Six month post chemo check-up and TNT

I recently went into the BCCA for my six-month post chemo checkup.  The typical routine was followed: physical, blood work and CT scan.  Anecdotally I feel excellent, all of my residual chemo side effects have cleared up, with the exception of very minor residual numbness in my fingertips.  Most importantly I don’t seem to have any issues relating to lung toxicity from Bleomycin, which was enough of a concern during treatment that the doctor decided to discontinue the use of Bleo on me.  I have not symptoms of HL.  My blood work came back normal.

Here is the CT report:

CT Chest

Clinical Statement: Hodgkin lymphoma post chemotherapy.  Residual mediastinal mass; evaluation of pulmonary nodules; post Bleomycin lung toxicity.

Technique: Helical pos contrast images were obtained from the thocacic inlet to the diaphragm.

Comparison: 11/11/02

Findings: The dominant hypodense prevascular lesion is decreased in size and attenuation a 2.7x1.8cm, previously 3.3x2.3cm.  Triangular shaped soft tissue extending along its antrosuperior margin has slightly increased, consistent with thymic hyperplasia.  Additional mediastinal adenopathy is decreased, with subcarinal now measuring 1cm AP, previously 1.6cm.  No effusion.  Two left upper lober punctate nodules, three subcentimeter left upper lobe nodules are likelt unchanged. There are, however, two new ill-defined subcentimeter nodules medially in the right upper lobe, and in the left lower lobe.  No interstitial disease or fibrosis.  No osseous change.

Impression:

1.     Slightly decreased residual mediastinal adenopathy, with evidence of treatment.

2.     2. New subcentimeter right upper and left lower lobe punctate nodules may represents inflammatory or infectious disease, but short interval follow up CT suggested for confirmation.

3.     No evidence of interstitial pneumonitis.

In short this means:

1. The primary residual mass in my chest has shrunk

2. My Thymus (an orgran of the immune system) may be enlarged.

3. Other smaller masses in my chest have decreased in size or are the same

4. There are two new nodules in my chest, less than a centimeter.

5. There is no effusion or other indication is disease.

My comments:

1.     This is obviously good, the residual mass is likely scar tissue.

2.     Unsure of what to make of this.  The doctor didn’t mention it to me and I had not seen the report when I met with him so I was unable to ask.  He didn’t think it was worth mentioning so ‘meh’.

3.     Same as 1

4.     Urgh, well that is annoying.  These are very small and not nearly interesting enough to warrant concern especially given the lack of related symptoms and good blood work.  Unfortunately it does mean more scanning and radiation but that is certainly more appealing than getting biopsied (which probably isn’t even an option due to the small size of the nodules, I believe they need to be 2cm or larger to be able to effectively biopsy with an endoscope).

5.     Good.

So that concludes my six month check-up.  I would have preferred “all is well, screw off for six months” instead of having to go back in September for more testing but obviously it could be worse, much worse.  

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In other news I have recently started training to compete in a triathlon with Team in Training to fundraise for the Lymphoma and Leukemia Society of Canada.  Aside from crashing my bike once (oops, luckily was not significantly hurt) training is going very well, my cardiovascular fitness and strength are both better than they have ever been.  If I get around to it I may post a training video.  If you’d like to donate some money to LLSC I’d really appreciate it and you’d be doing some good in world. :)

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