The Cancer

My Cancer story begins with a painful knee.

I’ve had pain in my right knee from running for a few years. But this year it progressively got worse. First was pain from less strenuous workouts like box jumps and squats. Then pain from walking down stairs too quickly, then from just walking a lot in a day. This happened over the first 4 months of 2014.

Then the sharp pains began. Kneeling down on my knee in a certain way would cause a sharp pain like a knife stabbing into the knee. I would jump up in agony, but the pain would only last a few seconds then ache for a few hours. Then the sharp pain began being caused by other pressure on the knee. Leaning down and placing my hands on my knees to look at something would cause the pain. (and embarrassment when I yelped in the ear of the guy who’s shoulder I was leaning over to discuss something on his computer) Or crossing my left ankle onto my right knee when sitting would make me jump out of the chair. Next hyper extending the knee would cause it. Kicking off a shoe would be enough. By July it progressed to where even the stretch when first waking up in the morning was flexing the knee enough to cause me to yelp and jump off the bed, waking up my less than appreciative wife.

This had escalated to the point where I reluctantly (at the demands of my loving wife) went into my Doc’s office. They played around with it and found it normal except that when laying straight on the table if they pressed straight down on the knee it cause me extreme pain. (awesome, thanks) I was told to take motrin for two weeks and do no lower body exercise and see what happens. I was also sent to get X-rays of it to check for bone spurs or patella damage. X-rays were normal, motrin did nothing.

At the end of the two weeks I was sent for an MRI and was called two days later with the news that they had found a bone marrow replacement process at the bottom of my right femur. (Uh oh..) This could be caused by an infection or possibly even Ewing’s Sarcoma. (FML) A biopsy of the tissue was conducted and on Sept 11 (appropriately…) I found out that it was B-cell lymphoma. Much more treatable than sarcoma, however it is rare for lymphoma to manifest as a primary bone cancer, especially in someone less than 30. A lucky break from the much more serious sarcomas.

The next step was to go through a staging process. I had none of the typical symptoms of someone with systemic lymphoma, lethargy, anemia, etc. I was perfectly healthy but for the whole cancer thing. But to be sure a PET scan was conducted using an injection of a sugar with a radioactive tag to find where large metabolic activity was happening in my body. The goal was to find if the cancer originated somewhere else, had spread to another area, or if this was localized to my femur. The PET scan showed the following:

As you can see there is concentration in my brain, heart, a little in my kidneys, and in my bladder, all expected. The tumor in my right femur is very clear but there are no other indications of cancer anywhere else in my body. Great news. I was diagnosed with Stage 1E Diffuse Large B-Cell Lymphoma. 1E means that the cancer is in one location that is Extra-nodal, not in my lymph node system.

So far I have won the cancer lottery. If I had to have cancer, a localized B-Cell lymphoma in an extremity is the one to have according to my oncologist. It is very treatable and the prognosis is “as good as you can get while still calling it cancer”.

Treatment for this cancer is usually a combination of R-CHOP chemotherapy followed by radiation to the localized site. Lymphoma typically responds well to both treatments and achieves a cure in most patients. Since I am young for a lymphoma patient my oncologist wants to try and avoid using radiation since they have found an occurrence of secondary malignancies 30+ years down the road in patients who receive that treatment. For a 65 or 70 year old patient that is less of a problem than for a 29 year old one. I would like to be around for more than 30 more years so to me it is a problem.

My current treatment plan is to conduct two rounds of R-CHOP chemo, then have another PET scan to see how the cancer is responding. If it is responding as expected we should see little to no metabolic activity in the area. If that is the case then we will do 4 more rounds of chemo and expect a full cure at that time, avoiding radiation and it’s long term risks. If it isn’t responding as well as we would hope we will look into the possibility of a shortened chemo regimen followed by radiation treatment. Obviously the current cancer is the primary concern, don’t skip the bomb under your truck to worry about the bomb down the road right?

Oh, and to ease the chemotherapy process  I will also have a port installed in my chest. It looks like this-

It allows the doctors to push chemicals that could harm your tissues directly into the major arteries that lead into your heart so the chemicals are quickly diluted and spread around your body. It also means you don’t have to have needles hanging out of your arm every time you go in.

That pretty much catches you up. I’m writing this the night before I get my port installed and my first chemotherapy treatment. At this point I am just ready to get started. So much talking and tests and waiting is starting to get frustrating. If chemo is what I need then lets get it over with. Who needs hair anyway? Really opens the door for a great Voldemort costume this Halloween…

I also need to mention that the single most lucky break I’ve had in this whole experience is that I am married to the beautiful and caring Crystal. She also happens to be mere months away from graduating with a bachelors degree in Nursing so is perfectly poised to not only put my doctors through a inquisition with each appointment but ensure I get all the best pain meds and that I take them diligently and am prepared and on time for all my appointments. I don’t know where I would be without her, she is the most caring (and sometimes mean when I need it) provider I could ask for.