Billy Bob's Wild Ride: 2011

Thursday, February 10, 2011

CELLS GONE WILD-diagnosing liver cancer

Here is a pretty good article about diagnosing Hepato Cellular Carcinoma, also known as LIVER CANCER, or Primary Liver Cancer, as apposed to secondary Liver Cancer aka liver metastases.
It seems to this liver that the techneque to diagnose these CELLS GONE WILD is as much art as it is science, and even maybe a small dose of VOODOO thrown in for good/bad measure.
Any way the LUMP being hunted and stalked by the hepatology department at CU, headed by the World Famous Hepatologist Jane Berman (name changed to protect the innocent)
is still at large, not being called an HCC and not seen clearly due to technical matters, which are detailed in the linked article. So, if you are a friend or daughter, or mother/dad, or sister or brother of the same human family as billybob belongs to, and you are curious what the hairy hell Bobby is talking about when the subject comes up, just check out the part on "washout" as far as the CT scan is concerned... Think about why Sawyer's Mommy doesn't drink from his bottle and employs the super cool bottle cap trick, to avoid washout... Liver nodules which have scar tissue, can flood with the blood which is not dyed by iodine, mixing it with dyed blood, at the precise moment they are supposed to light up like the Vegas strip, because of an auto injection of radioactive iodine, they get "washout", and they hide from the camera. It seems that this is the only time during a CT scan this could occur in the whole human body. Scarred livers have blood flowing in all kinds of crazy directions. Dual phase CT scan is supposed to take pictures of non radio active tissue and then it takes pictures of the same tissue a moment later with a shot of that iodine, to light it up all the blood vessels... but in order to see a small just forming tumor, it has to be snapped at just the right moment, and the body rides through the scanner for several seconds, moving, and by the time the camera catches the part where the suspected tumor is located, the dye may have "washed out". Portal hypertension in action. Backward blood flow.

Here is what the radiologist said about it-copied in shortened version:

The vague hypodensity bulging the capsule in the left lateral segment anteriorly, best seen on series 9 image #38 is not significantly changed. No lesion here is more conspicuous on delayed imaging suggesting possible early washout. Additionally, there is vague mottled hypodensity throughout the right lobe of the liver.
IMPRESSION:
1. No change in subtle left lobe of the liver lateral segment anterior hypodensity which may have early washout. Diagnostic considerations include regenerative nodules after infarct, focal fatty infiltration, although mass cannot be excluded, given recent normal ultrasound and stability, this is felt to be less likely.
What else is there to say, lol.

Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)