We've had some mild success with Lansurf. It's been able to slow the cancer's growth. Karen's cancer often appears stable during treatment, but the term "stable" allows for a small measure of growth. This is due, in part, to the inaccuracies that can occur when measuring not just cancerous growths, but any organ in your body. When you turn an apple or orange to the side it can appear wider or narrower. Similarly, small shifts in how you are laying or how things inside your body are resting can affect measurements. So while Karen's CT scans have shown the cancer to be stable while on many different treatments, there always seems to be small amounts of growth. An earlier scan during Karen's Lansurf treatment however, showed zero growth, which if it's not a first for us, hasn't happened in quite a while.
Unfortunately, as you treat cancer, the cells slowly evolve resistance to the treatment. So, as has happened with all our treatments in the past, Lansurf has become less effective. For the most part Karen's CT scans appeared stable. But her pain level has been increasing lately, and doing so at an increasingly quicker pace. This is a sign that even if the scans aren't showing significant growth yet, it's happening, and in places or ways that are causing pain. A vast, vast majority of this pain is all in one spot on the right side of her abdomen. This is the spot that has been bothering her on and off as long as I can remember. It's the spot that last year's big abdominal surgery was suppose to fix. It was also the most painful spot targeted in Karen's previous radiation therapy. It's reached the point that when it bothers her, her pain spikes to a 10 out of 10. She doubles over in pain when it flares up.
It's gotten to the point where Karen has to sit or lay a very specific way to avoid hurting. Walking for more than a few minutes has also been painful. Luckily, Karen discovered if she wears ones of the wraps she got after her big abdominal surgery last year, she can tolerate walking and moving around a lot longer. It varies, but it gives her an extra 5 to 15 minutes of activity. Initially I referred to these as constricting bands, but we've heard them called "support wraps" more often since then. (They look like this.) She's also been learning which subtle changes in position put less pressure on this sensitive area.
It's hard to remember exactly what dose of Fentanyl patches Karen had been using at the start of the year, but I'm thinking either 75mcg or 100mcg. Either way, the dosage has been pretty consistent for a long time now. In the past month or so, the dosage has been bumped up 50% to 150mcg. I have no doubt this is the highest dosage of Fentanyl Karen's ever been on, but she says the increase hasn't helped at all. She's already told me she plans on going back to the 100mcg she's used for so long. Certain kinds of medication just don't help with certain kinds of pain, and we just haven't been able to find anything that helps much with this. It seems perhaps ibuprofen has been the most effective. She even feels turmeric helps to a degree. So we think the pain must be related to inflammation.
Earlier in the month the oncologist said he'd check if radiation therapy could retreat this spot. Things were quiet for a week or two, and then suddenly everything happened rather quickly. Insurance approved everything pretty much instantly, even though special (more expensive) precautions must be taken when you're receiving radiation a second time. Karen had her radiation simulation on Monday. This is where they make a mold for you to lay in during your treatments, and then CT scans are done of you in that position to map out how they are going to target the tumor without damaging anything else. They also mark you so they can line everything up again later, but her previous markings did the trick. The planning was complete less than 48 hours later. Yesterday and today she received a total of four radiation treatments: one each morning and one each afternoon. And that's it; two days and we're done. It's a higher dose over a much shorter time compared to last year's treatment. It's also been administered twice a day instead of once a day. We've been told "mixing things up" helps the effectiveness of repeat treatments, as cancer also adapts to radiation therapy.
Just like last time, things are getting a worse before they get better. The tumor site has gotten more inflamed and is making it hard for Karen to find comfortable positions that don't put pressure on the spot. Last time it took a couple weeks before she noticed any improvement, but that treatment was over 3 weeks, so hopefully we'll see results sooner than that. Things slowly improved for a long time after last year's treatment, for 6 to 8 weeks, or maybe even longer. In the meantime we won't be going back onto Lansurf. There's a very promising clinical trial that Karen's was approved for several months back. It required a cancer sample to test against, but they still had a sample from a previous clinical trial we didn't get into. This time however, there was a match. Since the radiation targeted just one spot, and there are other spots they can monitor, we don't have to wait for an extended "cool down" period to start the trial. We are scheduled to begin near the end of the month.
