Tuesday, November 5, 2013

All Clear

Today I met with Doctor Chemo (medical oncologist) and Doctor Cutter (ENT and surgeon) at Dana-Farber for follow-up and to discuss the results of my scans from October 23.

The headline:

Scans are clear.

I am cancer free.

I was expecting that, but it's still nice to have it confirmed. I have to admit that I had a little sliver of concern that my scans might not be clear. It does happen.

The radiology reports from the two scans are at left. Click on the images to embiggen.

The first is the CT report. This scan allows the radiologist to closely examine the anatomy. The main finding there is "...improvement of prior tongue base mass. No new neck mass is noted."

They also noted some lymph nodes that are still enlarged, and that there is post-treatment thickening remaining at the base of my tongue and my epiglottis.

I experience that as coughing while eating because food gets stuck a little bit on the way down. During my doctor visit Doctor Cutter used a scope to look down my throat through my nose (not nearly as unpleasant as it sounds - this is the fifth or sixth time I've undergone the scope). The base of my tongue looks much more normal now. But as the CT report says, the base of the tongue and the epiglottis are still swollen from treatment. Also, the normally round shape of my throat is flattened significantly. Doctor Cutter told me that will return to normal but it can take a couple of years. But my throat is narrowed, which is also contributing to the mild difficulty swallowing.

Doctor Cutter told me the lymph nodes are completely normal. He also told me that as my neck heals and softens, "lumps" will become apparent. But they are usually just normal structures that the patient never noticed before. He advised that if I find a lump on one side, check the other side. If they are the same, it's normal.

The PET-CT report is next. It's key findings are distributed through the various sections, with each including the phrase, "There is no FDG-avid malignancy".

FDG refers to fludeoxyglucose, which is the radioactive sugar I was injected with prior to the PET scan. "FDG-avid" refers to glow in the PET image. This report indicates that nothing was glowing where it shouldn't be.

No cancer.

There is one interesting line in the chest section: "Postradiation changes seen in the apices right greater than left." "Apices" refers to the upper tips of the lungs (each referred to as an "apex"), which were apparently in the radiation field. This is also normal after neck radiation - apparently the tips of one's lungs reach all the way up past the collarbone. This will also heal over time.

As of today I move from the "treatment" phase to the "surveillance" phase. For the next two years, I will see a doctor every 2-3 months for a physical exam and scoping. Since the site of my tumor is visible, they don't do imaging scans to monitor for recurrence. They just look at the site directly.

Doctor Chemo told me that the highest risk of recurrence for this cancer type is in the first two years after treatment.

I also now move into "survivor" category and I'll receive advice on survivorship.

I expected this result all along but I still feel a pretty big sense of relief to hear that I am officially cancer free today.

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