OK, surgery is done.

Chemo or Radiation is done.

Now what?

A member of your care team will want to monitor your health for a long time to come.  This will involve blood tests and probably imaging of some sort (CT, MRI, PET, etc.). Some tests will occur quarterly, some annually.  Timing extends the longer you survive from the original surgery date.

Another common waypoint occurs when one of those routine monitoring tests pops out of range or with a question mark.

Let me be more specific about the words or phrases you might read in your radiology report’s conclusion section:

Atypical

Abnormal

Unusual

…Can’t rule out metastatic disease…

I’ve been told that the state of our current imaging capabilities makes it possible to see a wide variety of things. Some radiologists can immediately explain.  Some they can’t.  Some are merely computer noise that can’t be identified, so they issue a cautiously worded finding.

Three months after I completed my chemo protocol, I had my first follow-up CT.  Chest and abdomen with contrast.  Unremarkable is a good word to see in your radiology report.  So is the phrase, “no evidence of metastatic disease.”

My chest CT findings included a “9mm groundglass nodule. Metastatic disease is difficult to exclude.”  

The first 15 minutes were the worst.  

Three months after completing six grueling platinum based chemo rounds? Metastatic disease? How do I tell my wife? How do I tell the kids? How is this even possible?  

Facts and additional conversations (information) made things better but that took time. Eldest bro said this was highly unlikely.  My Med Onc said he couldn’t believe it, he did not think it possible.  When my Onc and I looked at the CT output together; he asked some questions.  Yes, I had a chest cold with a bad cough that was just resolving when I did the CT.  My Onc thought that was the culprit.  He chose a conservative follow-up, though.  I had a PET scan in 30 days and another CT scheduled 3 months after that.

And it was a nothing-burger.  Emotion, worry, and stress – fortunately, all wasted.

My sherpas weighed in and informed me that this was another common experience in the club.  Everyone gets one of those, sometimes more,  I’m told.  

So, when in the future you get one of those carefully worded Radiologist notes, give it time and space to develop.  Don’t get too concerned unless your doc gets concerned.  But you follow-up.

My ever-wise eldest bro tells me two things.  

First, my job is to survive for 5 years.  There is a pretty good chance, given the current state of research and discovery, new and better therapies will exist then.

Next, don’t give the devil his due too early.  

Cancer may get you eventually.

But don’t allow it to kill you every damn day.

Wise words.