The Waiting Game

After the shoulder surgery scare, I have had two more consultations on my cancer (both planned before the shoulder surgery).  I met with Dr. Charles Nutting in Denver about the Sir-Spheres treatment.  Dr. Nutting has been doing this treatment for about 7 years and currently does about 100 treatments per year.

Sir-Spheres is officially approved for metestatic colo-rectal cancer which is not what I have but the treatment is frequently applied to carcinoid cancer and insurance has not normally been an issue.  Your liver receives about 90% of it's blood supply from the portal vein that flows from the intestine while the tumors receive about 90% of their blood supply from the hepatic artery.  Sir-Spheres are injected through the hepatic artery and then get lodged in the tissue fed by this artery which just so happens to be the tumors we want to kill!

Sir-Spheres contain Ytttrium-90 which has a half life of about 2.5 days.  This means that, within about a week, the radiation has reduced by a factor of 8.  Dr. Nutting says that the amount of radiation emitting from the body of someone treated with Sir-Spheres is similar to that of a high altitude flight (so, not too much).  That said, it is recommended that you keep your distance from young children, pregnant women, and sleep in a bed by yourself for about 3 days.

The primary side-affect experienced from the treatment is flu like symptoms (fever, nausea, and fatigue) that show up a few days after the treatment.  Normally Dr. Nutting performs an initial injection of a tracer to identify your personal physiology a couple of days before the actual procedure as everyone's actual artery makeup varies.  There is also the possibility that treatment is not an option if your plumbing does not direct the majority of the radiation into the liver (the lungs are the next stop after the liver) but that is an uncommon situation.

My second consultation was with Dr. O'Dorisio at the University of Iowa to get his opinion on when we should begin treatment.  His radiologist looked at my scans and concurred that my liver burden was increasing but his opinion was that I only had about 10-15% of my liver consumed by the tumors.  This means it is probably a bit early to treat as Dr. O'Dorisio generally waits until 30% or more of the liver is consumed.

I can hear you asking already, what do you mean, too early???  Well, there are only a limited number of times that you can receive Sir-Spheres before it is either no longer effective or you have received too much radiation to be safe.  Because of this, you don't want to waste any of your ammunition by attacking when it is too early.  This treatment only prolongs life and will not eradicate the cancer so waiting a longer amount of time increases the total amount of life I will receive from all the treatments.

So what then do we do now?  First we are going to get the symptoms of my cancer under control for now and then we will delay treatment until the liver becomes more consumed.  In January, I make my annual trip out to Iowa to meet with Dr. O'Dorisio and we will get a Doppler ultrasound to reassess the tumor burden at that point.  I don't expect to have hit the magic 30% point by that appointment but do hope to have my diarrhea and flushing under control.

So, when do we treat?  About 9 months ago, a Doppler ultrasound put my tumor burden at less than 10%.  I have a personal guess that I will be at or at least close to the magic 30% point in about a year. 

The great thing about my cancer is I get the option of waiting which is not an option for so many other cancers.  Of course, the bad thing about my cancer is the continual image of the sword of Damocles, suspended over my head, hanging by a single hair and threatening to fall at any time.   I will enjoy my time.  Everyone is dying from something.  I just happen to have the fortune of seeing one of the threats bearing down on me!