Take a look inside
About a week after that post, I had my first CAT Scan to look for possible spread of tumors to other parts of the body. It's kind of an interesting experience if you've never done anything like it before.
First, you spend an hour before your appointment drinking this white, milky barium contrast drink. It's not something I'd consume for fun, but it is tolerable. Kind of like an a diluted, unsweetened milk shake.
Once you get in the room, you lay down on this movable table that's positioned to go through the large tube in the scanner. The scanner's only a foot or two deep, so there's no real problem even if you're a little claustrophobic.
Over an intercom from the next room, the technician tells you to hold your breath; then the table moves you through the scanner and back, all in about 10-15 seconds. Then you breathe again. This repeats a few times for several different scans.
In my case, I also had to get iodine contrast injected for some of the scans. As soon as the technician starts the IV, you suddenly feel a strong heating sensation around your neck and in the groin. Very strange feeling. This lasts about 25-30 seconds as they do the next couple of scans.
After that, you're done. The radiologist looks over the scans for any problems and sends the report to your doctor in a few days.
The good news
After my first CAT scan, the results showed no evidence of any cancer remaining in my body. It was confirmed that the tumor was Stage I Seminoma, just about the best type of cancer to have. Success rates are overwhelmingly high, and my urologist said I probably have an 85% chance that I won't need any further treatment. But there was a huge decision to be made.
The big game
At this stage, every testicular cancer patient must make a big decision: go through radiation treatment to kill any possible microscopic cancer cells that may still be there, or simply watch and wait. With the radiation therapy, your chances of relapse go from 15-20% down to 3-4%. Most patients opt to do this, even if there's an 80% chance that they don't need it.
Should I reduce my chances of relapse by going for radiation, or should I take my chances and hope I'll never need it?
This was a very difficult question. I like the idea of reducing the chance of relapse as much as absolutely possible. And judging by the fact that the majority of patients opt for this treatment, so do most other people. But I was also concerned about the side effects of radiation therapy.
The near term side effects I can deal with if necessary. Nausea, skin rashes, and other potential side effects are temporary and livable. But what about long term side effects? And what if I don't even really need the treatment?
Most cancers strike towards the end of life. If your choice is between maybe succumbing to cancer at age 65 or possible side effects at age 95 (if you're so lucky to make it that long), the choice is easy. But in my case, I certainly plan to be alive and kicking in 30 years, at age 62. I don't want a potentially unnecessary treatment causing me problems in 20-30 years from now.
The thing about cancer treatment is that it's poison. Whether you get radiation or chemotherapy, you're poisoning your body, knowing that the fast-growing cancer cells will be the first to die. As soon as they die, you cut off the poison and hope it didn't ravage the rest of your body too badly. People recover from this process, but there can be lasting effects, manifesting decades later. In the case of radiation therapy, this can include increased risk of secondary cancers and heart disease, among other complications.
Playing the odds
So it comes down to the percentages. What are the chances of relapse and subsequently unsuccessful treatment versus long term effects in a few decades? I spent a few weeks researching this, combing through dozens of medical journal articles I found. It was actually kind of fun, and made me feel smart again, like when I had to research journal articles in college.
Numerous studies have been done over the years, applying all sorts of statistical analyses to the available data on patients over the last few decades, their treatment choices, and ultimate outcomes. Unfortunately you can't just take statistics from patients who were treated 20 years ago and apply them to your situation now. Treatment methods have changed, hopefully improving, but we won't have long term data on today's treatments until decades from now. In short, it's impossible to know for sure.
Still, I collected the numbers from numerous studies until I felt like I had a good handle on the problem myself. And it was about time for me to make my decision. Either start radiation therapy or begin scanning for relapsed cancer every 2-3 months.
Placing the bet
I chose surveillance. I felt uncomfortable enough the increased odds of long term complications from radiation that I decided not to risk poisoning myself for possibly no reason. I'm pretty comfortable with the 85% chance that I'll need no further treatment, especially given the fact that treating relapse is still well over 95% effective. If it happens, it'll require chemotherapy, but I'll get through it. At that point, the poison is necessary to save your life in the near term, so you have to do it. I'll cross that bridge if I get there, but hopefully I won't.
I realized that I'd feel really horrible if I got a secondary cancer in 20-30 years because of the radiation, cutting my life short. Especially given the fact that at that point, I wouldn't even know if I really needed the radiation to begin with! Either it would have worked and we'd never know, or there wasn't anything there to begin with. Now I know I'll never be in that situation, and I'm happy about that.
So far, so good
I had my second CAT scan the other week. This time I got to keep the CDROM with the images on it. Pretty cool stuff. The machine basically does x-rays of various slices through your body, both horizontally and vertically. From just a couple of images, I can identify several major organs, including: lungs, heart, stomach, pancreas, liver, intestines, bladder, kidneys, bone structures, and more.
Click on either image to see an animation of of the slices through that axis:
(1.4 MB)
(3.2 MB)
Neat stuff. This scan came back clean, so now I'm two for two. Next scan in June.
New problem!
Are you still reading this? Well, tomorrow I go back under the knife for more surgery. What, you say? Didn't I just get a clean bill of health from the CAT scan? Well, yeah. It turns out I had a completely unrelated problem come up after recovering from January's surgery, and this one requires another operation. Rather than bore you any more, I'll tell you all about it in a few days as I recover from that.
This surgery thing is starting to become old hat!