The MRI and CT Scan's
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| GOOD NEWS!!! There is always good news, just look around and thank GOD. 2/15/08 CT scan results Here is some very good size and number of tumors in Liver, huge reduction of the main tumor in the Pancreas (6.3 cm to 4.5 cm!) 3/14/08 Infusion Friday - last infusion of cycle 5 - start "off-week" on Monday. Blood work came back good as ever. Reduced Steroids has helped the tense and irritability that I experienced in the previous cycles, however a bit more fatigued from the Chemo regiment. But all said and done, When on chemo, Tuesdays thru Thursdays are normal days for me Friday thru Monday I may seem a little tired to you. On the "off-weeks", I feel absolutely normal Tuesday thru Sunday. (I know "normal" may not be a word many of you use in the same sentence with my name!) When you pray, Thank God! 4/11/08 CT Scan results The news is great...no recurrence in the liver or lymph nodes (still clear). Even more reduction in the Pancreas. The news just doesn't get better than this!!!! Thanks for all the prayer's!!!! |
| 1. PA and Lateral View of the Chest, 06/24/2008. Clinical History: Pancreatic carcinoma. Findings: The lungs are clear. No adenopathy is seen. The cardiac size is within normal range. IMPRESSION: No metastasis. 2. CT Chest, 06/24/2008. Clinical History: Pancreatic carcinoma. Findings: Current CT was done with IV contrast. Comparison was made to 04/08/2008. There is no pulmonary metastases or adenopathy. IMPRESSION: No metastases. 3. CT of the Abdomen and Pelvis, 06/24/2008 Clinical History: Pancreatic carcinoma. Findings: CT was done without and with IV contrast. Gastrointestinal contrast was used. There is a biliary stent in place. The tumor involving the head of the pancreas is not identified with confidence. There is change in the texture of the pancreatic tissue in the head just proximal to the papilla. The hepatic metastases are not identified any longer. There is no adenopathy. No implant is seen. The adrenals, kidneys, spleen are within normal range. There is no evidence of disease in the pelvis. IMPRESSION: The known treated metastasis and primary tumor of the pancreas are not identified with confidence any longer. There is no new site of disease. |
Findings: Metallic wall stent is identified within the common bile duct. The pancreatic mass, as has already been noted for the study of 09/04/2008, venous structures (portal vein or superior mesenteric vein) nor is there involvement of the celiac artery or superior mesenteric artery. There is a Findings: Metallic wall stent is identified within the common bile duct. The mesenteric artery. This artery is also not involved. No adenopathy. Adrenal glands are unremarkable. No hydronephrosis. Stable small low density foci within the kidneys are nonspecific. Evaluation of the liver is somewhat limited because of fatty infiltration with sparing seen near the gallbladder fossa. Previously there were very subtle questionable abnormalities identified within the liver on the prior CT examination that cannot be definitely identified today on CT. Workup had been recommended for MRI and there are two lesions seen on the interval MRI that were T2 bright and that cannot be seen on other sequences and were assumed to probably represent small hemangiomas. These cannot be seen on the CT, which will be supported that these represent solid lesions such as hemangiomas rather than cysts. There is also a small hypervascular lesion seen in the posterior aspect of segment VII on image 26 that measures only 9 This abnormality is not seen on later phases. It could represent an etiology such as focal nodular hyperplasia and is seen on the prior CT of 09/04/2008. It is located in close proximity to where at one point there were clearly seen metastases on the study of 11/30/2007. This could represent unusual manifestation of residua of the patient's prior metastatic disease. There is an ill-defined region of heterogeneous enhancement in the liver segment V on image 37 of series 4. This can be followed. This may be simply a perfusion abnormality at this time. Currently, I cannot definitely identify metastatic disease within the liver and close attention and followup would be advised. The gallbladder is contracted. The spleen, adrenal glands are probably unremarkable. There are degenerative changes of the lumbar spine. IMPRESSION: 1. Primary lesion within the pancreatic head cannot be visualized. This was also the case for the prior study of 09/04/2008. No evidence of involvement of vasculature. 2. In this patient with clear evidence on the study of 11/30/2007, of multiple liver metastases, today, I cannot definitely identify metastatic disease to be within the liver on CT examination. There are subtle areas of heterogeneity that can be monitored. When you pray Thank God!! |
