Wednesday, June 10, 2009

Those fiendish cells

The protein called carcinoembryonic antigen (CEA) speaks volumes about my battles with cancer. I wrote about it twice before:

Today I have an update tracking the concentration of that protein in my body over the past five years.

When chemotherapy stopped holding down the cancer in late 2008, I traveled to Baltimore for a heroic surgery to remove the two big tumors and apply heated chemotherapy drugs to kill any stray cells. My surgeon was pleased that he was able to remove the tumors without too much destruction, but there was one area at the back of my pelvis where he worried that some cancer cells might still be hiding.

So our plan was to let me recover from surgery and then follow up with chemotherapy or radiation to clear out that trouble area. The big drop in CEA in January 2009 shows that the surgery was effective in reducing the tumor load and a CT scan in February looked good (for a person who has been reassembled a couple times already).

In the following months my CEA climbed back up to the limits of normal (5 nanograms per milliliter), solidly abnormal (over 10 ng/mL), and now stratospheric (633 ng/mL). Scans in May showed a tumor at the back of my pelvis eroding my tailbone and another sitting on the pubic bone in front of my bladder.

I've spent the last few weeks scurrying to figure out the current situation and choose the best plan of attack. The leading contender right now is radiation, first to the tailbone and then to the pubic bone. I'm hoping that those areas are the only ones with cancer and that the radiation will be at least as effective as it was on my pelvic mass in 2007.

There are other options to consider too: Taking the chemotherapy drug Xeloda during radiation to increase its effectiveness. Trying another chemotherapy drug like Vectibix (which is related to the drug Erbitux which brought me much suffering and little benefit). Or entering a clinical trial to try re-engineering my immune system to attack the CEA-laced cancer cells.

The rapid rise in CEA and the sudden worsening of pain is spurring me to move quickly. I was looking forward to summer travel, more time with family, and gainful employment; but those plans are postponed now. The next stage of treatment – six weeks of radiation – is scheduled to start in five days.


Rick Wagner said...

I used a logarithmic scale for the CEA so that changes are measured relative to the current value. A rise from 3 to 5 is more important than a rise from 93 to 95, and this scale puts those changes in proportion.

This means that during the periods when my CEA goes up or down linearly on this graph it is actually undergoing exponential growth or decay. Exponential growth looks like (1, 2, 4, 8, 16, 32, 64) rather than (1, 2, 3, 4, 5, 6, 7).

The linear portion for 2009 corresponds to a doubling time of 3 weeks. That means the amount of new CEA added every 3 weeks is equal to all the CEA added over all time (back to the last minimum).

That's why cancer growth is scary. A week left unchecked now is far worse than a week left unchecked three months ago. In fact, it can be expected to grow eight times faster now.

I need treatment soon. It's been frustrating trying to get it started, since there are so many tests, preparations, and discussions that have had to happen first. I'm not sure that the doctors and their staffs appreciate how important swift action is once a problem has been identified. Every day of delay is another day of extraordinary pain, unchecked cancer growth, and a day (or more) taken away from my allotment of good days after treatment.

Mads Andreas Elvheim said...

Best of luck to you sir.
From a fellow slashdotter.