The good news – I have a fantastic radiation oncologist.
By: Robin Harry
The less than good news – She’s so good that my radiation planning appointment got postponed…
The radiation planning appointment consists of a scan to figure out what’s left of the cancer and where it is. There’s also a simulation of the radiation appointment so that they figure out what position I have to be in for each real radiation appointment. That’s what I was scheduled to do last Thursday.
I went to the appointment as scheduled, and first met with my radiation oncologist. I REALLY like her. She’s friendly with a very dry sense of humour, but also incredibly knowledgeable, and she’s very straightforward and confident with her patients (like a certain neurologist that I know and work for). When I got there, she asked me to reiterate what my medical oncologist had told her, regarding my scans and figuring out what was left of the cancer. So I told her what he said: he was going to rely on the CT scan done during radiation planning to see how effective the chemotherapy was and what was left (if anything) of the cancer. I’d then go through radiation and get another CT scan after that to see how well the radiation worked. If the scan still showed something there, given that the CT can’t really tell the difference between scar tissue and cancer tissue, I’d then have a PET scan to figure out what was left.
(FYI – a CT scan is a structural scan – it shows the changes in anatomy but can’t always show exactly what the changes are made of. A PET scan is functional – it uses cell metabolism to figure out where there’s abnormal activity or abnormal cell function).
So my radiation oncologist disagreed with that sequence of events. She thinks it would make much more sense to do the PET scan NOW, figure out exactly how much cancer is left with more certainty, and then tailor the radiation treatments accordingly. If the scan is negative, then we just do the 18 days we planned to (lymphoma can often exist at a microscopic level, unseen by scans). If the scan is positive, then I would have to go through a longer regimen. Quite frankly, I think that’s brilliant. Why didn’t I think of that!!
So we rescheduled for a day when the PET scanner was available, which is tomorrow. The whole planning session will be done then. I’m quite glad to be doing it now – I’ve had some mild chest pain over the weekend reminiscent of the pain that started this whole ordeal, so this is good timing to figure out what’s going on. This kind of PET scan uses glucose metabolism to show cell activity, so I’ve been on a strict no-carbohydrate diet today. No bread, rice, pasta, potatoes, milk, sugar, fruit…just meat, eggs and water all day. A true carnivore!