MRI ABDOMEN W&W/O CONTRAST 3/17/2009 12:06:00 PM Accession: 7495415 FULL RESULT: Examination: Magnetic Resonance Imaging of the Abdomen - 03/17/2009 Clinical History: Pancreatic carcinoma. Findings: 1. Comparison was made to a previous study dated 01/15/2009. Small lesion in the right lobe of the liver (series 3, image 23) which may be related to a small hemangioma is again identified. There is no MR evidence of active metastases in the liver. The lesions noted on a CT scan of 11/30/2007 had previously resolved. 2. Patient with a reported history of pancreatic carcinoma and no change in the region of the pancreas since the previous study, no obvious mass identifiable. Biliary stent is noted in place. Some normal-sized abdominal lymph nodes are noted. Renal cysts are identified bilaterally. No lesions in the adrenal glands. No hydronephrosis. No evidence of any abdominal fluid. IMPRESSION: Relatively stable study since 01/15/2009 with no definite MR evidence of active metastases in the liver and other findings as described. Study has been obtained in coronal, sagittal and axial projections utilizing relative T1 and T2-weighting along with some gradient sequences and dynamic pre- and post-contrast-enhanced imaging through the region of the liver. 489 - VARMA, DATLA SIGNED BY: 489 - VARMA, DATLA 3/17/2009 4:05:00 PM |
| Time Line (I keep adding to the bottom as time marches on) Nov. 07 – After CT scans, ERCP and EUS (procedures to place a stent and biopsy the tumor), the Doctors confirm the diagnosis; Pancreatic Cancer, Stage IV, 6cm tumor in the head of the pancreas (pressing against the Superior Mesenteric Artery, 8-12 metastic lesions in liver, and local lymph nodes involvement, ...GI Doctor and Surgeon both gave me 3 to 6 months to live! Dec. 07 – After confirming the diagnosis with their own CT scans and examinations I started the GTX treatment protocol under the guidance of Dr. David (MD Anderson Cancer Center - Houston Texas). Dr. Dave doesn’t give expiration dates…we (Missy, me and Dr. Dave) set Sarah’s wedding date as our first goal... June 21st 2008. Dr. Dave also told me that I needed to gain weight (I was at a healthy 223lbs) because the cancer makes people lose weight and he wanted me heavier. Feb. 08 - CT scan reveals great improvement - can't find the spots on the liver, tumor in head of the pancreas has shrunk by half, lymph nodes appear normal. This is unheard of! Dr. Dave was VERY pleased. Missy and I were ecstatic! (Weight 235lbs) April 08 – CT scan results: Still no spots on liver, more tumor shrinkage! (Weight 250lbs – Dr. say’s, “put on some more”) June 21 - Walked my oldest down the aisle at her wedding!!! CT scan two days later reveals no spots, Pancreas appears normal in size and function!!! (weight 275) Sept. 08 – CT scan reveals that there is no longer any vascular involvement, everything else normal too!! Doctor tells me to STOP gaining weight! I was at 285!!! Nov. 08 – Dr. Dave switches me to MRI exams instead of CT scan to get a better look at the Liver and Pancreas to make sure that the cancer is not coming back. The scan reveals “all normal”! Now we are starting to worry that the Chemo is going to kill me, not the cancer!! Blood tests for liver function (AST and ALT) have been rising but go out of the normal range for the first time. Dr. Dave suspects that the PC is not the culprit, but rather, my chemo!!! Jan. 09 - MRI reveals that there still are no lesions, but blood work reveals that the AST/ALT numbers are still climbing. I was still taking the GTX Chemo - cycle 20. Jan. 16 – Blood test reveal that the AST and ALT are still climbing. To give the liver a break we suspend all chemo for 5 weeks to see if the liver will improve. I feel great, fewer side effects than ever. Feb. 20 – Blood test show a slowing of the climb that the AST/ALT have been doing. However, Dr. Dave wants me back on chemo, so I started back on the GTX. March 2009 – MRI reveals, still no sign of cancer anywhere! But the blood tests are still not great so Dr. Dave wants to cut out the Gemzar and Taxotere from