Today I met with the oncologist. It is part of my fortnightly routine, only this time included some extra discussion about the consequences of my recent scan.
Essentially, when the scan was discussed amongst the radiologists, it was established that although from scan to scan I have had stable disease, when you compare a recent scan with a scan a year ago, what you see is gradual change. This means that even though my disease has been stable, there has actually been slow, gradual change over a much longer period of time.
So the question of the moment is, what does this mean for my management? Well, it hasn’t been until relatively recently that ‘stable disease’ has been a desirable end point of treatment in oncology. In the past, if cancer showed any sign of non-response at all, it was considered to be unsuccessful, and chemo was either stopped, or the treatment regime changed. Now, since stable disease is in fact considered a worthwhile endpoint, treatment will often continue even if there is no progression, or in my case, very slow progression. Added to this is the fact that within the public system, we are out of treatment options. The next line of treatment would be cetixumab, a monoclonal antibody that costs around 3000 NZD per round, on a fortnightly regime. I am currently getting my tumour tested for the K-ras mutation to see whether or not my cancer would likely be a responder to cetixumab.
The final outcome of all of this is: treatment will continue as is for the time being, likely to be reassessed at the next CT scan in 3 months; and secondly, the consideration of the addition of cetuximab if my cancer is the wild-type variant. On balance, I’m not such a fan of bankrupting ourselves to add a few months extra life-expectancy that cetximab would offer, especially when you consider how many vaccinations the money spent on cetuximab might buy in the developing world, and the lives it would save spent there. The money spent per life ratio is somewhat more beneficial if spent in a cost:benefit context. People say you can’t put a price on a life… however the reality is that some lives come at a cheaper price than others, and we seriously over spend in the developed world.
Until next time..
The Kingsland was festival recently had, and to be honest, it was a little lack-lustre. It did however give me an opportunity to try wandering through the street shooting from the hip. Invariably, most my shots were rubbish, most with a characteristic horizontal tilt reflective of the angle the camera sits in my right hand at hip height. A few of them provided some interesting perspectives though. This one did, and the cones help draw the gaze towards the horizon.
Shutter 1/800, f/4, ISO 400, 17mm.
The cancer is growing again….. according the most recent CT scan. My CEA is slowly creeping upwards as well, although it has been doing that for 5 months now, at least it has been a slow creep.
The latest report shows that 3 of the 4 nodes remain largely unchanged, but unlike previous reports, this time there is convincing change in one of the nodes sitting in behind my left renal vein. The January scan measured it as 9 x 17mm, it now measures 13 x 21mm, thats a 4 x 4 mm increase in growth over the last 3 months.
Essentially it spells out that the beginning of the end is slowly creeping up on me. It was always going to be an inevitable turn, the question was a matter of when rather than if, and to be honest, when came a lot later than both I and oncologists would have expected.
So the question where to from here is yet to be answered. The next oncology appointment that I have will clarify that further in terms of treatment options. Also, any further surgical option at this stage has also been ruled out as any resection is likely to be risky and unsuccessful.
Until next time…
This was taken around 7 in the morning just after I woke up on our recently holiday in dunedin. I was able to capture the fog on the other side of the bay just starting to lift out of the valley Due to the distance involved, it was a bit of a low contrast shot, but it captures the mood and the lighting at the time.
Shutter 1/80, f/11, ISO 400, 74mm