3/8/25

The last six weeks or so have been such an emotional roller coaster for me, I just didn't want to sit down in front of the computer until I had a concrete update about the suspicious "cavitating left upper lobe mass" in my lungs. The problem is, I still don't have a solid answer on what it is and what to do about it -- even though it has nearly tripled in size since September, when it was first noticed. Here's the background:

In January, a needle biopsy was scrapped at the last minute because the radiologist said the suspect nodule (left upper lobe, or LUL) intended for examination was too close to my shoulder blade, and therefore he could not insert a needle and withdraw a plug without unintended harm. He recommended a bronchoscopy for the next step, which I had on Jan. 30. However, the pulmonologist who performed the procedure was not able to say definitively what the LUL mass is, although she suspected some sort of bacteria and recommended I go back for a second attempt at the needle biopsy. My oncologist concurred.

In early February I contracted a nasty upper respiratory infection that flattened me with a chest-heaving cough. My already low white blood cell count plunged even lower and I could barely move from fatigue. My appetite dropped (I lost 10 pounds) and my oncologist put me on a heavy-duty antibiotic, some codeine cough syrup and prednisone (a steroid).

In the midst of all this, I masked up and went for the biopsy. I had a different radiologist who somehow was able to maneuver around the nuisance shoulder blade and get a good specimen. The resultant tests ruled out bacteria and declared the mass as benign. The written report said "no pneumothorax post left lung biopsy." (Pneumothorax is a collapsed lung). The pulmonologist jubilantly stated in a message to me: "Good news! Your biopsy showed inflammation, no evidence of cancer."

So we know what it isn't ... but not what it is. The pathologist's report made this final diagnosis: "benign, non-necrotizing granulomatous inflammation." An additional comment stated: "the differential diagnosis includes sarcoidosis and various infectious etiologies. The special stains for organisms were negative, but do not completely exclude the possibility of an infectious etiology."

What?!! Talk about adding to the confusion. My oncologist tried to explain that all of this scary language boiled down to some kind of inflammation that "may" have been caused by previous radiation to that LUL area and "should" have dissipated by now. Except it hasn't. She sent me for a CT scan, which came back with the following report: "The cavitary mass in the left upper lobe is slightly larger and more thick-walled than seen previously. This is concerning for neoplasia versus chronic infection/inflammation. I note a benign CT-guided biopsy dated 02/18/2025. Therefore, a granulomatous inflammatory process is the most likely underlying diagnosis. There is additional peripheral scarring versus masslike nodularity seen more anteriorly in the left upper lobe." On top of that, the nodule has now gone from 1.5cm in September to 4.4cm.

None of this is comforting, but I hope it helps put into context why updating has been sketchy. So the next step? The oncologist has referred me to an infectious disease specialist. The appointment is scheduled for March 12, but I certainly don't expect to have a definitive outcome that day. I'll probably be sent for additional tests.

I'm exceedingly glad that my reports continue to say "no new cancer," although my oncologist has dialed back from saying I'm in remission because I'm still in treatment for existing cancer. But I'm very concerned about this LUL mass that keeps growing because I don't want it to endanger my cancer stability. For me, the best case scenario is that it turns out to be something that is easily treatable and eventually goes away.

I'll update when I know something more, even if it's incremental.

1/13/25

Happy New Year!

Can you believe we're 25 years into the 21st century?! That's a quarter of the way through. Couple that with the fact that I was born halfway through the last century (1951) and it really makes me feel like I have been around a long time, crossing several decades of change in this crazy country of ours. But praise God, I have never been so happy to be alive.

Somehow, I managed to skip right on past December in updating this blog, and that's primarily because a lot had not changed with my cancer journey -- until a few days before Christmas. That's when I had a CT scan and discovered that Houston, we have a problem. I certainly didn't want to write about that and put a damper on anyone's holiday (least of all my own), so I waited until now to bring everyone up to date.

At first glance, the radiologist's report for my CT scan on Dec. 20, offered in two sections, was encouraging. "Stable unenhanced CT scan of the abdomen and pelvis. No evidence of active neoplasia." That was the first line of the first section. (Stable, of course, is my favorite word nowadays). Neoplasia is a reference to tumor activity. But the second section of the report, about the thorax (chest area) contained this suspicious sentence: "Cavitating left upper lobe mass, increased in size since the prior examination [in Sept.]." I drew breath and kept reading. The report goes on to say that a pre-existing translucent (cavitating) nodule, that had previously responded well to radiation and was considered stable, had now increased in size from 1.5cm to 2.5cm. What the CT scan doesn't reveal is WHY the nodule increased in size.

That same evening I went home and took a hot, soaking bath with bubbles up to my chin to think and pray. When I stepped out of the tub, I mentioned to hubby that I felt light-headed. I remember thinking I also needed to get something to eat. Seconds later, he was standing over me and asking me my name. Apparently I had fainted, and on the way down I bruised my lip (no skin break but a little swelling) and bumped my forehead (tiny lump, no headache).

I saw my oncologist, Dr. DeRidder, on Christmas Eve. She said the fainting spell might have meant I was overcome by the heat of the bath and a likely drop in blood sugar due to hunger, but if it happened again, she'd send me for a brain MRI. As for the increase in the nodule size, she said it could be due to anything from inflammation (which happened in late 2023 when I had my first bout with Covid) to new cancer. She referred me for a biopsy and braced me for the possibility that I might need to have more radiation. She also said that if this does turn out to be more cancer, then obviously I would no longer be in remission. This was not the kind of information I wanted for Christmas.

The biopsy was supposed to take place on Jan. 7. I was prepped for it (IV inserted, monitors placed in chest area, etc.) but when the radiologist tried to take images to guide his placement of the biopsy needle, he couldn't find a good place to perform the procedure -- so it was abruptly cancelled. Here's how he put it in his report: "Initially scanned the patient in the supine position, and the scapula was covering the lesion, and there was no percutaneous path. The patient was then switched into a right-side-down decubitus position, and images through the left lung again demonstrated the scapula to be covering up the lesion. The patient was then scanned in the prone position with similar results. The patient was scanned with the arms up and the arm down. I could not find a safe pathway for percutaneous biopsy. Recommend navigational bronchoscopy with biopsy."

Yeah, it's a mouthful. The translation is that even though the technicians turned me every which way, the radiologist could not perform the biopsy because the nodule is too close to my shoulder blade (scapula) to insert a needle and withdraw a plug without unintended harm. He recommends a bronchoscopy for the next step -- which I had about 18 months ago when I was first diagnosed. It's a much more invasive procedure (through the mouth or nose), requiring me to be anesthetized.

The radiologist's office bounced me to the pulmonologist's office -- the same pulmonologist (Dr. Enilari) who first told me I have Stage 4 lung cancer. She will likely perform the bronchoscopy. I have a "consult" scheduled with her for Jan. 21.

In the midst of my angst and prayer about all this, I got some good news: the maker of my chemo drug, AstraZeneca, sent me a letter saying I had been granted "legacy enrollment status" and would be able to continue getting my drug (Tagrisso) without cost. Hallelujah! The sobering part of this news is the "status" is good for one year. We'll cross the next bridge when we get to it. Meanwhile, I'm determined to trust God for this journey a quarter of the way through this century.