December 8, 2006 - A Two-Year Window

This afternoon I drive over to Dr. Lerner’s office for a consultation. This is the first time Claire hasn’t accompanied me for one of these. We already know, from last Friday’s phone call, that there was nothing remarkable about my CT scan, so we expect the consultation to be rather perfunctory.

It is. Port flush... uneventful. Blood work... normal. Examination... a quick once-over, with the doctor feeling my neck, armpits and groin for lumps, then a quick listen to my heartbeat and breathing, through the stethoscope.

Then, we get down to business. Dr. Lerner opens my file, reads through the radiologist’s report, and examines a miniature version of my CT scan pictures. Everything looks good, he tells me. There’s no change in the appearance of the scar tissue, what remains of the abdominal mass.

He’d like to see me in another three months – this time, after another PET scan as well as a CT scan. I ask him how long he thinks it will be before we can begin spacing these tests out, at longer intervals. He says he’d like to keep the three-month testing interval in place until at least two years have elapsed.

Dr. Lerner reminds me that I was diagnosed with two different kinds of cancer cells: indolent and aggressive. With the aggressive cells, he explains, there is a two-year window, during which a high degree of vigilance is necessary. After two years, the chance of recurrence drops off significantly. As for the indolent cells, there will probably never be a time when we can completely let our guard down. Indolent lymphomas can persist below the radar for many years, before coming back.

Should that happen, he reminds me – should I discover a lump in the neck or armpit, for example, and a biopsy reveals it to be indolent lymphoma cells – the strategy could be simply to watch and wait for a while. Indolent lymphomas can be so slow-moving that “no action” is sometimes the best action. If an immediate response is called for, there would very likely be new treatments to choose from. The field of lymphoma treatment is changing so fast, Dr. Lerner points out, that even two years from now the treatment protocols could be completely different.

I ask him how long he’s planning to keep the implanted port in. As long as it’s not giving me any problem, he says, he’d like to leave it in “a while longer.”

Hmmm... the ravenous beasts may have been driven off, for now, but it seems my wilderness guide is still keeping the shotgun loaded.

So, I’m in a two-year window. Every three months – once each season – I’ll submit to one sort of scan or another. I’ll of course be hoping the results continue to be as unexciting as they are today.

“Stable is good,” the nurse said to me, as she took my temperature and blood pressure, before the doctor came in. Indeed it is.