The Wife here updating the blog for a change.
Today we had a doctor's appointment again, this time with the "head guy" so we were happy. The platelet count was still below 100 but the doctor said that now it looks like the disease itself is keeping it low. This means that the tumours may secrete something that keeps the platelet level low. However, as it has been low but on the same level for a while now he said the treatment can be started again so they started today.
The new combo is irinotecan (brand name Camptosar) and cetuximab (Erbitux) as injection, once a week this time, and the old friend capesitabine (Xeloda) as tablets for two weeks. The set of most common side effects from irinotecan is nausea, diarrhea, hair loss, and from cetuximab an acne-like rash in face and upper torso. There are effective medicines against nausea and diarrhea, and the rash may be milder with proper body lotions, and with hair we will just do the regular summer cut for Jan Arne already. But keep your thumbs up or pray, whatever suits you best, that the side effects will be on the mild side. There is, however, a chance he will finally start looking a bit different though. This far you have not been able seen at all that he has cancer.
We also asked about the CT scan results as the doctor last week could not say much about them. This is what the "head guy" replied: The unclear borders of tumours indicate that they may be growing (especially interpreted with CEA value). The mention in the CT scan report about lymph nodes next to liver being small means that they are normal size but that does not mean there wouldn't be any cancer cells in them. And about the number of tumours in liver: the six whose measurements we have been following (sixth one supposedly no longer seen in the most recent scan, according to the radiologist report) are the biggest and measurable ones, but that does not mean that there would not be other smaller ones in the liver as well. So no positive news really but I guess we already knew the answer.
Let's just all now hope (and keep our thumbs up, and pray, again whatever suits you) that the new combo will do the deed again and kick the cancer back a few notches! It is indeed a battlefield, no wonder they use a lot of war metaphors when talking about treating cancer.
Tuesday, May 19, 2009
Wednesday, May 13, 2009
Change
The doctor called me up this afternoon as she promised. They had discussed my situation in the department meeting this morning. They had come to the conclusion that the current chemo regime is no longer working as the tumours have not decreased in size significantly since the February CT scan. My new regime will contain only one drug which is marketed as Camptosar. I will get it as IV once a week for four weeks in a row. Then there will be a two weeks rest period. The plan is to start it next week if my platelets count is good enough.
I asked why they wouldn't combine Camptosar with Avastin and she said it is because of my the situation with the platelets as Avastin could also have a negative impact.
In yesterday's discussion with the doctor, my wife asked about a drug called Erbitux that could be combined with Camptosar. The doctor promised to bring this up in the department meeting. In today's call she said that they will add Erbitux to my new chemo plan only if my cancer cells "express EGFR". Actually, I've no clue what this means even after reading about it. They will use the biopsies of my tumours taken last summer to determine EGFR expression. If there is a positive finding, they'll put Erbitux in as well.
The Eurovision Song Contest festival is on. My wife is a big fan. I would say there's one country this year that has got something special. It's Armenia with the song "Jan, Jan". According to the Norwegian media, Norway is again among the favourites.
I asked why they wouldn't combine Camptosar with Avastin and she said it is because of my the situation with the platelets as Avastin could also have a negative impact.
In yesterday's discussion with the doctor, my wife asked about a drug called Erbitux that could be combined with Camptosar. The doctor promised to bring this up in the department meeting. In today's call she said that they will add Erbitux to my new chemo plan only if my cancer cells "express EGFR". Actually, I've no clue what this means even after reading about it. They will use the biopsies of my tumours taken last summer to determine EGFR expression. If there is a positive finding, they'll put Erbitux in as well.
The Eurovision Song Contest festival is on. My wife is a big fan. I would say there's one country this year that has got something special. It's Armenia with the song "Jan, Jan". According to the Norwegian media, Norway is again among the favourites.
Tuesday, May 12, 2009
May scan
Yesterday I was supposed to finally start the now twice postponed treatment round, but the platelets count had further declined compared to last week. The value was now 78. The nurse said they would postpone the treatment with another week.
Today I had the doctor's appointment where I got to hear the analysis of last Friday's CT scan. I was quite nervous this time and expected to hear some negative news. I had the increased CEA value particularly in mind. The senior doctor I thought I was going to see had taken a one week holiday (!). His deputy was one of the young doctors we have met before.
The situation in the liver is roughly on the same level as in February. The strategic measures are now:
* 3,0cm x 2,7cm (in February 2,7cm x 2,6 cm)
* 6,9cm x 4,5cm (in February 6,7cm x 4,2cm)
* 6,6cm x 2,8cm (in February 7,6cm x 3,7cm)
* 3,1cm x 2,3cm (in February 3,1cm x 2,2cm)
* 1,2cm x 0,9cm (in February 1,1cm)
The sixth tumour they measured in February to be 6mm in diameter can no longer be seen. The report also mentioned that there are no new tumours and that some measurements were difficult as the edges of some tumours were unclear.
