An Oncologists Dream

APRIL 20, 2015

The CT scan results were very good. I thought I’d get straight to the point, I was told off by someone for prevaricating on the phone when giving results, so much so, they presumed the worst. I went to the Marsden on Thursday, I’ve now had two months of dabrafenib and I had CT ( chest/abdomen/pelvis) results waiting for me. As soon as the doctor turned up, who wasn’t either of my consultants, I knew the results would be good. If they needed to urgently start me on a new treatment, I’d hope I’d see the boss. The CT showed that the tumours had shrunk by a third to a half, in terms of volume. The good points. Firstly, I’ve actually responded to the drug, approximately 20 percent of BRAF positive patients don’t. All the tumours had shrunk showing that they’re all responsive to the drug, which as they’re separate entities isn’t a given. Thirdly, it’s a decent amount of tumour shrinkage, perhaps in the top 20-30 percent of responders. There’s a caveat to this, unfortunately longevity of response isn’t associated with the quality of response. You would think that those patients who had complete shrinkage of the tumour, the drug would work for longer, as the cancer is very sensitive to it. This isn’t the case and the cancer may come back quicker and be insensitive to the drug. The oncology registrar was keen to point this out, as not to get me too hopefully, what each patient wants is a long response, frustratingly that seems impossible to predict. Fourthly, the SpR thinks my LDH is a good marker for my disease activity, it isn’t in some patients.

The bad points, well there isn’t any really. To be perfectly honest I didn’t hide my disappointment to the room, as I’ve been feeling incredibly well considering how unwell I was. I was assuming that I’d have a very large amount of tumour shrinkage. On reflection I was expecting too much, and on reading the CT report I was reminded that I still have a lot of cancer. It does explain why I presented late, Therefore clearly I could sustain a lot of cancer in the areas it’s made home and feel fine.

This leaves me onto my last point. I disagree with the stages of grief DABDAand would like to add an F. An F for forgetance not really acceptance as I just can’t yet comprehend that I won’t be here, but there was times particularly even back then and in most of that April I managed to just forget about it. It’s been so deep rooted in my thoughts that I didn’t think that was possible. But I’ve had times now where these thoughts have vanished. Whilst playing squash a week before this, the first time since diagnosis a sport, I’m only decent at because of years of practice*, I know where the ball will go out of habit, I drift back to the T on autopilot. This normality was so distracting. Beating my grumpy welsh friend 7-0 on games, I was so tired I fell straight to sleep. Also there’s been times where I’m lost in the moment, for example, in Leicester having afternoon tea in Bradgate park after a short plod around it. Lastly this effect was most apparent during my fantastic holiday to Malta, which you’ll read much more about. Reading blogs about those on chemotherapy, particularly Dr. Kate Granger who’s blog is both better and much more thoroughly established than mine (https://drkategranger.wordpress.com/). You realise quite how rubbish it is. Chemotherapy that is… not my blog! Traditional chemotherapy to put it simply, attacks all fast growing tissues, therefore the blood gets affected, loss of white blood cells and red blood cells, leave patients prone to infection and anaemia. The bowel lining has a fast turnover so patients feel nauseated, patients have issues with infertility, and miserably to give them the classic cancer look, for some, their hair falls out. With that sort of treatment it must be much harder to simply forget it’s all happening to you. This gets me to the title, the SpR described me as an “oncologists dream” and for now I am… I’m symptom free, side effect free and treatment is working well. Long may that continue.

*Computer tomography, when explaining things to patients I tend to explain the words and then usually they understand the meaning. Tomography is the Greek for mapping and this is done by a computer. The patient goes into a donut shaped machine in which sends X-rays from all angles through the patient, this information (technically the impedance of the X-ray) is then interpreted to form a cross sectional image.

*LDH – lactate dehydrogenase, a crude marker of cancer activity in the body. It was 1234 on admission to Kingston it’s now been consistently normal.

*lacking the natural flare and technique of my biggest nemesis Miss Green. Who I only beat once throughout the whole of medical school.

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