This past week I had my routine CT of chest, abdomen & pelvis, chest x-ray, and bone scan. After some new disturbing symptoms developed a couple of weeks ago, an MRI of the pelvis and lumbar spine were also ordered. Yesterday I saw Dr. Coscio and received the results.
I had been feeling generally good, albeit with low energy levels, considering being on chemo for over a year. However, a couple of weeks ago, I noticed a pronounced weakness in my right leg. It was difficult for me to lift my leg (flex at the hip,) as if my leg was unusually heavy. A few times in one day, my leg "gave out" while walking. It was difficult for me to go up steps. Or down steps. I also had pain that encompassed what felt like my entire pelvis on the right side. I knew that something wasn't right.
In retrospect, this had been coming on for at least a couple of months. I noticed that I was having trouble getting up and out of the bathtub. Or up from the toilet. Ever being down on myself for some reason or another, I had decided that my lack of exercise was resulting in decreased muscle tone and loss of muscle tissue. I needed to start exercising! And so I did. I went for a neighborhood walk with Christa. One brisk walk, and I even threw in some short intervals of very light jogging. I don't remember the duration of time between this walk and the onset of my new symptoms. Maybe a week or two?
Regardless of the timing, the new symptoms presented themselves and caused me to immediately panic. And do some internet research! I diagnosed myself with femoral neuropathy. I knew that Abraxane caused neuropathy, but usually in the hands and feet. Perhaps being on it for so long it could cause other neuropathies as well? Or perhaps I was having some sort of mechanical compression of the nerve, causing my leg weakness and pelvic pain? I notified Dr. Coscio, and she added the MRI's to my test schedule.
For the past several scans, things have been relatively stable. Slight growth here and there, but not significant enough to warrant discontinuing Abraxane. Most areas, including the widespread bone metastases, were relatively stable. Tumor markers creeping upward, yet still within normal limits. But my hair was growing back and that coupled with my new symptoms really ramped up my anxiety levels of this round of tests/scans. I'm always anxious around test time, but this time I was really worried.
I've been with Dr. Coscio since I first started Abraxane in 2012. She has never had to be the bearer of bad cancer news to me. Until yesterday! The reports she described and the "films" she showed us (computer images of the tumors, etc) were similar to the devastating ones we received when I was first diagnosed with stage IV cancer in 2006. The details are different, but the widespread nature of the cancer growth (and my feelings of doom) are not.
For starters, my CA15-3 tumor markers are now up to 22.6. A graph illustrates its slow but steady climb in the past year from 11 point something to where it is now. The CT of the chest shows significant growth of several lung nodules, and also a small pleural effusion. The CT of the abdomen and pelvis shows significant growth of several metastatic lesions on the liver. MRI of the pelvis shows "diffuse widespread bony metastasis of the bony pelvis and bilateral proximal femurs." And here's the kicker... The MRI of the lumbar spine shows "penetration of the metastatic process through the inferior dorsal aspect of the L3 vertebral body, creating an epidural tumor extension... with neural foraminal encroachment on the right." This means that tumor is creeping out of the spinal vertebra and into the epidural space of the spine, hence causing disruption/compression of the nerves exiting at the L3 level -- the very nerves responsible for the hip flexor muscles and other leg functions. *A sinister explanation of my symptoms* Additionally, the report's impression reads "Progressive metastatic disease in bone marrow throughout the region imaged including the lumbar spine, sacrum and both visualized innominate bones." And there's more, but really there is no need to go on.
So, here's what the plan is. Starting Monday, I will receive 10 days of radiation to my lumbar spine and sacro-iliac areas. Dr. Coscio is discontinuing the Abraxane -- this is obviously no longer working. Instead of Zometa, I will begin Xgeva for the bone mets. Clearly the Zometa has also stopped working! There are two clinical trials involving combination chemotherapy and hormone therapy that she thinks may be a good fit for me. If there is an opening in either of those, I will join in. If not, I will switch to Erebulin, a chemotherapy agent similar to Abraxane. I should know sometime this week which direction we will go.
It's been a heck of a week! I am tired, so will stop for now.