As a summary, some of the tumours are still big, some have increased in size, some are the same size as before and some have shrunk. The doctor didn't give a clear conclusion but she said it may be the current chemo regime is no longer working as the tumours have not decreased in size significantly. There will be a department meeting tomorrow morning where my case and treatment plan will be discussed. She would call me in the afternoon and give me an update. The senior doctor will be back on Monday and probably make the final call.
We also discussed the issue with low platelets count. The doctor said their practice is to wait until the body recovers and starts producing platelets normally. Re-fill of platelets is done only when the value goes below 20 which means the situation is life threatening. We said we are a little worried about this as it has now been three weeks since I stopped eating the Xeloda pills and five weeks since last dose of Avastin. We also asked if there could be other reasons for low platelets count than the chemo. Could the cancer for example have spread to the bones where the platelets are produced? The doctor said no as such a situation would be seen in other blood values and they all are fine. We agreed I'll wait for the next blood test (Friday or Monday) and cross my fingers that the count is up.
Today I had the doctor's appointment where I got to hear the analysis of last Friday's CT scan. I was quite nervous this time and expected to hear some negative news. I had the increased CEA value particularly in mind. The senior doctor I thought I was going to see had taken a one week holiday (!). His deputy was one of the young doctors we have met before.
The situation in the liver is roughly on the same level as in February. The strategic measures are now:
* 3,0cm x 2,7cm (in February 2,7cm x 2,6 cm)
* 6,9cm x 4,5cm (in February 6,7cm x 4,2cm)
* 6,6cm x 2,8cm (in February 7,6cm x 3,7cm)
* 3,1cm x 2,3cm (in February 3,1cm x 2,2cm)
* 1,2cm x 0,9cm (in February 1,1cm)
The sixth tumour they measured in February to be 6mm in diameter can no longer be seen. The report also mentioned that there are no new tumours and that some measurements were difficult as the edges of some tumours were unclear.
As a summary, some of the tumours are still big, some have increased in size, some are the same size as before and some have shrunk. The doctor didn't give a clear conclusion but she said it may be the current chemo regime is no longer working as the tumours have not decreased in size significantly. There will be a department meeting tomorrow morning where my case and treatment plan will be discussed. She would call me in the afternoon and give me an update. The senior doctor will be back on Monday and probably make the final call.
We also discussed the issue with low platelets count. The doctor said their practice is to wait until the body recovers and starts producing platelets normally. Re-fill of platelets is done only when the value goes below 20 which means the situation is life threatening. We said we are a little worried about this as it has now been three weeks since I stopped eating the Xeloda pills and five weeks since last dose of Avastin. We also asked if there could be other reasons for low platelets count than the chemo. Could the cancer for example have spread to the bones where the platelets are produced? The doctor said no as such a situation would be seen in other blood values and they all are fine. We agreed I'll wait for the next blood test (Friday or Monday) and cross my fingers that the count is up.
Wednesday, May 6, 2009
Vappu
I checked in at the hospital yesterday morning just to find out that the platelets count in yesterday's blood sample was still too low to start another round of chemo. The value was now 87 so it's roughly at the same level as one week ago. The nurse consulted the doctor who postponed chemo by yet another week in an attempt to give the body more time to start producing platelets normally.
I asked to see the doctor to hear his analysis of the situation but he had another patient. I didn't want to hang around and wait as I have an appointment with him next Tuesday for the CT scan results, so I left.
This weekend there was the traditional May Day or "Vappu" celebration in Finland. I looked up in Wikipedia and found a page on Walpurgis Night where there's a pretty good description about the Finnish traditions. This is the time of the year when everyone drinks home-made mead ("sima") and eats home-made doughnuts and when students from the technical university take over. You see them wear overalls and white student hats and run around doing various rituals. Though the rituals seem to vary from place to place, a common nominator is that there's a bit of alcohol involved. In Tampere, the dipping of first-year students into the river downtown is a popular show. Another tradition is that everyone that has completed high-school will take their white student hat on and get downtown.
I asked to see the doctor to hear his analysis of the situation but he had another patient. I didn't want to hang around and wait as I have an appointment with him next Tuesday for the CT scan results, so I left.
This weekend there was the traditional May Day or "Vappu" celebration in Finland. I looked up in Wikipedia and found a page on Walpurgis Night where there's a pretty good description about the Finnish traditions. This is the time of the year when everyone drinks home-made mead ("sima") and eats home-made doughnuts and when students from the technical university take over. You see them wear overalls and white student hats and run around doing various rituals. Though the rituals seem to vary from place to place, a common nominator is that there's a bit of alcohol involved. In Tampere, the dipping of first-year students into the river downtown is a popular show. Another tradition is that everyone that has completed high-school will take their white student hat on and get downtown.
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