Post Chemo: Probe and Scan Results

Less than twelve hours after being disconnected from my chemo grenade, it was time for my wife to haul my fatigued and poisoned ass back to the university. I had 6 hours of back to back appointments for CT’s, MRI’s, and a radiation therapy planning and simulation session. To put things into context, I usually spend my post-chemo Monday’s lying around doing as little as possible, since I’m often exhausted. So, the thought of walking through a large hospital was hard to wrap my bald head around. On the other hand, I was extremely anxious to see what the results showed, so I plugged on.

The first appointment of the day was with my radiation oncologist. After checking in, my wife and I expressed some concerns with the radiation nurse regarding timing. Why were we scheduled to do the radiation planning session before we had even seen the CT and MRI scans after completing chemo? The nurse said she would let the doctor know, and someone would be in to talk with us shortly. As we waited, I noticed that in my chemo-brained, anxiety-filled rush to get out of the house, I had forgotten to trade in my slippers for shoes, stylish.

We spoke with the radiation oncologist’s resident regarding our concerns. As far as timing goes, almost all protocols for rectal cancer involve some sort of radiation + oral chemotherapy regiment. So, the timing was appropriate. Then we had a bunch of questions regarding radiation side effects.  

In previous discussions with other doctors, we had heard that weeks four and five of radiation can be extremely grueling, sometimes involving uncontrolled diarrhea. The resident assured us that in almost all cases, diarrhea is well controlled by medications. There are actually three tiers of anti-diarrheal drugs starting with Immodium ranging all the way up to some heavy hitters. That made me feel more comfortable because we were initially thinking that we’d need to stay really close to the hospital. However, the resident assured us that many patients drive themselves each day without any issues. 

Then we moved on to some quality of life questions ranging from, will it break my manly bits to longer-term loss of bowel control. It turns out that I’m going to receive a much lower second-hand dosage to my manly bits than those undergoing prostate cancer treatment. Often times, men undergoing treatments for prostate cancer have no masculine issues, so that’s good to hear. Bowel control should also not be an issue since they will be treating an area above where the major muscle structures reside. However, like all medical procedures, there is always a risk.

After all our questions were answered, we met with the radiation oncologist to walk through the treatment plan. I will be undergoing 28 days worth of radiation therapy plus oral chemotherapy M-F with weekends off. So in total, we are looking at 5.5 weeks of treatment. That’s a whole lotta driving, I better find a few good podcasts for the truck. After ironing out the details, it was time for the radiation simulation and planning session.

The planning/simulations session was interesting, to say the least. The ordeal began with me gowning up so they could get a clear view of the target area, a.k.a my ass. I’ve grown accustomed to random medical people poking and prodding in that region, so that wasn’t a problem. Then they hit me with a curveball I wasn’t expecting; they needed to affix a small metal BB to my asshole. Yep, you read that right, they needed a “reference point” on their imaging, and a metallic BB lights up like a lighthouse on the images. So, there I was the table one leg up in the air while they affixed their “reference point” to my “exit point.” So as you can imagine, I immediately bonded with my simulation technicians.  

After our bonding moment, they got me positioned correctly using several laser beams in the room. Once I was lying the exact way they wanted me, they created a foam casting of my feet and legs. The cast will keep me in place during future radiation sessions. Then they busted out their tattoo gear to mark where the lasers should line up each time. I got a tattoo on each hip and what I’ll call the <ahem> centerline, which was a bit close for comfort if you get my drift. In case you’re wondering, they don’t have a fancy tattoo gun, they place a drop of ink on the skin and pierce it with a pin.  

Since we already bonded over a BB, the med student assured me the tattoos would get me into biker bars, and I needed to wield that power carefully. Never wasting an excellent opportunity to crack a joke, I told him I tried with my first tattoo (internal to mark the tumor) but kept getting kicked out. It took the med student a few moments, but once it dawned on him, I got the chuckle I wanted.

Sufficiently tattooed, it was time to do the scans to help them plan future radiation sessions. This only took about 10 minutes of me laying still while they ran me in and out of the CT scanner a few times. Then they came in and did a few measurements to aid in the planning process.  

Finally, it was the moment I was dreading since my BB bonding experience, the removal. You see, the BB was affixed to a sticky pad similar to the ones they use for an EKG. If you’ve ever had one of those suckers ripped off, you know how they grab ahold. Now imagine one of those stuck to Sasquatche’s asshole. The technician grabbed hold of the fur-BB-gone patch and yanked. I’m not sure if its a gift or a curse, but I generally think of something rather quickly when inflicted by pain, and I have no filter. So before I could stop words from coming out of my mouth, I uttered: “Sweet Jesus, do you charge extra for that service?” That got the whole room to chuckle; finally, I cracked the hard exterior of the battle-hardened radiation techs. Mission accomplished!

