"Changes"

Today we met with E.'s oncologist.

The PET/CT looked good. "There is no abnormal activity along the esophagus. There are no enlarged FDG-avid nodes in the mediastinum, paraesophageal, axillary, left gastric, abdominal or retroperitoneal regions. Normal tracer activity seen in the liver, spleen, adrenals, or visualized bone marrow."

The MRI is questionable. "There is a decrease is size of the surgical cavity within the right frontal lobe. Marginal enhancement surrounding the resection activity is more prominent; however, still within the realm of postoperative enhancement. This bears close followup to exclude recurrent tumor."

E.'s oncologist said there are definite changes in E.'s brain, which is a possible consequence of surgery, but could be a possible consequence of recurrent cancer. He recommended that we consult with a neuro-surgeon to see if any intervention is needed.

We then met with a neuro-oncologist at the Brain and Spine Center.

She reviewed E.'s history and agreed with the conclusion that E. was probably having focal or partial seizures rather than generalized seizures. She found it interesting that E. is slowly titrating on the Keppra and then will be slowly weaning off the Dilantin ... in her practice, they start and stop those meds abruptly.

She reviewed the MRI. While the cavity where the front tumor was is smaller, the walls are thicker. And they are more "enhanced." "Enhanced" means brighter. So, looking at the MRI, the walls around the cavity are thicker and are glowing much brighter. As you may recall, when you're looking at an MRI, you really don't want anything to glow brightly! The neuro-oncologist did say that sometimes "enhancement" is caused by healing from radiation and the "time is right for radiation induced changes." She pointed out some white cloudy areas around the cavity, which she explained could be swelling caused by a tumor.

She really didn't have anything definitive to say. She summarized by saying, "Based on my assessment, 1. Right now, I do not know what's in there. And 2. I am going to need to repeat the MRI in two or three months. If it is stable or improved, that will show that it is side effects from the treatment. If it is worse, that will show it is the tumor coming back." Furthermore, she stated that during that interval of time, if E. develops any symptoms such as vision trouble, increased seizures, headaches, disorientation, etc, he is to report them immediately.

We then got a call from the thoracic surgeon's physician's assistant. She wanted us to come over so they could see us before we left. She called the surgeon out of a meeting, simply so he could touch base with us. They had both reviewed the PET/CT and MRI reports and were full of optimism. Essentially, there is nothing that can be done about it right now anyways, so we are not to let it consume our lives. "Go, live life, enjoy .... and we'll see you in three months." It was just the pep talk we needed to end our visit.