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Radiology report:

My previous scan showed the presence of 2 lymph nodes, pleural effusion and thyroid nodules.

The current scan describes previous findings as stable with the exception of one lymph nodes that increased slightly in size. It also describes the pleural effusion as small. Best of all no new sites of disease are identified.

Oncologist findings:

Patient has enjoyed an excellent response since beginning of treatment. Slight improvement in right pleural fluid and thickening. - Continue with maintenance therapy every 3 weeks and restage in 9 weeks.

I am scheduled for thyroid biopsy next week. My TSH level went from 0.034 to 0.56 and turned from red to normal. I stopped taking my one day vitamin because it contained iodine and also discontinued iodine salt.

My take:

I asked my oncologist if he can confirm or deny the presence of cancer in my lung. His response was the only way he can is by performing a biopsy. Since the areas of concern like scar tissue, nodes and pleural effusion are too small and scattered the only way to do a biopsy is via an open lung surgery which is not practical. I also do  not qualify for any type of radiation because there is no concentration area to radiate. He attributed the the size increase of one nodule to inflammation  due to Keytruda.        So thus we continue with the current plan because it is working. I also asked him if I could be declared N.E.D one day and his answer was certainly yes.

I am thrilled and hopeful with working, stable and no progression especially since my treatment side effects are manageable. 

 

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Gary,

I am thrilled with you! Indeed, immunotherapy has a tendency to demonstrate "pseudo metastatic behavior", swelling or expanding on a scan as a result of inflammation from the Keytruda assault. I do hope that is what is showing on your scan. Your 4 words: working, stable and no progression are elegant descriptors and worthy of celebration!

Stay the course.

Tom

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Good news Gary!!!  So glad to hear it.  I have no experience with chemo, but Tom seems to have a good grasp so the enlarged gland could well be a reaction to the Keytruda...  I'm learning that stable is a good place to be.

Lou

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Tom: Thank you for the interesting remark on immunotherapy. It led me to do more research on the subject and I found this: 

It is now thought that the immunologic response can affect cells surrounding a tumor, creating benign lesions that mimic cancer cells on a CT or PET scan. In some cases, a biopsy may reveal that the tumor has completely disappeared and that all that is left are the residual lesion.

Pseudo progression most often occurs with lymph nodes but may also affect the kidneys, liver, lungs, adrenal gland, and chest and abdominal walls.

What I learned from my last scan are two things:

1-) Pseudo progression due to immunotherapy that may even affect other organs.

2-) The difficulty of making the call on N.E.D due to the unfeasibly of biopsy. 

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