Is it possible to be too positive? This is not really a rhetorical question but rather one I am posing to anyone that reads this blog. When I was first diagnosed with cancer, one of the biggest things that people would tell me is to stay positive. For the most part, this is something that I have no problem doing. I am generally a pretty upbeat person and tend not to dwell on the negatives. During this new phase in my life, I have found myself trying to find the silver lining in any news that I receive.
Here is an example. A while back I had a liver biopsy taken to run tests on the cancer and see what possible treatments can be used down the line to fight it. This procedure was not pleasant. I was stabbed in the chest 3 times with a needle that sucked out small pieces of my liver. Unfortunately, Clover and I recently found out that they were unable to run all of the tests on the samples because only 1 of the 3 samples taken were malignant, and they had neglected to run the more important tests first, and would thus have to take another sample (and stab me again) at some point in the future. While Clover reacted to this by looking like an old Warner Bros. cartoon with steam coming out the ears, I simply turned to the doctor and Clover and said "Well isn't it kind of good that 2 of the samples they took weren't even cancer?" In my mind, they had taken something they thought was cancer from my body and were wrong, so maybe there isn't as much cancer in my body as the scans show. I’m not necessarily looking for a simple way out but I am trying to make the best of the information I am receiving.
The reason why I am writing this post is because this past Monday, I had blood work done checking various markers in my blood to keep an eye on the cancer and how well the chemotherapy is going. Clover will be able to fully explain the markers and probably go into further detail about the liver biopsy below, because to me it is a bunch of acronyms that I do not fully understand yet. These markers have been tested 3 times since I started chemotherapy, and there has been a dramatic drop in the markers. In some cases over 50%. Now this does not guarantee anything, however it is a good sign. While I am extremely elated with the news, Clover chooses to keep her feet on the ground. She explains that while she is extremely happy with the news, she does not want to get her hopes up and build up false expectations. I am not sure what way is better, but I do know that together it works for us. I will be the one floating on air with every piece of news that can lead me to believe that I will beat this thing, while she sees everything for exactly what it is and tirelessly works with the doctors to make sure everything is being done to ensure my recovery.
I have dreams regularly that I will go get these CT scans at the end of the month and the doctors will come into the room and say that I beat cancer in 6 months. Will it actually happen? Probably not, but it's dreams that make up the future's reality.
It’s true. I am definitely more of the realist, while Ryan is the dreamer. I hope the dreams prevail.
I’ll explain my side of the story with bad news first followed by good news.
So as Ryan stated earlier, I looked a bit like an apopleptic cartoon when he told me that the liver biopsy did not yield the desired results. The reason for my dissatisfaction was multifold. First, there are quite a few masses in the liver, and though some are small, two in particular are pretty sizeable. Unfortunately, since the technicians were aiming for malignant tissue, it wasn’t necessarily the case that the seemingly malignant tissue was benign, but rather that they did not catch the tissue they needed. This bit of technical error, though not completely uncommon, was a bit difficult for me to grapple with because this procedure was done under CT guidance. Which brings me to my second point. The benefit of using the CT for guidance of the needle should to outweigh the risks of irradiating Ryan further, and though repeated CT scans for staging won't necessarily expose Ryan to enough radiation to be an independent risk factor for other malignancies, it does makes me wonder whether use of ultrasound guidance would have been a more prudent alternative for us to consider. Third, we recently started a third chemotherapy agent called Avastin, which works by blocking new blood vessel growth and essentially cuts off oxygen/food supply to the cancer. We held off on the Avastin until after the liver biopsy because Avastin can result in an increased risk of bleeding as well as impairment in wound healing. In order to take another biopsy, the Avastin would need to be stopped 4-6 weeks prior to the procedure. Since Avastin has been found to be very beneficial in metastatic colorectal cancers, we would not consider stopping it just to take another biopsy. Fortunately, we had strongly pressed the gastroenterologist to order the same genetic tests on the primary tumor specimen, so we were able to get back some of the results that the lab was unable to run on the liver specimen.
Now the good news. Yes, it appears that the markers that are used to track tumor progression have decreased. The tumor markers they are tracking are CEA, CA19-9, and CA125. They are a bunch of acronyms, and to be honest knowing them probably won’t blow your mind. However, as Ryan said, they appear to have decreased dramatically. For example, the CEA (carcinoembryonic antigen) was 3,683 on 10/1/15, then 5,135 on 11/2/15, and has now dropped to 2,424. To put it in reference though, a normal level of CEA is less than 3.7. So, while it is a large drop compared to previous values, which is fantastic, I am still waiting for the CT scan at the end of this month to create the full picture. No, my message is not as uplifting as Ryan’s. However, I think it is important that I remain cognizant of all of the “what ifs”, even while my better half feels much better clinically. It is still, as far as we know, Stage IV cancer. It is still an extremely serious condition. And while I don’t want to bring anyone down, I do feel the need to remain vigilant about any changes. I don’t know how quickly things change with Stage IV cancer. I have no experience with it, and hopefully none of you out there know either. I just know that I want to be prepared for anything and hopefully never need any of that preparation. Ryan needs to walk among the clouds while I dig down in the dirt. But ultimately I really hope that he is right. Mostly because Ryan West loves being right. :)