Next Phase

In the professional, concise manner we’ve come to expect at the TBCC, Dr Trotter, the radiation oncologist, explained to us the results of the PET scan. To do this she showed us photocopied PET scan images of Charl's midsection from different angles: front view, side view, cross-section. The images were in black and white and varying shades of grey. His heart, bladder and other organs were shown as solid black. His lungs and spine were represented in solid grey. Other fleshy areas, say around his chest and arms, were very light grey.  What they are looking for is active cancer cells, which manifest on the PET scan as darker areas (to be clear, they know the abovementioned black or dark grey areas are not cancerous). The darker the area in or around the tumor, the more active the cells. So we knew when we looked at the results, the cancer was still present.

We had prayed, and hoped, for the best outcome, the outcome where the tumor would be miraculously dissolved by the chemo with not a cell of it left. But we also prayed for the ability to accept the results as they came, even if it was not what we wanted to hear. In fact the tumor hasn't shrunk since the last CT scan in April. You could still clearly see it in his chest. In medical terms, 'a rim of moderate hypermetabolic activity remains in the anterior mediastinal mass.. And the overall findings are consistent with residual active tumor.' The center of the tumor is dead (this is good) but the cells around it are not. It actually looks similar to a donut, from one angle anyway. They know for sure that some remaining cells have indeed been impacted by the chemotherapy and will in fact divide and die. But they can't be sure all of the remaining cells are of that type. If remaining active cancer cells are not of that type, they will eventually spread. And Charl will be facing a bone marrow transplant.


So how bad/good is this news?

After we both asked many questions and after receiving very thorough answers, we feel like we understand at least enough to know what risks Charl faces by not doing radiation, and what risks he faces by going through with the radiation treatment. Charl has two options: Option A, he could choose to wait, observe, and see if it comes back. If it does, he would have to undergo a bone marrow transplant, as it has already clearly been shown that not all his cancer cells responded to (died from) chemo. I don't know if any of you know someone who has gone through a bone marrow transplant but I would give my right arm to prevent Charl from having to go through that.  Option B, if he completes the scheduled combination therapy by undergoing 20 days of radiation now, there is a very good chance those remaining cancer cells will be killed. There are increased risks of other health problems down the road, of which I won't go into here, but he felt these were less of a risk than not attacking the cancer immediately with this present course of treatment. It wasn't a hard decision, but it was definitely one in which Charl was acutely aware of the both sides, their benefits and risks.

So what does this mean, really?

It means in order for Charl to get a 90+% chance of cure, he must endure some  unpleasant side effects of the radiation, plus a longer recovery until his life gets back to normal. For one thing, he is willing to do that, and for another, he promised me 60 yrs of marriage, so he has to go through radiation. (Yes we planned to live to 99 and 104 respectively, and we still do).