It’s Tuesday, 19 days after The News.
I awoke groggily at 8:00 after my alarm clock went off. Yes, my body is ever so slowly fighting off the anti-nocturnal regimen. I’m relieved. My condition is stabilizing. Now I can just worry about the cancer.
(Some of you might wonder why a vampire might set an alarm clock for 8 am knowing he really should be fast asleep. I’m attributing this to mental decline induced by frequent exposure to sun-worshipping medical personnel. It generally resolves on its own after the exposure is removed.)
Abdominal MRI Results
The radiologist must have been up bright and early (clearly someone I don’t want to be around too much.) The abdominal MRI report was posted around 8:15 this morning.
To cut to the chase:
“IMPRESSION: Allowing for technical differences there is no significant interval change in the scattered subcentimeter hepatic lesions that are nonspecific but likely reflect a combination of cysts and/or hemangiomas. Some are poorly visualized on the current examination, not well characterized, probably related to technical differences. Stability can be confirmed on follow-up CT.”
“REPORT: Corresponding to the scattered subcentimenter hepatic hypodensities are several small hepatic cysts some of the foci are not well seen on the current MRI possibly technical. Some have increased T2, decreased T1 signal with no enhancement which is reassuring. No new lesions.
MR images through the spleen, gallbladder, pancreas, kidneys, adrenals are unremarkable.”
The T1 and T2 stuff relates to how the RF pulses that generate the MR images are generated. Most metastases are hypo- to isointense (less intense) on T1 and iso- to hyperintense (more intense) on T2-weighted images. So increased T2 and decreased T1 would be consistent with the lesions not being metastases. This article goes a bit into MRI imaging of liver metastases.
Alas, after spending a relaxing half hour or so in the machine it appears that they got some sub-optimal pictures. At one point the MRI technologist (apparently that’s term for the people who operate the MRIs) mentioned he was seeing some movement in the images and wanted to make sure I was ok and not having any problems holding my breath. No problems on my end – if anything I was overly relaxed. Vampires generally don’t have issues being in confined spaces. Its a genetic thing. Most of those with claustrophobia died off in the medieval ages when sleeping in coffins was all the rage. No one quite knows how the silliness started off, but it was out of fashion by the 19th century. A bed in a room with good blackout blinds is much more comfortable.
But what the radiologist could make out goes further down the cyst/hemangioma route, which is what the surgeon and medical oncologist are thinking. The medical oncologist previously said she wants to order a PET scan to more definitely rule out that they’re metastases. Hopefully that gets approved.
Rectal MRI
This afternoon was the second MRI. The first one was to figure out what those hypodense liver foci that the CT scan found were. Today’s was ordered by the surgeon to focus on the tumor itself.
The MRI technologist who did yesterday’s scan was apparently the individual who was trying to sort out exactly what scan I needed when I called to figure out why the pelvis MRI wasn’t scheduled. The surgeon had originally ordered a pelvis MRI with and without contrast, but after reviewing my chart the MRI folks determined what was really called for was a rectal MRI without contrast. The technologist commented that doctors frequently don’t order the right MRI so the technologists and radiologists always review the orders. Apparently different MRIs are needed depending on its intended use and whether its pre- or post- surgery. All I know is that the surgeon confirmed that the revised order suited his needs.
Today’s scan was a little more pleasant – the technologist said this one used a newer machine than the one I was on yesterday. As a bonus there was music playing in the headphones. Elevator music. The same type they use when you’re on hold and hoping you’ll hang up. Also no breath holds this time
But the newer machine makes equally loud buzzing noises. Just when you’re about to drift off into a nap – BZZZZZZ. And still no VR glasses. Maybe they’ll add it to the next version.
One of the goals of neoadjuvant therapy is to shrink the tumor, so going in I wasn’t entirely certain why the MRI was being done now vs closer to surgery. This scan was ordered by the surgeon so one assumed it has to do with preparing for surgery. Was there value in knowing the tumor’s extent prior to neoadjuvant therapy? But as I found during the consultation, the surgeon is generally knowledgeable of rectal cancer and not just in the surgery aspect. So I suppose I shouldn’t be surprised that he ordered scans that have more meaning than just imaging the tumor for surgery. As it turns out this MRI also provided its own assessment of the tumor staging.
The radiologist’s report was posted within a couple hours and confirmed what was found earlier. If anything it provided a slightly more positive picture:
“1. 3.7 cm mid-rectal tumor, stage T2N0M0 by imaging.”
“2. Borderline-sized right perirectal lymph node measuring 5 mm in short axis which does not meet imaging criteria for a suspicious lymph node. No suspicious lymph nodes meeting imaging criteria.”
Previous staging from the EUS put the tumor at T3 with an overall staging of T3N0M0 (corresponding to “stage IIA” cancer – see this article for more information on colorectcal cancer staging). That the MRI radiologist classed it as a T2 is somewhat positive news – the tumor may be a little smaller and less invasive than previously thought. T2N0M0 corresponds to what is commonly referred to as “stage I” cancer – I’m probably at the borderline of stage I and stage II. The not-quite-suspicious lymph node is something I intend to ask the medical oncologist about.