*This blog is actually from March 11th. But it didn’t post so I’m sharing it now. I’ll also get another post out tonight about my surgery and how things are going. Not having a left thumb is wild.
Busy, Busy, Busy
Last week at this time the only thing on the agenda was the thumbectomy on Thursday. Then I got a few calls and sent in a few questions and all of a sudden the week lit up.
PET Scan II
I had a PET scan in mid January. It was the one that revealed the polymorphous adenocarcinoma tumors in my neck and throat. However the PET also showed a remaining lymph node in my left armpit that could be cancer. It didn’t meet the size criteria, so it wasn’t certain at the time. We need to know if it’s cancerous though as that would dictate some of what we do with radiation or (my preference) just have another surgery to remove the thing. So today I had a repeat PET scan to see if this little node gets brighter or dimmer. Dimmer means it was most likely inflammation from the surgery. Brighter means that little shit needs to die.
Precision Genomics
It’s funny when your present meets your past. Many years ago I had Cancer Treatment Centers of America as a client. And specifically my client was their Precision Medicine division. So when the nurse asked me if I knew what Precision Medicine was, I recalled just enough info to sound somewhat intelligent.
The quick explanation is that historically we’ve classified cancers by body part. Breast Cancer. Bladder Cancer. Throat/Neck cancer. But just because a cancer is in a different area of the body doesn’t mean it is 100% different. There could be genes or mutations expressed in cancers that we historically considered different. Maybe one of the more well known ones (if nothing else because of commercials) is HER2. Commonly associated with breast cancer it can be a factor in many different cancers. Drugs like Herceptin are approved to treat Breast Cancer and Stomach Cancer.
Precision Robnomics
So what all of this comes down to is that they will send a sample of my blood and samples of my neck tumor to a specialized lab. The lab will do a few forms of testing including sequencing the DNA of the tumor. Ultimately what we come away with is detailed information on which drugs are best suited to treat the cancer and which, if any, clinical trials might be a match. Again, the head/neck cancer is the more ominous of the two. It’s already a unique cancer which means it hasn’t been studied as much and since I’ve had a stem cell transplant, I’m a unique patient. Put the two things together and there really isn’t any good data that the doctors can turn to. Thus the test.
Swallow
Swallowing will be a running theme in my treatment. First because of the surgery. Now because of radiation. Today I had my overview with the Speech Therapist on what to expect during radiation, what exercises I can do with my mouth to keep it strong, and some baseline testing. I’ll see this therapist every other week as I go through radiation. It is possible that swallowing gets so painful that I need another feeding tube. However this one would be gastric instead of nasal so that would be a big plus. She also said I’d have someone from Palliative care follow me, which is fantastic. No begging doctors or PAs for pain relief. Palliative care will be much more understanding.
Dr. Durm
The final non surgical appointment of the week will take place with Dr. Durm. Dr. Durm is the Oncologist overseeing all my care. Basically we check in with him to talk about how things are going and what we might do next. On tap for today will be the PET results, immunotherapy timing, and getting a referral to look at a few other spots on my skin that aren’t cancerous but I’d rather just get them taken out. Seems like leaving things up to chance doesn’t work too well for me.