I'm Cured?

I'm Cured?: Having gone through the surgeries, chemo, and radiation my doctors were very optimistic that I had a high chance of being cured. The most optimistic was convinced I was cured while the more conservative thought I had a mere 15% chance of the cancer coming back. It was during this initial period of remission, that, ironically, I suffered from the most anxiety. It is hard to explain but having gone through aggressive treatment and still being pretty weak, I couldn't help but worry that the cancer would come back and I would back in treatment again. Also, I knew if it came back, it was likely incurable and I would be dealing with it for the rest of my life.

On the bright side, I started riding my bike again within one week of completing chemo and took a new position at work in the Corporate Real Estate Group, which I enjoyed. The biking was great since I had built up a new titanium bike while I was sick so I would have something to look forward to when I was done with treatment. I began to ride 150 up to 250 miles a week, which is quite a bit of mileage for someone just out of chemo treatment. And within six months, I rode from San Francisco to LA in a sponsored bike ride that raised money for arthritis patients. I absolutely felt great and was back to 100%, although I still was carrying quite a bit of anxiety around about the whole ordeal. Also, Jen and the kids were all doing great and we continued to make plans for the future, having believed we dodge a rather large bullet, we even put our house on the market, planning to move to Santa Barbara since that is where we ultimately want to live. We figured we might as well live where we want to live after having gone through what we did (Ultimately, this fell through but that is a different story altogether).

What's that under my arm?: Every three months, I would get a PET/CT scan. This is a scan that can detect any new or recurring cancer. I went in for my quarterly screening just before Christmas in 2007. I got the call from my doctor a few days later, he said there was a bright spot under my arm showing up on the PET scan, but most likely it was from an infection and not cancer related. Of course, this drove me crazy because up until then every scan had been totally clean. They recommended waiting another three months and then do another scan to see whether the bright spot on the scan was still there.

In the month after I got this first result, I noticed that I could feel a hard lump forming in my armpit, so I went into the Oncologist. He also felt the hard lymph node. He still didn't think it was anything, but since it was such a low risk procedure to remove the lymph node, he recommending removing it, since then we would be 100% certain what was going on.

Biopsy 2: The second biopsy was also an out patient treatment. I was in and out in a couple of hours. The doctors couldn't tell much from looking at the lymph node, but said they would have pathology results within a week. A week passed and I went into the doctor’s office. It turns out that the lymph node was in fact cancerous, so I was back in action for more surgery, radiation, etc.

I don't think most people realize the seriousness of a recurrence of cancer. When cancer first shows up, if it is limited to a small area or can be removed by surgery, you have, many times, a very good chance of a cure. Even with chemo, radiation, etc., if you get rid of the cancer from the primary site, it is very good news. However, when cancer comes back, and it comes back to an area that is not close to the original site and it is the same type of cancer (thymic cancer in your bone for example), this is not good and in most cases it means the cancer is most likely incurable. Given that my cancer recurred in my lymph underneath my left armpit, which is pretty far away from the original location, it was indicative of metastasis. Or in other words, the cancer had spread widely throughout my body, not good news.

At this point, we decided to remove ALL of the lymph nodes under my arm. There are anywhere from 25-40 lymph nodes in this area. It varies from person to person. We decided that there was a small chance that the cancer had spread there via my chest wall and therefore we still had a small chance for a cure, if we could remove all of the cancer cells and be lucky enough that the cancer had not spread anywhere else.

Surgery 2: This surgery was done by a different surgeon than my first three procedures. The procedure I had was the same procedure that woman have when they biopsy lymph nodes for breast cancer. Therefore, I had the chief breast cancer surgeon perform the surgery since she was more familiar with identifying and removing lymph nodes in this area. The plan was to keep taking out lymph nodes until she was confident that any remaining were cancer free. In total she removed about 30 lymph nodes and about 12 of them tested positive for cancer cells.

Jen and I were pretty shocked to learn that so many nodes were positive for cancer, this means the cancer definitely has the ability to move throughout my body, which is not a good sign. The doctors at this point still thought it would be worth radiating the whole area under my arm, just to make sure all cells were killed. And if this was the only place the cancer had spread, then I still had a chance of a cure. However, before they would get me setup for radiation, I needed to have additional scans of my whole body to ensure that the cancer had not metastasized anywhere else, otherwise the radiation would be a waste. You may wonder why this is, well, if the cancer had metastasized outside of the area then it meant that the cancer got there via either my blood or lymphatic circulation, rather than through the muscle of my chest. If the cancer had spread via my chest wall, then it would possibly mean that the cancer had not spread throughout the rest of my body. Earlier scans had not indicated any other cancer in my body.

I went for these scans and we were about ready to start radiation treatment when I got the call from the radiologist. He saw a very small "bright spot" on my hip joint. It had been there before in other scans and didn't think it was anything, but wanted to perform a more detailed MRI of my whole spine and hip to make 100% sure I was clear. He said he was 95% sure it wasn't anything but wanted to check. Well, I had the MRI and it turns out that I, in fact, did have signs of cancer throughout my hip socket, upper femur, hip, and lower spine, but it was very small and difficult to make out. The tumors were smaller than bb size. At that point, we canceled the radiation since it would have been a mistake to take on extra radiation if it was possible the cancer had spread. This was in June of 2008.

About a month later, my Oncologist called and said he had reviewed the scans and had the experts at UCLA review them as well. Given my PET/ct scans were negative for cancer, but the MRI was positive there was still a small chance that what they were seeing wasn't cancer, but they were pretty sure that it was. He recommended I start treatment with a new product named Avastin and then have scans in a few months to see if there was any change to the tumor size/location.