"Thyroid cancer." Again? I thought the point of last week's surgical biopsy was to genetically-sequence a lung cancer tumor. Now you tell me the radiologist/pathologist found more thyroid cancer. As it already has happened, my oncologist - in coordination with my endocrinologist, said that my most recent CT scan showed "excellent results" (from my previous thyroid cancer treatment - which ended with radioiodine therapy), and furthermore noted that the thyroid cancer was confined to my neck. Yet a few weeks later, the thyroid cancer is back in my lungs. What happened? Or more importantly perhaps, what didn't happen?
Well, if I understand what my oncologist said to us over the phone on Wednesday, disappointing as it initially sounded, it might not be at all bad. Apparently, the dose of radioiodine (nuclear medicine) I received had been modified (reduced) due to my pre-existing kidney function issue. Since this modification was not a "normal" dose, it didn't locate all the thyroid cancer tumors; the smaller ones, that is, so the presumption was that all the thyroid cancer had been found, identified and eliminated. Until last week's biopsy found otherwise. What does it all mean? I'll try to explain, although I'm sure I'll get lost in the science somewhere.
I still have two types of cancer: non-small cell lung cancer and papillary thyroid cancer. However, I may have thyroid cancer in the lungs which actually may be better than having lung cancer in the lungs. The reason being: papillary thyroid cancer is curable whereas non-small cell lung cancer is not (it is treatable, though). Moreover, thyroid cancer is slow-growing and at present, so small that there may not be any treatment to follow. To learn more definitively what is happening in my body, I'm scheduled for a PET scan this week and then another surgical biopsy the following week. This time the biopsy will be a lung biopsy. This will get tissue from within the lung (a bit of a lung-collapsing risk), not from the periphery (the lymph nodes). Presumably, this biopsy will provide some clarity.
According to my oncologist, I have a dozen or so tumors in my lungs, some of which may be thyroid cancer. Unfortunately, it's not practical or prudent to biopsy all of them so a complete assessment will not be possible. Therefore, an educated guess will have to be made: continue to treat the lung cancer with immunotherapy or not, and/or only treat the thyroid cancer which given its small size and slow-growing nature wouldn't require any treatment - for now. And might not for years.
But if there are more tumors that are lung cancer - which the doctors can't confirm, and I'm not receiving any treatment for them (because of the thyroid cancer diagnosis), won't my lung cancer tumors grow? And since one medicine doesn't work against two types of cancer, I may not be receiving treatment for the cancer that's really active and receiving treatment for the cancer that is not active. And the only way to find out what types of cancer exist is to biopsy each and every tumor - which is not going to happen. As my oncologist said in response to our characterization of this damned if I don't and damned if I do scenario as being very complicated: "Mr. Lourie has always been a complicated patient."
As I review this column and reconsider what my oncologist has advised going forward, it's not only complicated, it's confusing and a bit disorienting. What exactly do I have and what are the risks, and more importantly: what is my life expectancy? Nevertheless, as my oncologist said: "I'm glad we did this biopsy." Me, too.