart, or what we should do if my body decides to reject this treatment, and she said that it would have to be pretty bad to get her to quit the treatment.  Her2+ cancers (that's mine!) are nasty, so it's better to suffer a bit of heart damage than to risk the potential consequences of ceasing the treatment.

That led me to a question about prognosis.  A few people at work have asked me about it, and I haven't known what to tell them.  My prognosis is technically "poor" because the best evidence suggests that I had (have?) stage 4 cancer.  That's cancer that has spread past its original source into an incurable location.  My question for her, then, is whether I should tell people that my prognosis is poor even though I am clearly doing so well and have unproven metastatic lung cancer that has nearly gone away? (I'll discuss the "nearly" part next.)  She then looked me in the eye and asked if I wanted her answer based on the previous data, or if I would settle for the word "optimistic".  The reason for this cryptic response is because I am on a therapy that has only existed for a year, and I have been on this therapy for its entire existence.  There are no previous data points on which to draw that would answer my prognosis question.  The previous data points didn't have the awesome treatment that I'm on.  Therefore, her expectation and her hope is that I will do better than what the available data would suggest for me.  I am the new data point.  I therefore opted to decline the technical answer to my prognosis question and accepted the word optimistic.  It suits me better, anyway.

Then dad and I took an intermission to inhale our lunch at our favorite falafel joint in the universe.  Oh man was it good, but we ate way too fast.

We scurried back to the clinic to meet with Dr. Pulmonary Oncologist.  This ended up being every minute worth the drive and the wait!  He pulled up images of my chest CT from last February and from the recent scan.  The chest CT is always taken at the same time as the PET scan.  The difference between the two types of images is that the PET is colored based on the radioactivity that my cells take up, but the chest CT is more like a standard x-ray.  So although the PET scan showed completely normal cellular activity, Dr. Pulmonary Oncologist scrutinized the CT images for abnormalities, which he found and showed to me.  He put my pre-chemo chest CT on the left, then my January 2015 chest CT on the right.  He had used the glowing data from the PET scan to find the suspected cancer nodules on the old chest CT.  Then he found the matching image on the recent chest CT.  What he pointed out to me is that when you look at the two CTs side by side, you can still see a trace of each nodule.  He said that they are less than 90% of what they were and that the extent of their diminution is better than expected.  He said that without a biopsy it is still impossible to concluded whether or not they were or are cancer--they could be cancer that has responded to treatment, or they could be my body healing a lung infection or scar tissue from an infection.  No matter what, the news remains excellent.  He said he doesn't need to see me again unless the pendulum swings back in the other direction; that is, unless the nodules show activity on the PET scan or start to grow again.

I also gave him my email address, because his son is an undergraduate interested in veterinary medicine and gut bacterial communities.  I study gut bacterial communities, I have a veterinary pathologist postdoctoral fellow starting in my lab in March, and I have a job opening for a summer student.  Small world.

It was another great trip with a whole pile of good news.  I hope I can stay on this trajectory for a long while.