On Tuesday, I had my second PET-CT scan. As before, I arrived at the hospital early and with an empty stomach. I was given the sugar fluorodeoxyglucose (FDG) and asked to relax for an hour. Ok, not quite right, I was ordered to lie motionless for an hour. The last time I had a PET-CT, this was so relaxing I fell asleep towards the end. This time, it was a bit less comfortable.
Once inside the body, the sugar goes to places of high metabolic activity. If the muscles are resting, these are the brain, the heart and not much else. Cancer cells will gobble up the sugar as well because they’re always on fire. Because of the missing 2-hydroxyl group of regular glucose, FDG cannot be broken down and remains in the cells at least for the duration of the scan.
The key of the method is that the fluorine atom in FDG is a radioisotope that releases positrons (the opposites of electrons) as it decays. The positrons are detected during positron emission tomography (PET). X-ray computed tomography (CT) is used to get a clearer picture of the anatomy of the patient and to assign the PET signal to individual organs and parts thereof.
Today, I went to the hospital to get the result. I was optimistic. There is of course no point of being anything else when living with a life-threatening disease, but how I felt during and after chemotherapy boosted my spirit even higher. Almost everything had gone my way. I saw myself on the verge of becoming a survivor. I was in for a brutal let-down.
The oncologist didn’t mince words. “It doesn’t look good”, she said. “We see tumors in the liver, and there’s something growing in the lung.” There’s no point, she continued, to surgery or radiotherapy. The signal from the liver was so diffuse, nothing would remain if one started to cut everything out that was cancerous. It was a grim picture.
It was also a picture to be expected. When I started chemotherapy, the consensus was that I am beyond hope and that palliative care is the name of the game. I convinced myself that I’m not the average cancer patient and that my relative youth and relatively good physical shape will boost my chances of survival. Diagnostics are derived from past observations, and most of these come from geezers that are falling apart anyway. This fantasy was good for keeping me in a good mood and giving me the strength to endure chemotherapy and train on my bicycle at the same time, but it was always unlikely to amount to much.
In the examination room, I was thinking back to the last few weeks where I had plenty of wine and beer and the occasional gin and tonic. My liver hadn’t complained. It seemed to work just fine. How come it’s now shown to be all messed up? The doctor dispelled my worst fears. The liver is still largely ok. But what’s growing inside it will destroy it if no measures are taken.
Which measures? What can we try that we haven’t tried before? The first chemotherapy program was obviously not a success, but it was not the only way of attacking a cancer either. With a few changes, the regime - based on the inhibitory effect of 5-fluorouracil on DNA replication – can be repeated. The outcome might be better. Or nothing will change and the cancer will grow.
Realistically, nothing will change and the cancer will continue to grow. The patient information leaflet about the new chemotherapy says in the first paragraph that there is no cure for metastatic colon cancer. This would be a good moment to sink into despair, curse at the world or jump off a tall bridge (of which Baden has two fine examples). I’m not that kind of guy, and I won’t change the subtitle of this blog.
I know my prognosis. I can still remember the first conversation with the oncologist before the first chemo started. He was not optimistic and didn’t pretend. Cure was not a word he used. I know I’m screwed, but I thought that at the very least I’d be able to delay the inevitable – and maybe even achieve something utterly unexpected.
I firmly believed that the PET-CT would be negative. It’s only one month after the chemo. How much could have realistically gone bad? Everything went bad. A lot grew inside me. Depressingly, I’m looking worse now than I was before the chemo. This is hard to stomach, the worst possible outcome crashing into with my carefully nurtured delusion. I could have accepted (and did expect) a regrowth of the tumor or new metastases, but not so fast. The speed of this is frightening.
Against the odds, I still believe I have a chance. After all, I’m relatively young and in relatively good shape. And I have a positive mindset. No one will survive if not me. After getting a second opinion from a renowned oncologist at the University Hospital in Zurich, I will probably take this new chemotherapy, which will keep me busy almost until Christmas. I might also take the mushroom supplement my friend Sean alerted me to. It might not help but it’s unlikely to hurt.
I should enjoy the time before the second program starts as much as I can. Now would be a good time to do all the things I’ve always wanted to do. Visit Korea, learn kite-surfing, chase the ghosts of the Moors through southern Spain, learn the piano. With coronavirus still holding the world hostage, most of these are out. The piano sounds too hard and too much work. But there are my children, my bicycles and my work. How much more fun does one person need?
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