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| 25 years ago, at about this time of year, while anxious over finishing my Ph.D, I found out that I had cancer, and I made an appointment to see the cancer specialists at Dana Farber Cancer Institute. This edition discusses staging of the cancer. |
| Once a person has been diagnosed with cancer, before treatment the cancer must be fully staged. Cancer is general staged and ranked by a number I through IV. The meanings of these stages are: |
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I - Cancer is localized. II - Cancer is localized, but has spread locally III - Cancer is localized, but spreading is more extensive than stage II IV - Cancer has spread to other parts of the body |
| The lower the number, the better the prognosis. The severity of the stages varies by cancer. For certain lymphomas and testicular cancer, even Stage IV can be cured with chemotherapy. For organ cancers such as pancreatic or lung cancer Stage IV usually has a poor prognosis. Each cancer has its own effects on the body so cancer staging is specific to each cancer. |
| For Non Hodgkin's lymphomas, here is a standard set of tests that are used to stage evaluate the cancer. I had most of the standard tests, and there are a few additional test to the ones I will describe that are optional. |
| Before I describe the tests, I will describe another preliminary procedure that I had to undergo in preparation for chemotherapy. Because, one of the drugs in my protocol was toxic to sex cells, I had to bank some of my sperm. I want to keep these documents family friendly, so I won't say to much about it. There are some great jokes and observations of the situation that are pretty funny, but too off color. I will describe one thing. Before I went to the sperm bank, I had to call them up to get instructions. I called and a nice lady explained to me in clinical detail the "procedure" that I had to go through in a neutral voice like a bored waitress describing the specials at a restaurant. It was a surreal phone call. Nevertheless, I am happy for this form of insurance. If I ever meet the right girl, there is one half of a baby waiting in vials at the bottom of a container of liquid nitrogen in a suburb of Boston. |
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The tests that are generally standard for Non Hodgkin's lyphoma are: Biopsy Blood work Bone Marrow biopsy Chest X-ray CAT scan Gallium Imaging |
| I had these test on different days, but I will describe them together. I will describe how each test works, what the physicians are looking for, and the outcome in my case. |
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Biopsy -- The initail tumor had been examined by the pathologist at Dana-Farber. The exact cancer type was determined. Initial examination of me during my physical detected no additional tumors of lymph irregularities, so I had no extra biopsies at this time. |
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Blood work -- Blood work looks at all the components of blood to see overall health. There are specific things that are looked for for lymphomas because lymphomas are cancers of the circulatory system. A elevation of white cells of a diminution of any of the main blood cells: red cell, white cells, or platelets are often seen in lymphomas. The health of the liver or kidneys where the cancer may have spread are reflected in certain enzymes or small molecules in the blood. All my blood work was normal. |
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Bone Marrow biopsy-- We tend to think of our bones as hard structural elements that are static, but bones are actually factories, and in our marrow the cells for the blood and lymph system are made . The cancer may have originated there or it may have spread to there. A sample of marrow is extracted to check for abnormalities. It is not easy to get bone marrow out of the body. It is in the middle of the bone. The most convenient place doctors use is the rear of the hip bone. A sample of bone tissue is also required. The procedure uses a narrow hollow metal tube that is ground into the hip bone to take a sample of the bone and marrow. It is similar to devices that are used to take core samples from the ground. Local anesthetic is applied, but it is impossible to get the drug into the bone. In other words ripping a piece of bone out in going to hurt. I had learned how to concentrate through lifting weights in college. I focused on a spot on the wall and started deep breathing. I told the doctor to go ahead. He jammed the driller into my bone and screwed out a core sample of my bone. ...... or so he thought. As he pulled it out he realized the core was missing. "This has never happened before. You must have strong bones." Thanks for all the milk growing up, Mom. He went in again and successfully removed the marrow and bone sample, on the second go. The marrow and bone was normal. It felt like a horse kicked me for a couple of days. |
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Chest X-ray-- Lymph nodes line the arteries and veins of the chest cavity. Sometimes a simple X-ray can reveal the enlarged denser cancerous tumors. My X-ray was normal. |
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CAT scan-- A CAT scan (Computerized Axial Tomography) uses an X-ray camera that takes circles around the patient. A computer uses the varying density as the camera rotates to produce an image of a slice corresponding to the circle. Slices are taken about every cm or so a set of slices can be assembled to give a 3-D picture of the body. For lymphomas. slices are taken from the neck to the legs. There is no pain involved but one drinks about a quart or Barium Kool-aid as a contrast agent. This leads to near the end of the procedure a looped conversation: Me, "I have got to go" Tech, "Almost done." I barely made it back to the dressing room. Fun fact, in the word tomography the root tom- = cut comes from the same word that begot atom, a- = not + -tom = cut. |
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Gallium Inmaging-- Gallium-67 is a radioactive isotope of element number 31. Gallium 3+ ion is about the same size as iron 3+ ions so the body treats it like iron. The gallium will go to places in the body were there is a large uptake of iron. These are generally where there is infection, inflammation or a rapidly growing tumor which has a high demand for iron. A solution of gallium-67 citrate is injected and a few days later, the patient stands in font of a gamma ray detector and images are taken of the head, neck, torso and limbs. The gallium decays by capturing an electron and a proton is converted to a neutron producing an atom of zinc with release of a gamma ray of energy. The zinc is elliminated or used by the body. The half life of gallium-67 is 78 hours, so the isotope is essentially converted completely to zinc in a few weeks. the equation for the decay is shown below: |
| Gallium-67 + electron --> Zinc-67 + gamma ray |
| This scan was the only one with any irregularities. There was a small darker spot on my temple near the place where the original tumor was removed. What was this? Scar tissue? Regrowth of residual tumor? Signs of healing? An inflammation from the trauma of removing the tumor? An infection? By this point it had been decided that I would be getting chemotherapy, so a biopsy to find out exactly what this was would be unnecessary, but this spot would need to be watched carefully. |
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Overall evaluation: Stage 1B Non Hodgkin's lymphoma. Chemotherapy to remove any residual cancer cells. Prognosis: very good. |
| Stay tuned for more of the story. |
| (Cancer Chronicles is a series of status updates that account the events of 25 years ago when I went through a bout with cancer. Its purposes are multi-fold: catharsis, education, information, celebration, etc. ) |
| This originally was posted to facebook October 23, 2012. |
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