PET Sounds

TL;DR
PET scan shows just one small speck of cancer on Vic's tongue—nothing in the lymph nodes, nothing of significance anywhere else. Next stop: What will the treatment be?

Full blog post
When last we met, I was writing the blog and Vic was taking pictures of birds at our feeder, particularly our beautiful Western Tanagers.

Taking pictures and watching the wildlife that comes to our yard (a wide variety of birds, squirrels, a skunk, a raccoon [or two], a fox and our neighbor's cat) are two of the activities that help Vic feel normal and take his mind off the cancer —even if only for a moment.

OK. So. The PET scan. It went about as expected—it took a long time, but at least it was boring. No need to dwell on that, except for these pictures Vic took while he was there:

You know how people always take pictures of their feet?

The dreaded donut.

We saw the oncologist, Dr. Maymani, Friday. He is a genial fellow who nevertheless uses big words that I continually had to say "Ummm, what does that mean?" Note to all you medical professionals out there: It's OK to use big words, but do please follow-up with "What that means is ..." Thank you.

• The PET uses a "radio-labeled glucose" that is attracted to areas with high activity, such as the brain and the organs—and cancer cells.
• The PET found a teeny-tiny dot on the right side of the tongue 👅near the mandible (jaw). Vic said, "Wow, that cancer really is small. Dr. Maymani said, "That's your brain. The cancer is over here." It's so small that it basically only shows up in one of the many, many views of the PET scan.
• The PET did not find any dots—teeny-tiny or otherwise—in the neck (lymph nodes).

Bottom line of the PET scan, the cancer has not metastasized. For those of you who do not watch Game of Thrones Grey's Anatomy, what that means is (medical professionals: see how I did that?) that the cancer has not spread. This was the absolute best news we could have gotten from the PET, other than "The biopsy was wrong. You don't have cancer. Sorry!" 😉

Now, here's where the news from the PET scan goes a little downhill: Treatment.

• Surgery is Dr. Maymani's preference.
• Pros:
• Surgery removes the cancer. If there is no cancer left, it can't spread.
• If the surgeon (Dr. Song) thinks he got all the cancer, there would likely be no follow-up treatment (radiation and chemo- or immunotherapy). For those of you who remember the last round of treatment, you know why this is a pro.
• Cons:
• Any surgery is risky.
• While emotionally, Vic's heart is big and full, physically his heart is not strong. Surgery will take a toll.
• Even though the tumor is small, Dr. Song may have to take a large area of the tongue or even the jaw to make sure he gets the whole thing. This would require a much more extensive surgery as well as reconstruction later on.
• The medical team (Dr. Song, Dr. Maymani and the radiation oncologist Dr. Weeks) may decide he needs follow-up treatment in addition to the surgery.
• If surgery is not an option, the next best treatment is radiation therapy.
• Pros:
• Radiation kills the cancer. If the cancer is dead, it can't spread.
• Cons:
• Radiation therapy sucks. Just read past entries of this blog.
• He may still have to do chemo. (This would be decided by Dr. Maymani and Dr. Weeks.) Radiation and chemo? That's a low blow.
• If surgery and/or radiation are not options, the next best treatment is chemo.
• Pros:
• Chemo shrinks the tumor (but doesn't kill it, which is a con, obvi).
• There are newer versions of chemo that weren't available last time around and may have fewer side effects.
• Cons:
• Chemotherapy only keeps the cancer at bay for awhile—so it could recur.
• Side effects, side effects, side effects. Even the newer version of chemo will have side effects. The last round of chemo was not great for Vic.
• And if all of the above are not options, the final possibility is immunotherapy.
• Pros:
• Immunotherapy targets your T cells, which boosts your immune system. If it works, you're immune to that cancer for life.
• Cons:
• Immunotherapy doesn't work for everyone.
• You have to have repeat PET scans. Vic doesn't like repeat PET scans.
• More side effects! In this case, immunotherapy also targets other organs and can cause colitis, pneumonitis and other inflammation—all treatable, but still ...

It was a little hard to feel hopeful after this appointment, even though the overall news was great. If the cancer had spread, this would be a very different blog post. But now it's been a couple of days, and we've had more time to process. We definitely are grateful that the cancer has not spread, and we are not putting the cart before the horse (translation: we are waiting to freak out until we know what, exactly, to freak out about).

Next steps: We have an appointment with Dr. Song on Wednesday, May 29. This should give us most of the answers we need to determine what to freak out about decide on a course of treatment. We are "looking forward" to that.

I asked Vic if he wanted to say anything in the blog. He said, "I gave you a whole sentence already when I let you use that joke about my brain."

He's a joker. Also, an excellent photographer. When he can't sleep because he's worried about his cancer, sometimes we are the beneficiaries.

Thanks, as always, for all of your support and love and yadda yadda yadda. 💓