Brains. Ya gotta have them, and they gotta be operating on some level in order for ya to have a meaningful life. Lung cancer that’s metastasized to the brain can certainly get in the way of daily operations, and the brain is one of lung cancer’s favorite destinations.
Just to recap, this past spring, a routine check-up revealed a tumor in my brain. A tiny tumor, but growing nonetheless. I had a gamma knife procedure to burn it out and will now experience the joy of Brain MRIs every 3 months. Because an MRI uses magnets to get the images, there’s no chance of adding to my cache of accumulating radiation– darn! no glowing the dark yet!– but there’s always the chance that the contrast they use will wreck my kidneys, so the opportunity for medical fun is not wholly removed.
The MRI was Monday morning and the report arrived early in the afternoon. There’s a lot of doctor-y talk in it about how much of the contrast material they inserted, etc. What we care about is the meat of the matter. The spot that was fried in the spring remains unchanged. In fact, when Dr. Radiology pulled up images to compare scans from Then and Now, we could see the ring around the lesion was lighter and maybe less continuous. Yeah!
(Note about image below– it’s not my brain. My tumor was on the opposite side and was smaller, but the before/after shots are similar.)
There were two things that puzzled us.
“Similar appearance of small intracranial metastases, including the dominant right frontal ring-enhancing lesion. No new lesions are noted.”
Huh? I didn’t even know I had small intracranial metastases.
Moderate cortical volume loss
Volume loss? I know I’m more forgetful lately, but is this some kind of cancer development?
To tell the truth, I was rather sanguine about the whole thing. First, the MRI itself. The only thing to say about that is drugs. And the luxury of a heated blanket. Just Say Yes is the motto I would share with anyone headed in for any kind of MRI.
Interpreting the MRI Report
At a recent gathering of my local cancer group– in person! On someone’s patio!– I met someone who’d had 29 gamma knife procedures. Twenty nine. After all that frying, his cognitive processes were intact enough that he’d just been hired for a high level position in a global firm. So, I figured if there was anything new in my brain, they’d just gamma knife it.
As for the other stuff, here’s what I learned. The “metastases” is basically a CYA term. Mack the Knife & Dr. Radiology looked at the pictures long and hard and decided these little dudes were probably blood vessels. How will we know if they’re cancer? You know the answer to this: they’ll grow. OK, check off one concern from the list.
As for the, she showed us a black area (denoting empty space) that was larger than before. “Aging?” I asked. Yes. Except she phrased it more nicely, something about anyone who is lucky enough to continue to mature experiences this change.
We also looked at the most recent CT scan, comparing it to the one done previous to it. No visible nodes or tumor. Definitely scarring, which would account for some of the stiffness I experience when I’m riding (struggling?) up a big-ass hill. That might change, or it might not.
The main point is that I’ve done extraordinarily well. She suggests I responded really well to the radiation and chemo, and got enough immunotherapy to kickstart my own system (even though it less than the planned amount). HA. My blood pressure remains low and my pulse-oxygen level is 99, which is higher than it was BC. HA.
EGFR Mutations, Immunotherapy, TKI Side Effects?
I’ve read that EGFR mutations, which mine are, don’t respond to immunotherapy, but when I asked about this, she said that according to Pacific Study treatment protocols (mine), EGFR-positive patients had no difference in response than patients with non-EGFR mutated lung cancers. She thinks the brain may have been seeded with cancer cells that just didn’t develop into a tumor until after all the chemo-rads (since chemo doesn’t really penetrate the brain-blood barrier) and the TKI may be playing a role in keeping the brain physiology calm.
From her line of questioning about why Dr. Oncology prescribed the TKI (AKA checkpoint inhibitor), osimertinib, I wondered if she was going to suggest stopping it. I would have flat out refused to even discuss it, but when I explained Dr. Oncology’s desire to protect the brain, she nodded. As long as I was having no side effects… except, I told her, this gawd-awful itching that’s developed on my arms, from shoulders to wrists. I told her I use so many layers of a variety of moisturizers each day that when I get in the shower, the water just beads up. But it’s manageable.
Next scan in 3 months. Maybe after a year or two, she’ll pull back on scans, but the window on badness as a result of brain zappage stays open for about 2 years. Who knew?
Thanks for reading. Here’s hoping anything bad in your day just beads up and rolls right off.
