Friday 10 June 2005.
So, what was the result of the magnetic resonance imaging scan of the brain that I had on May 31st?
Today I went along to the oncology department at Auckland Hospital to find out, and a doctor called Shelley (a registrar) took me through the results. This was my first meeting with Shelley. The hospital system seems to have the capacity to generate an unending stream of new faces, and I've quite lost track of all the doctors and nurses I've met.
The report on the MRI scan of May 31st is divided into four parts, these being "Indication", "Technique", "Findings" and "Opinion". The Indication reads "Primary CNS lymphoma, completed 6 month cycle of chemo, ? remission."
According to my records, chemotherapy started in February and finished in May, and I make that four months rather than six. But let's not quibble!
Shelley started by reading aloud chunks of the report which, to be honest, didn't mean much to me. The offending globs of incomprehensible data didn't mean much even when I got a computer printout in my hot little hands. The following, for example, is more or less opaque to me:-
"Comparison is made to the previous MR of December 2004. There has been marked interval resolution on the multiple periventricular enhancing lesions."
I get the first sentence but the second one is beyond my grasp. I don't understand "marked interval resolution".
Fortunately, Shelley was able to interpret things, and the good news is that, overall, the situation is "looking quite good". The "looking quite good" bit I can understand.
The lymphoma, it seems, has still not quite entirely vanished as there are still some lesions (or, in the language of the report from the expert who had interpreted the MRI scan, some "enhancing foci") in the right frontal lobe of the brain. These lesions (diseased parts) are near a bit of a hole which is four millimeters in diameter.
Or, in the language of the report:-
"There are a couple of 1-2 mm enhancing foci at the anterior margin of the right frontal horn, adjacent to a 4 mm round partially cavitated area."
I wouldn't have been able to accurately interpret the MRI expert's report on my own because I don't understand all the technical language. Take "ex-vacuo", for example. That looks as if it somehow relates to "vacuum", but I can't even begin to guess how.
Fortunately, Shelley was there to explain it to me. It seems my brain matter has shrunk a bit and the fluid-filled areas have increased in size. Or, in the language of the report:-
"There is now symmetrical T2 hyperintensity in the periventricular deep white matter and involving the corpus callosum, associated with moderate generalised brain atrophy and associated ex-vacuo dilation of the ventricles, likely post therapy effects."
I gather, from what Shelley says about it, that this shrinking of the brain is the kind of thing that tends to happen in old age. Only, in my case, it's the result of chemotherapy.
I suppose that, for the sake of completeness, it would be nice to have at least some idea of what "T2 hyperintensity" might be, but I imagine that knowing the answer would not improve my survival chances.
I had my first ever MRI scan last year, on May 10th 2004. When I got feedback on May 17th 2004, the result was negative for brain cancer. However, my Japanese ophthalmologist told me, with some amusement, that the scan had detected "sinusitis", which came as news to me as I was not conscious of having any kind of sinus problem.
The report on my latest scan notes that "A mucosal retention cyst in the right maxillary sinus is unchanged". Shelley assures me that this cyst has nothing to do with cancer. And, as before, I'm still not aware of having any sinus problems.
For some time now I've known that an MRI scan does not supply perfect knowledge of what is going on in the brain. Sometimes (as in my case) an initial scan will show no evidence of lymphoma, and it will not be until months later that the lymphoma becomes evident on an MRI scan.
In the case of the latest MRI scan, Shelley pointed out that the scan does not supply perfect knowledge of what is going on in the brain, and that it is reasonable to assume that, in addition to the "1-2 mm enhancing foci" that are visible on the scan, there are probably much smaller areas of lymphoma activity which (we can reasonably assume) will be taken care of by the upcoming radiotherapy.
Which brought us to the subject of radiotherapy, on which Shelley was reassuring, saying that there was no chance of me suddenly walking out of the radiation therapy department as a zombie. Rather, the results of radiation therapy would probably constitute, in effect, a kind of accelerated aging, with the aging effects that I could, in the normal order of things, reasonably expect to encounter thirty years from now being experienced somewhat earlier.
After listening to Shelley speaking about radiation therapy, my perceptions of this process were unchanged: it seems to be a bit of a lottery with an individual's personal outcome hard to predict in advance.
One thing I did try to nail down was the status of the lymph node in my chest. This was first detected by a computerized axial tomography scan (a CT scan or CAT scan) that I had in Japan last year on May 31st. The Japanese expert who looked at that CT scan told me he thought the lymph node was "probably" benign.
Shelley looked up the data on her computer to see exactly what had been revealed by the CT scan that I had here in New Zealand in January, and found this lymph node described as an "enlarged right hilar node of uncertain significance".
The dictionary I have on my computer doesn't understand "hilar" and suggests that I perhaps mean "hilarious", while the encyclopedia on the hard disk throws up an article on Saint Hilarion. After dragging a very battered copy of Chambers Twentieth Century Dictionary out of the book case, I'm directed from "hilar" to "hilum". A hilum, in anatomy, is defined as "the depression where ducts, vessels, etc., enter an organ".
None of which is particularly helpful. But, going on what Shelley told me, the offending lymph node (lymph nodes which fail to explain themselves always cause offence) is somewhere near the heart.
What I know about the mystery lymph node, then, is that it's twelve millimeters in size, it's near the heart and nobody really knows what it is. Well, I guess I can live with that.
In summary, then, after six cycles of chemotherapy the medical result seems to be, in summary:-
(i) I am alive;
(ii) the cancer has mostly gone; and
(iii) my brain has shrunk but apparently still exists, albeit in diminished form.
At this stage, even though my brain has shrunk, subjectively I get the impression that I'm still functioning okay. It's true that I can't play the saxophone and am totally unable to read Tibetan, but then, these skills were never within my compass to start with. Apart from that, things seem to be more or less okay. I can still do basic arithmetic, for example. I can still count all the penguins in my parents' house (the number totals zero). And, when I count my fingers, I still end up with the figure ten, rather than twenty-seven or four and a half.
More complicated tests would not be useful: arithmetic has never been one of my strong points.
I came away from the oncology department with an appointment to see a doctor in about a month, on July 13th. And with a form to take to my local laboratory, the Devonport branch of Diagnostic Medlab, to have some blood tests. I should undergo these tests a few days in advance of the July 13th appointment so the doctor has the results on the day. The tests specified are for the liver group, creatinine, electrolytes, uric acid, a full blood count, something called LDH and (if I read a handwritten addition correctly) for calcium.
There's nothing on my medical calendar now until June 21st, the day on which my radiotherapy starts. That's when I and my shrunken brain start our game of chance in the realms of radiation, the ultimate outcome of which still seems to be not quite certain.