That’s why we call it cancer

Have I mentioned how much I love MRI scans?

I’ve been spoiled my my past several good scans, but my experience Tuesday (4/19/11) will surely cure me of that. The scan, itself, went as smoothly as ever. The path got rocky when I went over the results a few hours later with my oncologist. The bottom line: After being held in check for nine months by my combination chemotherapy drugs Irinotecan and Avastin,my GBM is living up to its fearsome reputation as the most aggressive and hard-to-control form of brain cancer. The scan revealed a growing, white area of tumorous enhancement in my brain that is about 60 percent larger than it appeared on the images just two months ago from my February 22 scan. That means the GBM is starting to spread and visibly infiltrate a wider area of my brain. We’re still not talking about a dense, focal mass the size of a golf ball, tennis ball or some other piece of sports equipment that we always like to use to describe tumors. Rather, we’re still talking aabout what looks on the MRI screen like a large, white, moving cloud of cancer. Instead of being 3.5 centimeters wide and 5.5 centimeters long, the “cloud” is now about 5.5 centimeters wide and 8.5 centimeters long, according to my doctor. This sort of disease progression on the backs of quick-dividing, fast-multiplying, rogue cells is why GBM is so scary, because growing and growing rapidly is what GBM does best.   That’s why we call it ‘cancer.’ Even though we associate it with decay and death, what cancer really is exactly the opposite. Cancer is growth, growth that will not be denied, growth gone wild. Cancer is life, life unkillable and out of control, . After living with this diagnosis since July 2009, I can’t even trim my fingernails or shave my beard anymore without thinking about my brain tumor. Long nails and scratchy whiskers are just another reminder of unwanted growth, relentlessly going about their unwelcome business ofcellular division and multiplicationwith a constant eye, as I imagine them, on the same metabolic clock that rules the daily proliferation and spread of cancer cells.

Given this biomedical reality, I can only continue to count myself lucky that I have enjoyed as many “clean scans” as I have in the 21 months since my diagnosis. I’ve had more good scans, in succession, than a GBM patient really has a right or a statistical basis to expect. These types of tumors typically grow and spread at a rate that cripple and kill patient in a matter of months, not years, from diagnosis. Until now, my biggest physical setbacks have come in the form of peripheral issues not directly related to recurrent brain cancer. There was a bad scan in May 2010 that prompted a second surgery to remove a chunk of my right temporal lobe that contained fewer live cancer cells than dead cells killed off by previous treatments. Then there was that horrible scan in October 2010 that showed a dangerous buildup of fluid around my brain that had to be drained in a third surgery followed by a grim week flat on my back in an intensive-care unit. Yet even through all of that, the cancer, itself, has remained mostly under control…until now. Until now, as I’ve often told people, I haven’t really been through the experience of what it’s like to have a brain tumor. I mainly know what it’s like to be treated for a brain tumor. I don’t yet know what it’s like to suffer from degraded motor function, muscular weakness, difficulty walking, slurred speech, frequent seizures and other symptoms that typically result directly from brain tumors and often prompt the discovery and diagnosis of such a tumor. I had one sudden and, for me, unprecedented seizure on an exercise bike at the YMCA – that’s how my tumor was discovered. Since then, all of my bitching and moaning has centered around the secondary effects of each phase of treatment – surgery, followed by radiation followed by then by a number of harsher chemotherapy regimes. Those remedies have affected my day-to-day functionality and quality of life far more than the underlying disease or tumor. Sure, the popular drama always casts the noble patient “battling cancer” and beating it against all odds. But the real story for me so far has not been about  the patient battling the cancer so much as it is about the medications battling the cancer and the patient battling the meds.

So now, after Tuesday’s scan, what does the path ahead look like? Right off the bat, my oncologist – Dr. George Bobustuc – announced that it is time to “switch gears” to new medications that will attack the cancer in new ways that it has not yet had time to adapt to or build up resistance. Some of the pills I’ve already had experience with. It also comforts me to know that I will continue to get regular, intravenous infusions of the chemotherapy drug Avastin, which has worked so dramatically well for me in the past. Dr. Bobustuc said he is optimistic that I will respond well to this new combination of chemo pills, given how well I have responded to previous chemotherapy combinations. “I think we will be able to turn this around again,” Dr. Bobustuc said Tuesday. He is also sending me back for a consultation with the radiation oncologist who oversaw my initial radiation treatments back in the late summer of 2009.  Usually an aggressive, six-week course of targeted radiation such as the one I went through is aimed at the original tumor cavity and a wide margin of surrounding tissue. My understanding is that when that tissue has been treated once it has essentially been treated forever. But now there is a chance that, with the cancer infiltrating into previously unradiated areas of my brain, we may be able to retarget radiation to those new areas and achieve a desirable result. I will know more on that front after meeting with the radiation doctor next week. My doctors and I will know even more about my new, overall prognosis in about a month, when I get another MRI scan to assess whether the new treatment will work or the cancer will continue to spread and grow.

Have I mentioned how much I love MRI scans? Have I also mentioned how much I hate them?