War with many fronts

(12/10/09)

There's no good way to express it. Life in the past few months has been rather shitty. The cancer beast is attacking on many fronts, and I am freaking exhausted. I really don't know how it's come to this, as mid-July found me with a clear PET-CT except for two shrinking lung nodules that had been treated with focused radiation. Then a little lung inflammation instigated a VATS procedure to biopsy my lung, thus pausing chemotherapy. After finally coming home from the hospital from the VATS, pain in my right side revealed a huge liver mass, and further scans showed new lung nodules (left lung) and a lesion on my left pelvic bone. Here's the current battle plan:


Front 1: Liver
Weapon: Radiation spheres and drainage

I still have a drain in my liver, but two weeks ago the IR docs shifted its placement and put in a slightly larger catheter to try and drain out more of the fluid. On Monday I found out the mass is finally getting smaller (it's shrunk about 15% in two weeks), but it's hard to say what will ultimately work the best to drain out the rest of the dead tissue in there. We have the option of putting in some anti-clotting agent and yet a bigger drain (the one that's in there is 5mm), but we're not sure if we're going to to that yet. The good news is that it looks like 95% of this tumor is dead from the radio-embolization. Hopefully the rest will go away with chemotherapy.

In the meantime, I continue to have fevers, although they're a little better than before. An alternating regimen of Tylenol and ibuprofen seems to keep them at bay, but I still get an occasional temperature spike and sweatiness that makes me feel craptastic and pretty much destroys my appetite.


Front 2: Pelvis
Weapon: Cyberknife

While I was in the hospital a while back I had some pain due to the pelvic lesion but it seemed to come and go. Now it's mostly back, but some days I can walk fairly normally (just not for long distances). Basically the pain is in my left groin and it hurts when I put weight on my left leg. The lesion is partially in the bone and partially in the tissue around it, but luckily, it's not too big to be a target for focused radiation. This is where Cyberknife comes in.

Cyberknife is basically a form of very focused radiation that can zap small tumors. I had focused IMRT radiation previously on my lung nodules, but this is slightly different. The Cyberknife uses images in real-time to guide its beam so that it can make adjustments during treatment and therefore be more accurate (supposedly within 0.6 mm). I had my last (5th) treatment on Wednesday, which was relatively painless. You basically just lie on a table for 40 minutes or so while a robotic arm rotates around you and zaps you with radiation. They have a little stereo with iPod dock so you can play your own music during the treatment. On Wed my iPod kept getting stuck on repeat, though, so I was listening to "Bleecker Street" over and over again for the first part of my session. Could have been worse, I suppose.


Front 3: Lung nodules
Weapon: Chemotherapy

It's a little odd to me that the one problem that's not causing me any physical pain right now may yet be the toughest to tackle. The three nodules in my lungs have not responded to the latest chemotherapy (taxotere and gemcitabine, for those of you keeping track), and so we're moving on to another type of drug, Nexovar (sorafenib), which is anti-angiogenic. Basically this means that instead of trying to kill the cancer cells directly, the drug tries to keep the tumor from growing new blood vessels so that it cannot get any larger. It's had some success in kidney and liver cancers, but using it against sarcoma is pretty experimental. The good news is that it's pill-based, so I can just add it to the list of drugs I'm taking every day rather than have constant trips to the hospital for infusions. The side effects aren't too bad, except that some people get "hand/foot syndrome", where they start to get really dry and flakey on their palms and bottoms of their feet. This can lead to blistering and (I assume) pain, but apparently being diligent with moisturizer can help keep this at bay. Hopefully I just won't have that problem.

The drug is systemic, so hopefully it'll have some effect on the bone and liver tumors as well.