Phase II

Today was a big day that brought some good news, and some challenges yet ahead. I met with my oncologist today to review the CT scan and discuss what is next. He had a preliminary report from the CT scan that showed a 50-70% reduction in the size of all tumors! That is great news, and according to him, an excellent response to the chemo. To refresh your memory, I had several extremely large masses in my abdomen and chest, as well as smaller masses in my lungs. One of the smaller masses in my abdomen is gone. The other large masses in my abdomen and chest have shrunk significantly. Obviously I was hoping he would tell me that everything was gone, but realistically this was the type of progress I expected and hoped for.

When I started the large masses were measuring 8 and 9 cm in length and 4-6 cm in diameter. These were huge masses. I don't have the final report from the CT scan yet, but their dimensions are now in the 1.5 to 4.0 cm range. One of the masses in my lungs was down to 4 mm in size. It was always expected that there would be remnants of the tumors when I finished the chemo, and this is excellent progress.

So the question is now what do we do with the remaining masses. Conventional treatment for this cancer has been to remove all signs of disease, meaning surgery to remove all tumors. What my doctor has suggested at this point is to send me to Indiana University to see Dr. Einhorn for a second opinion. Dr. Einhorn is one of the premier oncologist for testicular cancer. He created the treatment that I just completed, and he is the doctor that treated Lance Armstrong. Lance flew from Texas to Indiana for all of his treatments. My oncologist has been in touch with Dr. Einhorn via email regarding my case from the beginning, but he wants me to see him regarding whether to proceed with surgery to remove all of the remaining tumors.

There are two things that concern my oncologist at this point, that he feels warrant the trip to Indiana. The first is the fact that my HCG levels are still elevated. I had blood drawn today to check my HCG levels, but at the start of the fourth round of chemo they were still 932. Normal levels are 0-5. I started out with levels at >200,000. This number quickly dropped in the first two rounds of chemo, but then seemed to level off in the third round. There are two things that could explain this. I have not had the primary tumor site removed yet, and that could be releasing HCG. I will have that surgery on February 5. My oncologist also received an email from Dr. Einhorn earlier in my treatment, directing him to a study that showed that patients with my cancer sometimes have elevated HCG levels even after the cancer is gone. The tumor marker may never return to normal levels even with successful treatment. So we do not know if the elevated HCG is significant or not. We will know my latest levels on Monday or Tuesday.

The other question is whether or not to surgically remove all of the sites. The standard has been to remove all signs of disease, but recently at Indiana they have chosen to leave some tumors and watch them for changes. This is a change from the standard, but the standard was created by this group in Indiana, and they at the forefront of treatment for testicular cancer. So I will be heading down there to get their opinion on what I should do next. The surgeon that performed my biopsy at St. Joe's saw my CT scan on Thursday, and said she could remove the remaining masses for me, but also said she knew the surgeons at Indiana and agreed a second opinion was appropriate. I am thankful to have excellent, capable doctors taking care of me, but that they are also open to enlisting the expertise of others. Particularly when the others are some of the best in the field. I have had excellent care thus far, and are very thankful for my doctors.

The bottom line is that my treatment has gone very well. I have had an excellent response to the chemo, leading to significant reduction of the tumors. I feel very good, and my oncologist told me today that I have tolerated this very aggressive treatment better than any other patient he has seen. I will have surgery on February 5, and likely will head to Indiana after that surgery to determine what to do about the metastatic tumors in my abdomen, chest, and lungs. I also can expect my white blood cells to rebound to normal levels in the next 7 days, which means I can come out of quarantine!! So next weekend I can rejoin society. I have not been cleared to work yet, but I don't have to be afraid of crowds anymore.

I have made great progress, but we are not done yet. As I sat there after meeting with the oncologist, waiting to have my blood drawn, I felt the same rush of adrenaline that I felt when this all started. It occurred to me that it was the fight-or-flight response found throughout nature, and I choose to fight. I feel much better than I did when we started treatment, we have made significant progress, yet there are still some questions to be answered. It is time again to seek answers, decide on a course of action, and then finish this thing off. It is Matt 4 and Cancer 0, and I am still going for the shutout.