Don M Posted September 7, 2007 Share Posted September 7, 2007 I have been coughing a lot and having a hard time breathing in the last month or so. I thought for sure I had pneumonitis, but I got an x-ray today and it turns out I have pneumonia. It is the “walking pneumonia” variety. I don’t have a fever or chills. I got some medication for it and will start taking it tomorrow. It is a type of pneumonia that is associated with having lung cancer. They call it “post obstructive pneumonia”. I think the obstructive part is the tumor getting in the way of free movement of fluids through the lung but I am not sure. I will have to read up on it or ask the doc tomorrow. They want me to have a ct scan tomorrow and examine me at the Seattle office. The ct scan will give them a bit more information that the x-ray was vague on. It will also give them some good detail about the state of my cancer. I had my PET/CT scan on 8-31. The scan showed a new hypermetabolic nodule, about 1 cm in diameter, near the main tumor. It is probably a new tumor. If it is cancer, it is the first new disease in 2 years, so that makes it likely that it is a new primary rather than a spread. The radiologist noted a moderate increase in size of the big tumor. He did not know that I had the tumor treated with cyberknife at a different facility, so he read the apparent increase in size as tumor progression. I have not asked my radiation oncologist about it yet, but I am sure that she would say that the apparent increase in size is caused by the application of part of the tumor dose on healthy tissue around the tumor. The image shows a corona on the healthy tissue around the tumor, which is where I had some of the radiation, and so it would show up as an inflammation and be hypermetabolic in the scan and make the tumor look bigger. I feel pretty confident right now that I don’t clearly have progression in the big tumor. I am disappointed that I have what is probably a new tumor. So tomorrow I am going to Seattle to take care of my pneumonia issue. On 9-17, I go back to Seattle to discuss my scan and future treatment options with my radiation oncologist and I will also consult with a medical oncologist on the same day. My regular radiation oncologist is on vacation now. I am seeing a new guy tomorrow about my pneumonia. I am very happy that the pneumonia is going to be resolved. Soon I will be able to go through the day without coughing and I will save a bundle on cough drops. I already have a plan in mind that I will run by the docs. I am thinking of doing nothing for the next 3 months and then rescan. If the big tumor shows some favorable changes, then the treatment is working. Usually 3 months out from a radiation treatment is too soon to tell if it is working or not. It takes time for the tumor to shrink and just 3 months out, the inflammation makes the scan ambiguous. By the time 6 months has gone by, the treatment-induced inflammation should be gone and you can see the true scope of the tumor. I think the cyberknife center will soon have or may already have a technology up and running whereby fiducials are not necessary for the robot to see the tumor during treatment. Fiducial placement is the riskiest part of the cyberknife therapy because they have to jam these little metal markers in around the tumor so that the robot can track the tumor. If I can avoid that, I will. The risk is my one lung going flat. One of the requirements for the fiducial-less technology is that the tumor be at least 1.5 cm. I think my new tumor is now less than that and they may want to let it get bigger so that they can use the fiducial-less technology. So I may wait for 3 months to see what the little tumor is doing too. If the big tumor shows progression in 3 months, then I will do chemo or some form of targeted drug therapy, regardless of what the new nodule is doing. If the new nodule shows no change in 3 months, then it may not be cancer and I will continue to monitor it for changes. If it shows growth, and the big tumor is stable or shrinks, then I will get the little tumor zapped. I don’t think I can have cyberknife on the little tumor if I am doing chemo. What I hope happens is that in 3 months, the big tumor will have shrunk and the new nodule will show no change. I really doubt that they will advise me to do chemo at this time until it is clear what the big tumor is up to and/or I am done with the pneumonia. After the 17th, I will know for sure what happens next. Stupid cancer. Don Quote Link to comment Share on other sites More sharing options...
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