Friday, September 19, 2008

09/19/08 - MU - The Spread...

When it rains, it pours...

Right now, I wish I was in Southern California where it doesn't rain, at least according to the song.

My brain tumor has spread to my spinal cord. I found this out in an MRI performed when I was at Moffitt Cancer Center on September 9th. The tumor is in my neck, and it the can be seen, circled in red, in the MRIs below. In the picture on the left, there is an injected chemical called "contrast" which makes the tumor stand out as a white circle. The picture on the right is nearly the same, with no contrast.

MRIs of my "new" tumor (Click to enlarge)

At the time, it was about 4mm x 7mm. It is also rooted in my spinal cord, versus being just on the surface, which would seem somewhat better to me. Hindsight being 20/20, the tumor can actually be seen starting to grow in the MRIs taken when I last visited Moffitt on June 17th (so it was there on my recent vacation).

MRIs from June 17th

Next Steps. The type of tumor that I have (Medulloblastoma) typically only spreads to the Cerebrospinal Fluid (CSF), a clear liquid surrounding the brain and spine. A spinal tap (AKA a lumbar puncture) is supposed to microscopically detect tumors cells that may be "adrift" in it. I say "supposedly" because I had a spinal tap done after my initial brain tumor operation, which was negative at the time.

The doctors have wanted to do another spinal tap, but my platelets have not been high enough (my blood counts are updated at the link to the right). There's nothing that I can do or eat to raise them. They were at 65,000 this Tuesday, up from 56,000 last week. Normal low is 140,000. At my suggestion, the doctors may just go ahead and do a spinal tap (after checking my platelet counts) at Moffitt next Tuesday, 9/23.

Platelets control your blood's ability to clot. Although mine have been as low as 7,000 before, bleeding skin from a blood draw is not so bad. However, a spinal tap is basically a long needle stuck into your CSF (through one of the discs in your spine) to get some fluid out for inspection. One of my doctors reminded me on 9/16, and I seem to remember from my first brain tumor operation, that CSF and blood do not play nice together. To make a long story short, my platelets have to come up before I can get a spinal tap...

The spinal tap will determine my course of treatment. If positive (detecting tumor cells in my CSF - a possibility of spreading further), I will receive intrathecal chemotherapy before the tumor is attempted to be removed by radiation. If negative, the tumor will probably be radiated and I may not receive any chemo.

Intrathecal chemotherapy options

A step back. Because of its location, the tumor is pretty much inoperable, so it will likely be radiated (zapped). Radiation has the ability to focus beams and destroy bad cells while not harming so many good cells. I had radiation treatment after my first brain tumor operation to eliminate any tumor cells that were missed. This time around, I will likely just have radiation (no surgery). An example radiation session is depicted below.

An example of radiation treatment

Luckily, I have had no symptoms from this new tumor as of yet. I certainly didn't expect it at all, because I went through so much chemotherapy, and I assumed the cancer was dead, partly because my blood counts were so adversely effected. Once again, assume nothing.

Now, I am just waiting for my platelets to come up so I can have a spinal tap and be treated properly. Although there is a sense of urgency about my new diagnosis, there doesn't seem to be an immediate rush by my doctors to do anything until they can learn more. Hmmm... Assume nothing.


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