Facts, figures, and reality

I'm going to try and summarize what happened at MD Anderson. Hopefully if I also provide a bit more background about what we already knew about what is going in in my body, it will make sense.

After my January 2010 radiation treatment, the scan afterwords indicated that there was uptake of radioactive iodine, therefore there was cancer, in my neck, lungs, and 1 small spot in my vertebrae.

First a couple of facts:
In 2009, 37,200 new cases of thyroid cancer were reported in the US. 10,000 in men and 27,200 in women. In the same year, 1,630 people died from thyroid cancer (690 men, and 940 women). Just for perspective, in 2009, 1,479,350 Americans were diagnosed with cancer (excluding squamous and basal cell skin cancers), 766,130-men and 713,220-women. Total death rates from cancer in 2009 were: 562,340 people with 292,540 being men and 269,800 women.

Obviously cancer in bone sounds pretty bad. So, my doctor at Hopkins told me to go see someone who basically only treats aggressive thyroid cancer in Houston. Interestingly, the MDA guy thinks that all of my cancer is pretty stable and that the nodule in my back does not significantly increase my risk for (1) fracturing the vertebrae or (2) progression of the cancer. Both of those points are really important because they have huge implications for my daily life and for my plans over the next few months. The part about progression is interesting; when someone has metastatic disease, it isn't the metastases which do the spreading of additional cancer cells. Instead, it is usually the area where the primary tumor was located. In my case, my neck. So, he was much more concerned to know that there was persistent disease in my neck. Even though I've had 3 surgeries with the most recent in the summer of 2008 I may need another surgery.

Because this doc at MDA sees so many cases of aggressive thyroid cancer, he also sees more of his patients die than most other doctors treating thyroid cancer. He is also one of the first people to ever tell me how and why people die from thyroid cancer...which, despite the fact that may seem pessimistic or overly morbid to some, it is actually exactly what I wanted to hear. Mostly because I've been dealing with this for 5 years and no one ever talks about the small percentage of patients who don't ever get better. Anyway, the people that die often die with bone marrows that have been totally ablated by too much radioactive iodine and persistent disease (i.e. cancer that doesn't respond to radiation), so this doc is not a big fan of using additional radiation in me, sense it probably will do more harm than good. Furthermore, it is usually the case the bone mets and lung disease cause problems but don't kill. It is the persistent disease in the neck which often causes serious problems because the cancer grows into or interferes with the integrity of all those important structures in the neck (trachea, esophagus, jugulars, carotids, nerves, etc).

So for me, the plan is to watch the areas in my neck and bone very closely and to see if the radiation treatment I had in January has any positive effect. If either area shrinks, then we would consider giving more of the radiation. If the areas stay the same size, then we'll keep watching them. If they grow, then for the bone, we'll zap it and for the neck, I'll have another surgery.

Those decisions will be made this summer, hopefully after the 2010 Brek Epic! Which is to say that this doc saw no real issue with me living my life how I choose over the next few months! Mountain bike, here I come!

Just realized I didn't include any figures yet (see title) so here is a breakdown of the numbers I listed above: