The good news is that there were “no significant change(s) in multiple solid and ground glass nodules in opacities consistent with multifocal lung cancer.”
Also noted: “Interval development of a new 6-mm nodule in the right upper lobe with ground glass halo which may represent atypical infection (such as of fungal etiology) or new focus of neoplasm (primary versus metastatic).”
When I had the scan done on Friday I was in the thick of a sinus infection. So I am very hopeful that the 6-mm nodule is a result of infection and inflammation. If not, it would seem to have popped up from nothing, which is of course unsettling.
Since our last visit, Dr. Shaw had reviewed all of the scans from the past twelve months, and at this appointment she placed them side by side for me. Although she feels that my cancer is behaving in a fairly indolent fashion, it is nonetheless persistent. The difference between my most recent scan and that from a year ago is striking. So we talked about the benefits of getting a biopsy now, while I’m still feeling good, rather than later when shortness of breath will likely become more of an issue.
The purpose of this biopsy is not to confirm malignancy, as there is really no doubt that we are looking at metastasis. Rather, it is to gather genetic material in an attempt to ascertain why my ALK mutation has become resistant to the crizotinib. In addition, it may be possible to determine which line of treatment might be indicated as next in line.
We discussed the pros and cons of a needle biopsy (much less invasive but also able to harvest significantly less viable cells) and a wedge resection (major surgery, but a greater return on genetic material). It was decided that the needle biopsy would be my first choice. However, after discussing my scans with the radiologist who would perform the biopsy, Alice (Dr. Shaw) called me to say that there were two significant concerns: firstly, that because of the peripheral location of my cancer, it would be very difficult to successfully position the biopsy needle in order to zero in on the cancerous nodules, and, secondly, that due to the diffuse nature of BAC, the possibility of a post biopsy hemorrhage in my lung might be as high as 20%.
She felt that the combined possibility of negative side effects with an uncertain return made this scenario less than optimal. So, next Friday I will have a consult with the thoracic surgeon to discuss a wedge resection.
Although I was all too aware that another biopsy lay in store, I was hoping to avoid surgery. A hospital stay, general anesthesia, recovery. I’m whining a bit, I know, and it’s not attractive. For some time now it’s been pretty easy for me to visualize that I have cancer ‘lite’ and as a result I’ve indulged in several fantasy scenarios for the future. Lots of art, travel, skiing…cancer is messing with my plans again.
Whining aside, I’ve had it pretty good (poor grammar, I know, but concise and to the point). This is just another bump in the road. And besides, I just got back from Sweden! So, I promise, in the next post that is all I will talk about. Happy Friday.