Tuesday, October 18, 2005
What Are The Odds?
Well it's been a while since I last updated my blog and this is partly due to sloth, partly due to a lot of other things requiring attention, and partly due to an uncertainty hovering around the current state of my health.By the time you read this my health status will be known, but as I write this today, Tuesday October 18th, 2005 -- I don't know. Tomorrow I will receive the results of a PET-scan I took on Oct 11th. For long time visitors to my blog they might remember I mentioned a suspicious spot on one of my lungs that showed up in a chest X-Ray back in June this year. I had gotten an appointment for a persistent cough that would appear after any minor cold or flu. The doctor diagnosed me with asthma triggered by allergies. The spot was not overly suspicious, but he recommended a follow up X-Ray in 8 weeks. Assuming no change then to monitor every 6 months for two years and cancer could be ruled out. It then just being a run of the mill granuloma, some irregularity of my lung, perhaps (and I'm speculating here) like the pearl an oyster makes by surrounding an irritating speck of sand. So I've had the follow-up X-Ray and was informed no change... but to be really safe he recommends a CAT-scan, a 3D X-Ray that requires a dye tracer to be injected into the body. A week later I'm informed they still can't quite rule cancer out. The result remains ambiguous as there isn't quite as much calcification as they would like to see for a normal granuloma. A biopsy is recommended to settle the matter once and for all. The biopsy specialist recommends against one however due the spots placement which makes collapsing a lung a real chance during the biopsy. A PET-scan is recommended.
Each step seems reasonable and prudent, but I am beginning to realize that the odds of cancer seem to be tipping towards, rather than against. A PET-scan (positron emission tomography) involves being injected with a radioactive isotope of fluorine bound to a sugar molecule that disintegrates into an oxygen atom by emitting a positron. The positron plunks quickly into the first electron it encounters and emits a pair of gamma-rays in opposite directions from the mutual annihilation. Sensors in the PET machine detect simultaneous gamma ray events and extrapolate what line the emission occurred upon. With enough of these straight line events a 3D image of the interior can be extrapolated by computer. This scanning takes time (over half an hour) even though there are 10^11 positrons being emitted every minute inside my body. Since the fluorine is bound to a sugar molecule should my spot be cancerous it would take up the sugar preferentially due to a higher cellular metabolic rate than healthy cells and appear bright on the final image. This fluorine isotope has a short half-life however (about a week) and is also flushed from the body quickly. I'm told the radiation load is equivalent to about 100 chest X-Rays or about what my PET-scan technician receives in a year. Still it is odd to think of Anti-Matter and Gamma Rays being generated in your body continuously for a week or two.
So on the plus side for this being a benign granuloma, I'm a non-smoker, relatively young 47 (most lung cancers later in life) and while I had had a persistent cough from time to time, it seems to have gone away with the asthma treatments.
On the minus side for being cancer, about 1 out of about 100 non-smokers will develop lung-cancer in their lifetimes (about 1/8 the rate of a smoker), given I have some symptoms consistent with early lung cancer and given the aggressive test regimen my doctor has ordered... well the odds have to be much worse than 1 in 100.
No one has quoted me any odds, so in the absence of any way to really know for sure I guess I have to just assume 50:50. The real odds are almost certainly much higher or much lower.
Amazingly I am able to put this all out of my mind for the most part and am sleeping quite well at night (we'll see if tonight is any exception). Should I have cancer I'm determined to battle through it, or at least as long as life on average seems better than not. But the sad fact is only 15% of lung cancer victims live 5 years. This number had gotten better in recent years, but probably largely due to early diagnosis, thus starting the clock running early, rather than any real improvement in treatments. Certainly early intervention will add some time, but just making it past the five year mark doesn't mean you've licked this thing -- even after apparent remission it seem come back with very high frequency. 10 year survival is probably unlikely despite however encouraging your early treatments tend to be. Technology marches on of course, treatments will be better in five years from now, and better again in ten. Better enough? Who knows, using the past as a guide on the fight to defeat cancer are not encouraging. Still it offers hope. And any amount of hope can make the days bearable.
This post is a little long and on the dry side. I can't risk posting this until I've talked to Nian about whatever the outcome is. Should the news be bad I suspect she will be more devastated than I. I am of course hopeful for good news, but hope to be a model of composure and good natured coping in the face of adversity should things go the other way. We all must all face the Reaper someday, whether today or fifty years from now I hope to do so with dignity, composure and lack of fear. I am not a religious person, an agnostic through and through. Even thought I don't have the crutch of self-deluded false-knowing of a religious person, I also don't have the curse of absolute false-certainty of oblivion that a true atheist must have. If not this day, this year, this decade, someday in the future I will have to face the biggest unknown of all - what comes after all this.
