The Results Are In

On Wednesday May 14, 2014 Dr. Mares called my Mom with the definitive results of her lung biopsy.  She didn't answer the phone. I was seeing patients at Westminster Village and when I came back to my phone I saw I had a voicemail from her. She said Dr. Mares had called to tell her the results, but she thought it would be better if he told them to me. She thought I would be able to understand them better. What she didn't say, but what I knew, was that she was scared. I called him and he told me what he had presumed before was true. This was small cell lung cancer. The PET scan would show if it had spread. If it was only confined to the one lobe of her lung it would be considered "limited" stage small cell lung cancer. If it had moved beyond that it would be considered "extensive." Those are the two stages of small cell lung cancer.

It didn't really matter to me at that point which it was, limited or extensive. I already thought she had extensive, but the prognosis for limited was not really much better. From UpToDate:


Prognosis — The most important prognostic factor in patients with SCLC is the extent of disease (stage) at presentation. For patients with limited stage disease, median survivals range from 15 to 20 months, and the reported five-year survival rate is 10 to 13 percent. In contrast, for patients with extended stage disease, the median survival is 8 to 13 months, and the five-year survival rate is 1 to 2 percent.

Both terrible, both described in months not years.

She had her PET scan on May 15.  A week passed and she still did not hear the results. I thought that was a little strange, I knew the results had to be back, but I didn't push. I knew what they would be anyway. She had the MRI of her brain to check for spread there on May 21. She thought maybe they were waiting to get both test results back before calling. Fortunately on Thursday May 22 my friend Kristina was at work and happened to ask Dr. Mares about when the results would come. He asked her when my Mom had had the test done. The results had been back, but they'd slipped through the cracks and no one had notified him.

I was sitting on my bed at 7 PM on that Thursday when my phone lit up with Dr. Mares on the ID. I was surprised because of the late hour that he was calling. I ran downstairs, grabbed a pen and paper and went to the garage because I knew it would be quiet there. He told me that the cancer had spread to several places in her bones. I knew it. My heart rate didn't increase by one beat, this news was no surprise to me. I asked him exactly where it had spread and he emphasized the word several places again. Looking at the results now I see what he meant:

Multiple hypermetabolic bony metastases are identified, occurring within the left pubic bone, right medial ilium, left iliac wing, the L2 vertebral body. There is a fracture of the left lateral sixth rib with associated hypermetabolism and lucency within the involved bone, suggestive of a pathologic fracture. Of note, the L2 vertebral bony metastasis destroys the posterior cortex of the vertebral body, however, evaluation for central canal invasion is limited on noncontrast CT. 

Her rib was fractured. This startled me a bit. She had complained to me of rib pain what, 2 or 3 months ago? I had told her it was inflammation from coughing. Sigh, I'm sorry Mom.

I asked him about the brain MRI results. He said he would get back to me with the results. He wanted her to have an MRI of her spine due to concern of spinal cord compromise. He apologized for the delay in the test results and then assured me they would be praying for her.

I called and gave her the results. She did not act surprised either.

I received a text from Dr. Mares. Her brain MRI was negative. I was happy, but not as happy as I should've been. It was only later that I realized from reading articles and other people's stories how bad it would've been if it would've been in her brain too, how imminent death would've been. She would've needed brain radiation and I've read the side effects can mimic dementia. I believe she would've also have needed to wear a mask during radiation and I know that would've terrified her, absolutely terrified her.

I sent her this text. A Sexton always maintains humor.