Mets Day 480 - uncertain scan results

Today Jennifer and I went to Fox Chase for yet another round of blood work and CT scan.    One of the reasons I like FCCC is that you don't have to wait several days for the scan results.  I had the scan at noon, and by 2 Dr. Plimack had the written report.

The results of today's scan was not encouraging.  Comparing my CT to the prior studies, the radiologist detected several enlarged lymph nodes in my chest: "Several left superclavicular lymph nodes have slightly enlarged since the prior study, the clinical significance of which is uncertain."   Dr. Plimack said that the size of the node that she measurd was just over 1 cm (10.2 mm), which is the threshold size for clinical significance.

Dr.  Plimack was not willing to draw any conclusions from these data.  She said that it could be one of three things: 1) the bladder cancer has metastasized to other lymph nodes, where it is growing; 2) the nodes have swollen for a reason unrelated to cancer, such as an infection, or irritation, or some other reason; or 3) the nodes are not swollen at all, but it just looks that way because of how the scan sliced through it.  She added that it was very rare for BC to spread first to nodes above the diaphragm - she could think of only one instance where that had happened. I reminded her that, after my chemo, the CT scan detected three nodes of increased size of just around 1 cm in size, and it turned out that there were 12 positive nodes. A CT scan is a blunt and imprecise test, in my experience. 

The radiologist report continued, "Alternatives for management include short term interval CT follow up or PET CT. If either of these studies is suspicious, ultrasound-guided tissue sampling may be considered."  Dr. Plimack endorsed these recommendations, telling me to wait and see.  She said that a PET scan right now would not necessarily confirm metastatic activity, but might just reflect an enlarged node.  She also said that trying to biopsy a node that was just over 1 cm was very difficult.  She advised me to wait and have another scan in a couple of months.

I asked her about what-ifs, such as if my enlarged nodes turned out to be metastatic activity.  She said that we'd have a long conversation at that time, and encouraged me to not worry about it for now.  Easy for her to say. I pressed her, and she replied that there was no cure for metastatic cancer.  I knew that, but having her repeat it as a matter of fact drove home the point. She said that my options included investigating palliative treatments, and looking for the best clinical trial.  I already knew that the average survival time for a Stave IV bladder cancer patient with distant mets was about a year. And few clinical trials are effective.

Dr.  Plimack restated her advice to continue living and not obsessing about whether my cancer was spreading.  Because there is no cure, it really doesn't matter whether it's confirmed or not.  It does remind me of how tenuous life can be, and how we have no idea how long our mortality will be.  On the one hand, I'd like to know the details of my disease and the treatment options.  On the other hand, it's not going to make a whole lot of difference because there's not a whole lot anyone can do about it.

I'm still pondering this dichotomy, and how I incorporate this news into my life.  Do I live differently, and if so, how?  One indicator of how I'm processing this news is that, for lunch, I had a big Philly cheesesteak with fries, and for dinner, I had Five Guys.  Maybe I'm determined to not die from cancer, but of clogged arteries instead.




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