Recurrence Part 2: Bob Does Radiation

On September 15, 2022, Bob resumed Folfirinox chemo treatments to knock out the recurrence identified by Signatera ctDNA (click here to learn more about Bob's recurrence and ctDNA). After three chemo treatments, Bob’s ctDNA had increased. Doctors had not been able to identify the location of the resurgence. Which did not appear on standard testing.

A PET scan was ordered.

PET is the acronym for Positron Emission Tomography. It uses radioactive material to identify metabolic processes as they occur within the body. Physiological activities like blood flow, movement within the heart, and kidney and liver function light up like a Christmas tree in a PET scan. Unusual, out of place function brightens within a PET too. Like cancer, even when small – or lurking in areas standard tests (like CT and MRI) can’t access.

Unfortunately, Bob’s insurance does not recognize a positive Signatera result as an accepted reason for PET testing. Blue Cross/Blue Shield said NO to the doctor’s request.

The denial was appealed. Another PET was scheduled.

Again, insurance said no.

PETs were appealed twice more, each denied. “We’ll continue chemo while applying to trials,” said Bob’s doctor.

Instead, Bob funded his own PET scan (with substantial discounts for self-pay). 

On Wednesday, November 23, the PET scan found cancer lurking in ONE lymph node hiding in (forever know as) the “surgical bed” behind what remains of Bob’s pancreas. As the beast is surrounded by blood vessels, the node is not a candidate for biopsy or surgical removal.

It’s bad for cancer to grow in the lymph nodes. Left alone, the evil could spread via the lymphatic system, metastasizing in organs throughout the body.

Bob began targeted radiation therapy on December 19. Treatment focuses on the inhabited lymph node while also radiating the surgical bed as a preventative measure. Bob will endure 28 treatments, every day, Monday-Friday, with time off for Christmas.

As part of radiation treatment, Bob consumes six fat chemo pills each treatment day. He uses a spoon to take them. To avoid getting chemical burns on his hands.

Due to the location of the offending node, radiation is not expected to burn Bob’s skin. He may have other side effects, however. So far this includes extreme exhaustion. Stomach cramps. Nausea.

Following radiation therapy, Bob will have another PET scan. And a CT. There will be more Signatera testing. After a period of time, he may or may not resume chemo.

Today, as we battle forward through another Christmas, we’re extra grateful. For our children and grandchildren. Supportive, loving, extended family. For the clinical trials that produced Signatera testing. For PET scans. And hope.

Merry Christmas!