Suppose that you go away for two months, leaving your home unattended and unmaintained. What exactly do you hope or expect to find upon your return? Here are a couple of possibilities:
Scenario One: You return from the airport, open the front door apprehensively, and immediately notice some cobwebs in the corners and a thin coat of dust on the furniture and floor — certainly not something you would have wished for but, at the same time, not entirely unexpected either. And definitely not a crisis.
Scenario Two: You open the front door to discover that vandals have broken in and crapped on your living-room rug. Yes. A very ugly scene indeed.
As a brain-cancer patient, I have been on a long vacation of my own lately. That is, I went without chemotherapy treatments for a stretch lasting from October 12 until just yesterday (December 2). The chemo hiatus was necessary because of the surgery I underwent October 21 to drain a potentially dangerous collection of excess cerebrospinal fluid that had built up around my brain. One of the chemo agents I receive intravenously (Avastin) comes with a bleeding risk that makes it too dangerous to administer until the brain has fully healed from such a surgery.
A bi-weekly therapy combining Avastin with the cancer-killing drug Irinotecan has been extremely successful keeping my tumor in check since August. I was nervous being off the drug treatments for for so long. So I was more apprehensive than usual yesterday when I went in for my first MRI brain scan since October 20. Reviewing the results afterward with my oncologist would be a bit like opening the front door of my brain and wondering what we would find inside after such a long absence. Would it be crap on the carpet or just a little dust on the furniture? Thankfully, for me, it was more like the latter. Still, the so-called “clean scan that every patient with any kind of cancer always hopes for turned out to be too much to expect.
“”The scan looks a little worse. It shows the tumor might be coming back,” said my oncologist, Dr. George Bobustuc, stepping into the exam room.
“Oh no,” I thought. “My worst fears about being off chemo have been confirmed.”
But as Dr. Bobustuc calmly led me through the latest scan in a side-by-side comparison on the screen with my Oct. 20 scan, my fears quickly were diminished. He pointed out where the new MRI had picked up some “areas of enhancement” that showed up as tiny white flecks on the screen around the site of my original tumor. These little flecks looked nothing like the scary image of the full-blown recurrent tumor that I illustrated here with a photo of a comet afterI had a really bad scan on July 30. Now if you take out the comet and look only at the stars in the background of that picture you’ll have a better idea of what my new scan looks like. No turds on that carpet, folks. Just a little dust.
Another blessing I continue to enjoy as a GBM (glioblastoma multiforme cancer) patient is the fact that, while the disease is usually assumed to have infiltrated the entire brain by the time it is diagnosed, there have been no signs of new tumor activity anywhere in my brain beyond the site of the original tumor that was removed in July 2009. And that didn’t change with the latest scan. Less fortunate GBM patients often must deal with a progressive, spreading disease that creates multiple, new tumors popping up in more vital lobes of the brain.
Dr. Bobustuc put me further at ease when he used the term “soapy bubbles” to describe the little white flecks. He said he said he wouldn’t even use the definitive term “recurrent tumor” to describe what the new image showed unless those little dots had been larger, more dense and had popped up during active treatment — while my brain was being bombed with the chemotherapy. That would have been a troubling sign that my brain cancer might be”"learning” to resist the powerful medicine. Instead,the flecks’ appearance during the long treatment hiatus was fairly predictable. They are definitely signals that the underlying GBM cancer is still in there, and maybe just waking up a little until we can start bombing it again.
Speaking of that, I was extremely relieved that shortly after leaving Dr. Bobustuc’s office, I was back upstairs in a chemotherapy infusion room, sitting in an easy chair with an IV in my arm. I will have another infusion in two weeks, and then a third two weeks after that. Then I’m set up to get another MRI scan in early January to check on progress. Based on my history with these two drugs, having seen just two of these infusions wipe out a dense tumor mass back in August, I’m petty confident about what my next scan will show.
In other words, watch out, little soapy bubles. Avastin and Irinotecan are back in town.