Tumour 2

So here is the next  insatmenr of  "Ian's Tumour" But now it's Tumour 2. But more about this in a while.

Got rushed into accident at my favourite hospital on Tuesday at around 5pm. That was strange because although I was sent by Professor Neuro I had to go through "standard accident" stuff like blood sugar,  ECG   (but not EEG) and the obligatory saline drip etc. 

Went through a bunch manual tests while I was waiting for the CAT scan, which of course I was really waiting for Got the result (with picture, below) at about  8pm.

The result was unsurprising but still shocking a huge (to me it seemed) new tumour on the left hand site behind where the old one had been. I was now,  awaiting confirmation, Recurrent GBM 

I was kept in hospital and after an event in accident that Carol and I will never want to see again I got to a normal ward at lights out with no shower or wash and still with my drip that I did not need. The night was very restless, possibly my worst night in hospital. The second day, wednesday, consisted of an MRI which confirmed everything we had first seen in the CAT, and an EEG to see how manic my brane was (no too bad).

On the morning of day three I had four of Aarau's finest brain girls and guys at my bedside to put forward the options to me. At 3pm, on my request (to have a quite weekend at home) I was discharge with the report, and appoints for Monday an open ended sickness certificate  a prescription for a pile of drugs (my old friend Timonil that prevents seizures, Cortesone for getting the swelling down and 2 others to counter effect cortisone)

Welcome again to the big C emotional roller coster.

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For those of you who have not been paying attention I was diagnosed on 5th September 2007with a  Glioblastoma Multiforme  brain tumour, a primary tumour. After Radiation and Chemo treatment I was cleared of that tumour by the end of September 2009

Most beloved friends and family, of course, prefer to ignore that this is an currently incurable disease and nearly always recurs. For me it has jest recurred, the 1st recurrence and therefore Tumour 2 with clearly more exciting side effects. So after being risen from the dead, I am to die again. Unfortunately the great god of statistics shows us that  no 2 is not so easy to get rid of and puts my chances of continued survival at less than 2 years. So those are the facts (statistics).

LET THE BATTLE BEGIN!!!

and now a lot more of my (and Carol) decisions than last time. So the dream team (the famous Tumour Bord) met on Wednesday and gave me some options, so I and Carol have decided to go for all of them (best value for money)

First Line of Attack

Surgery : Some time next week I will probably go in for my second round of brain surgery, and remembering my 1st bout I am not looking forward to this again. The purpose of this exercise is to remove  as much of the tumour with as little brain as possible. Three is a 5% chance that I will not  survive this and I have already done it once (no smart ass statistics on this one from anyone its stills worse) but at least we know I have done it once.

Second and Third lines of Attack

Because the surgery will leave stuff around no matter how clean (do not want to take out too much brain)

We will probably go for what I had for the primary tumour conformal 3D Radiation therapy  concurrently with Temozolomid Chemo therapy followed by a further 6 cycles of Temozolomid 

There is another option I would like to discuss on Monday (Gliadel Wafer) before the final decision-

THE PICTURE -------------------

And for those that like picture, take a gander at this CAT span.

The big dark thing in the bottom right is the new tumour (actually on the left) the wide ring is fluid build up. I am already taking cortisone to reduce that fluid and drop the pressure on the brain (shown by the darker material in the lest brain (right of the picture). The other anomalies above the new tumour are the left over material from the old tumour not, we are pretty sure, additional tumours. Bit of a mess don't you think?

Talk to you soon I hope

p.s. if this is a bit hard to understand, imagine what it is like trying to write blindfold (actually not that bad as I have devised a way or reading with my broken mechanism see the next blog post).

Downgraded

I've been downgraded (maybe)!

I don't know if you remember that Universitätsspital Zürich were going to do a second opinion of my tumour histology? Well they have, and they couldn't find any features of a grade IV tumour (GBM), so in their books I have a (anaplastic) astrocytoma grade III which is good news isn't it?

Well yes and no?

• It makes my mortality statistics slightly higher (but not by enough to think about)
• Both agree I have malignant tumours (thank goodness, I wouldn't have wanted all this nasty treatment otherwise)

BUT

• Some trails are now out of my reach because they favour GBM's (like the Tumour Treating Fields trial I kind of favoured)
• It introduces more uncertainty

Perhaps I'll feel better about this when I've got over the current Cold & Chemo bout.
Did I mention Carol & I should be off Thailand for a couple of weeks starting Sunday?

Diagnosis & Treatment

Carol and I were a little suspicious when the Neurologist ask us to come into the hospital to get the diagnosis news rather than get it over the phone. So we quietly drove the 35km to the hospital to be told the bad news.

Essentially I have been diagnosed with the worst kind of Brain Tumor a Glioblastoma Multiforme with a survival rate of 25% at 2 years (with treatment). These tumours are incurable and the only hope is to slow down their growth with therapies such as Radiation and Chemo. It is most likely that this will kill me. That is quite a lot to take in.

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The rest of this posting is the technical details of the diagnosis:

Diagnosis: Glioblastoma Multiforme (malignant grade IV astrocytoma)

In order to get to this decision both cell pathology (histology) and tumour behaviour were taken into consideration

Pathology reported that all tumour cells were from brain material (primary tumour) and indicated a low grade astrocytoma with high grade areas found in one of the four samples taken during the biopsy. While Pre-surgery MRI's show that the tumour has pretty much DOUBLED in size in the 19 days between scans. This rate of growth is normally associated with high grade tumours.

Treatment:

Given the combined evidence of a Glioblastoma Multiforme , the tumour board decided to recommend standard treatment accordingly. This consists of 6 weeks of conformal 3D Radiation therapy to a total dosage of 60 Gray (maximum allowable dosage) concurrently with Temozolomid Chemo therapy followed by a further 6 cycles of Temozolomid (1 week in every 4) for the next six months.

Treatment cannot start until I have recovered from the Biopsy (basically until the scar has healed) because both Radiation and Chemo affect the healing process.