Tag Archives: lymphangitic carcinomatosis

Scan skinny

I had my scan a week ago and Dr. Lin called me the following day with her impression–Alice followed up on Saturday.

One of the most difficult aspects of being an oncologist is trying to keep both body and hope alive for patients. Jess (Dr. Lin) and Alice both felt the the subpleural opacity in my left upper lobe was possibly less dense than previous scans–‘more aerosolized’ is the way Alice put it. Maybe whatever the heck that is (never definitely labeled cancer) is partially resolving, and therefore accounting for the improvement in my breathing. It would be nice to think so.

I did not receive the official read of the scan until today and I must say, it is lackluster; said with all due euphemism.

Keeping body and soul together is getting to be more difficult for me as well. Neither of the last two treatments would appear to be a panacea. And social isolation is sapping me of my usual reserve of joy. These times were not made for extroverts.

Now my job is to just hold it all together in what sometimes feels like impossible circumstances—if I can avoid getting COVID-19 and keep this cancer from moving from a brush fire to burn the whole goddamn house down, well then I might be around when another treatment becomes available.

My general MO is to overcome and forge ahead—if you told me I had to walk 100 miles today I would be game to try. Laying low is an entirely different animal and I’m not gonna lie, one heck of a reach for me. But I am going to do my darnedest to hang in.

 TECHNIQUE: Diagnostic CT CHEST WITH CONTRAST COMPARISON: Chest CT dating back to 1/18/2019
FINDINGS:Lines/tubes: None. Lungs and Airways: Status post left lower lobectomy. The central airways are patent. There are new groundglass and tree-in-bud nodules in the anterior right upper lobe for example on images 49-51. There are also multiple enlarging subsolid nodules in the right upper lobe for example image 49 nodule measures up to 8 mm compared to 5 mm prior. Multiple nodules in the left upper lobe has also increased in size and attenuation compared to recent prior, for example spiculated nodule in the right upper lobe on image 53, measuring up to 10 mm compared to 9 mm prior, image 44 nodule now measuring 4 mm compared to 2 mm prior, and subpleural nodule on image 43 measuring up to 8 mm compared to 7 mm prior.  The dominant subpleural consolidative opacity along the lateral left upper lobe is essentially unchanged compared to recent prior now measuring 17 x 29 mm (image 64). The confluent consolidative opacity at the left lung base is without significant change in size compared to recent prior, measuring 77 x 20 mm (image 80). Pleura: Stable small loculated left pleural effusion with associated pleural and interlobular septal thickening. There is unchanged biapical pleural-parenchymal thickening/scarring, left greater than right. Heart and mediastinum: The thyroid gland is normal. Stable mediastinal and hilar lymph nodes measuring up to 6 mm in short axis, for example low pretracheal node on series 302 image 42 and AP node on image 46. The cardiac chambers are normal in size. There is no pericardial effusion.  Soft tissues: There is no significant subpectoral or axillary lymphadenopathy. Abdomen: Please see separate CT abdomen and pelvis report of same day.  Bones: There is moderate spinal degenerative changes. No suspicious lytic or blastic lesions. 
IMPRESSION: Lung cancer surveillance status post left lower lobectomy: Subpleural consolidative masslike opacity along the lateral left upper lobe is unchanged compared to most recent prior but remains suspicious for primary lung malignancy. Stable small loculated pleural effusion with interlobular septal thickening consistent with lymphangitic carcinomatosis. Enlarging pulmonary nodules bilaterally since at least 7/5/2019 suspicious for progression of metastatic disease. New groundglass and tree-in-bud nodules in the anterior right upper lobe may represent inflammatory or infectious process. Attention on follow up is advised.

Understanding the enemy

‘When there is dust rising in a high column, it is the sign of chariots advancing; when the dust is low, and spread over a wide area, it betokens the approach of infantry. When it branches out in different directions, it shows that parties have been sent to collect firewood. A few clouds of dust moving to and fro signify that the army is encamping.’ Sun Tzu, The Art of War.

My enemy, despite heavy artillery (lorlatinib plus carboplatin and pemetrexed) continues to advance. Hence the need for another approach. On Tuesday I have yet another CT scan in preparation for the upcoming clinical trial–it will be interesting to see if the fact that I am feeling better is supported by radiographic evidence. Either way, I think it is time to surprise cancer, which has grown both in size and cockiness.

7.1 cm is not my friend. Nor is lymphangitic carcinomatosis.

Deets

I am generally possessed of a mighty thick skin. Not a quality I was born with but rather one acquired through repeated injury. I don’t say this with any drama—it’s simply a fact. And I, being a scrappy survivor, have developed tools/personality traits to effectively protect myself.

However every once in a while something gets under my skin. When I logged onto Facebook this morning, another cancer survivor had characterized my cancer as ‘amazingly slow growing.’ I should have just let it go but I responded by saying that I wished my cancer did grow more slowly, before listing for her all the modalities of treatment that I have undergone since my diagnosis. And then I counseled her to be more sensitive when describing another’s cancer as amazingly slow growing.

For those who wonder what the fuss is all about, here is the synopsis from my most recent radiology report:

Surveillance for lung cancer status post left lower lobectomy. Sub-solid mass like opacities in the left upper lobe have increased in size and attenuation since the prior study as described.

Persistent and slightly increased groundglass and interlobular septal thickening in the basilar left lung, suggestive of lymphangitic carcinomatosis. 

Additional subsolid nodules in the left lung are stable or slightly increased in size compared with the prior exam. 

Slightly increased small loculated left pleural effusion.

First of all, the possibility of lymphangitic carcinomatosis. Now you don’t want to let those horses out of the barn.

Secondly, just for scale, the largest of my masses is now 4.4 by 2.1 centimeters. No small potato when one is talking about cancer.

So yes, I am darn fortunate that I have been able to survive for as long as I have. But I haven’t exactly been sitting around and eating bonbons as I’ve fought (yes, fought) rather tirelessly to stay alive.

There. Got that off my chest. Now if I could just get this other shit out of my chest I could get back to that box of candy.

xo