Then I was off to get CT scans. These were pretty straight forward, and very similar to the ones I had right after diagnosis and mid-way scans. After getting positioned, they took a series of images, then they hit me with the menopause inducing contrast for another round of pictures. After a short 20 minutes, I was off to see the folks in the MRI suite.

One of the benefits of going to a large university medical center is the state of the art imaging equipment. This was my first Tesla-3 MRI, which has an incredible resolution rate, meaning the doctors can see way more detail than the previous Tesla-1 machines. Similar to my earlier MRI experiences, they got me into position and gave me some headphones to block out the noise. Once the scans started, I immediately noticed that either the machine was quieter or the headphones did a better job of blocking out the noise. Nonetheless, the dub-step was still very much audible. I did notice how much more powerful the vibrations felt in my body. At some points during the scan, I swear I could actually feel my internal organs moving around a bit.

About halfway through the MRI, a nurse came in to give me a medication called Glucagon. This drug temporarily inhibits movement of the gastrointestinal (GI) tract, which allowed them to get more precise images. The nurse warned me that it may cause nausea, and she wasn’t lying. Two minutes after the medication was into my system, I felt incredibly nauseous, but I was able to control it with some deep breathing. I’m glad I was able to control it, vomiting inside an MRI machine would be quite awful. After another series of images, they injected contract and took a final set, and then we were finished.  

As my wife and I walked back to our car after about 6 hours of testing, I was utterly exhausted. I usually spend my post-chemo Monday’s relaxing, not running around a large hospital, getting BB’s stuck to my nether region.

Then we waited, I had another doctor’s appointed scheduled three days after the scans, but as you can imagine, the wait was the worst part. Luckily, the following day, I got a message on my electronic medical records saying that I had a new test result. I scrambled to log in to review the results. 

The MRI results showed “there has been a positive response to treatment with a corresponding tumor regression grade of mrTG-1. No appreciable residual tumor. Grossly stable small perirectal lymph nodes. Attention on follow-up.”  

In English, the tumor regression grade is the best one possible, meaning they cannot find evidence of tumor on the MRI scan. The lymph nodes are the same as they have been on all previous scans. Even though I’m not a doctor, I knew this was excellent news, so I jumped on the phone to tell Elaine. Needless to say, we were excited but remained cautious until we chatted with the doctors. 

The next day I got another message indicating the CT results were ready to view. Again, I logged on quickly and got the same story. No appreciable tumor was visible on the scans. They found a few other anomalies on the scans, but as the radiology report stated, these were common findings in most people, so, all in all, it was great news. 

Finally, the day arrived to talk to the oncologist. Immediately upon entering the room, she let us know the scans looked fantastic. This was the best possible outcome we could get with no apparent tumor on the scans and the best possible regression score. She said that we would get even more information after seeing the results of the flexible sigmoidoscopy, which was scheduled a few days out. We left that appointment feeling very good about the progress we had made.  

After a few days, it was time to head in for round two of a fully conscious encounter with the flexible sigmoidoscope. This time was more exciting since we wanted to see how things were looking, vs. gauging the size of the little monster trying to kill me. After a quick enema prep, it was time for the main event. Learning from the previous splash zone incident, my wife secured a chair as far away from the action as possible. After the scope was inserted, they quickly located the tattoo that was adjacent to the tumor area, and that’s about it. After exploring the area, they needed to round the bend to see if anything showed up there.

When they turn a corner with a camera inside you, it is a slightly uncomfortable experience. I imagine it being somewhere in the ballpark of nasty stomach cramps, possibly mixed with a baby kicking. After some finagling and some uncomfortable flopping by me, they got around the corner to see nothing but a healthy colon. As they eased the camera toward the exit, they took time to explore every nook and cranny to look for evidence of a tumor.  They couldn’t find anything except a small patch of scar tissue where the little ass goblin had once been.  

If you are curious, I posted buttons to the before and after images below. Viewer discretion is advised, but they are medical images, so there is nothing obscenely graphic. They are genuinely miraculous images, I couldn’t have imagined 8 rounds of poison could shrink something that nasty into nothing. For some context the grey/black areas in the photos are the tattoo to help identify the location of the tumor. The “string” in the post-treatment photos is lubricant (thank god for that).

After talking to the doctors and meeting with my oncologist a few days after the scope, we finally have the next phase of the treatment plan figured out. I will be undergoing 28 cycles of oral chemotherapy drugs paired with daily doses of radiation M-F. After these cycles are completed, I will have 6-8 weeks of recovery followed by another series of CT and MRI scans and another flexible sigmoidoscopy. If the scans look the same (or even better) than the previous images, I will qualify for “wait and watch.” This means many re-scans and scopes, but no need for surgery since everything responded so well. This is a relatively new approach, but it is becoming more of the norm for patients who respond so well to treatment. This is truly the best-case scenario for someone with stage 3B rectal cancer!  

After some very encouraging news, it’s on to the next, and hopefully final leg of the journey, oral chemo + radiation.