Monday (October 18, 2004) we got the report on the CAT scan Deb had the previous Monday. It all looked good. Dr. Lange proposed stretching out to six months between scans, which we agreed to. Due to the scheduling constraints, we’re actually going longer than that: the next one happens in May, unless we notice any worrisome symptoms between then and now.
I think there's a question that is on a lot of people's minds but is hard to come out and ask: Can we relax now? Have we gotten to the point where these scans are pretty much a formality?
Speaking from the logical part of my brain, the answer is no. Deb is on a drug (Gleevec) that was approved through a fast-track process and has no long-term record. In a large number of cases, the cancer manages to mutate its way around Gleevec eventually. The mean-time-to-failure is something just over a year and a half, which is where we are now.
On the hopeful side, mutations are more likely when you have a large number of cancer cells trying to mutate. A lot of the early Gleevec patients were people with large inoperable tumors that Gleevec shrank but never completely defeated. Deb's tumor, on the other hand, was removed except for trace colonies on the surface of the liver, which the surgeon cauterized but didn't get clean.
However, the tumor he removed was huge and could well have contained some of the Gleevec-resistant cancer cells. (The cancer cells don't need to see Gleevec to mutate around it; the mutation is a totally random event, not a reaction.) Some of those mutated cells could have hung around on the liver, or perhaps metastasized somewhere else entirely. But if it hadn't happened already, the odds of the mutation arising in the few remaining cancer cells are low. And if mutated cells were already present at the time of the surgery, you'd think we'd be starting to see their colonies by now. Colonies that are still too small to see on a CAT scan must not be growing very fast, which is one reason for increasing the time between scans.
But that's all wild speculation. The territory is too uncharted for us to think we understand it that well. There is another drug to try if Gleevec fails, but that's even more uncharted territory: the drug is still experimental and the results so far are hit-and-miss.
OK, that was the logical side of my brain. Emotionally, I am starting to relax a little, whether it makes sense or not. Neither of us got as keyed up this time as we did two or three scans ago. So, if you find yourself not watching Deb's situation as closely as you used to ... that seems to be the natural human reaction.
Those of you who remember Deb's 50th birthday last October may have noted that she turned 51 a couple weeks ago. But your invitation didn't get lost; the party this time was a private affair that we celebrated high over the Atlantic. The next morning we landed in London, where we spent most of the next week wandering around the city and going to the theatre. The No Regrets Tour continues.