the GTX to see if these two drugs are having an effect on the liver. So, we are cut back on the Chemo to give the liver a rest (just taking Xeloda). Re-evaluate in 6 weeks. Apr. 3 – Blood test show no change in rate of climb of the AST/ALT, all other numbers look great! I am still feeling wonderful. Missy, Rachel, Melissa and I did the Disney trip in the middle of March. My weight has crept up to 297. I’m having a problem with the weight! Apr. 24 – Blood test show that the AST and ALT are still climbing. Of course, I have been studying the problem for weeks now on the web, and have learned just enough to be dangerous! Dr. Dave, Missy and I were all discussing what could be the cause of this problem and just how bad is the problem…after all we have been talking about nothing else for months. So I ask Dr. Dave where I stood on the liver failure scale (something I learned about on the web). Was I a “one”, or a “two” or worse? He looked at me like I had “two” heads!! Seem that this problem is a long ways away from liver failure or the stages of failure…for a second there I could read his mind. He must have been thinking about some other patient because I got a clear reading of “Dumb Ass”! So, after he got me straight about the liver numbers we went on to discuss what else other than just the Chemo could be affecting the ALT/AST. We looked up all the med that I’m currently taking, none had any warnings about liver problems… other than the two we had already stopped taking, the Gemzar and Taxotere. Finally, I asked if it could be caused by being so overweight? He said that that definitely was a possibility. So we talked about diets to lose some weight…Dr. Dave wants me to lose 25 lbs. He is still wants me to keep the weight up! I told him that that was ridiculous that I needed to lose about 75 lbs. We compromised at 50 lbs. Will I go to hell for lying to an Oncologist? May 15th - Feeling G-G-G-Great!!! Just left the Doctors Office and got G-G-G-Great news...AST and ALT have been on the rise since last September...Today the AST dropped from 109 to 76...the ALT from 130 to 88...HUGE improvement!!! So when you pray make sure you thank God!!! June 5th 2009- The MRI test results have been incredible! "No sign of metastic disease in the liver... No indication of a mass in the head of the pancreas" That's the verbal report from Dr. Fogelman. Does it get any better than that. Coupled with the news earlier in the week about the AST and ALT dropping more... ALT from 88 to 82 and AST from 76 to 65. I'm walking/jogging more each day (just completed my second 1 mile jog as part of todays 4 miler) I'm getting stronger each day...All the glory goes to God!!!! Be sure to thank him for answering your prayers and mine. And if you don't think he is working miracles TODAY, could you please think again, because what He is doing in me is, and has been, a Miracle. I was diagnosed Stage IV PC with mets to the liver, inoperable...19 MONTHS AGO!!!! I ran a mile today...for Christ's sake (literally)! Feb. 2010 I have been NED for almost 2 years. Considering that I was diagnosed as Stage IV, with mets in the liver and local lymphnodes with vascular involvement, inoperable... back in Nov. 2007, and given 3 to 6 months to live, I guess I have done alright. God has been good to me! Anyone have any doubts? Well, today's news isn't as rosey as it has been. In January the MRI identified a identity. Dr. Fogelman scheduled a EUS and fine needle biopsy in February. The EUS could not locate the 12mm spot that the MRI found so we scheduled another MRI for March 3rd to try and determine the location and type of "spot" that this is. Well, today I got the results. The "spot" has grown from 12mm to 13.9mm, It has become more defined and looks like it is most likely a recurring PC lession. But it is too small to biopsy. I will re-start GTX starting Monday. Dr. Fogelman is looking into a possible CT guided biopsy for later in the week to verify the nature of the lession. If this is not PC, Great! However, if it is PC, so be it! I will fight until my last breath. Most people here have read my posts and know that I will not give up. You all should know that I give it all to Christ! His will be done! As soon as I know it is Gods will that I leave this world for the next, then I go willingly. Remember, what I have always preached, Eternity is a long time, Earthly life is short... which is more important? I, personally, look forward to Eternity. God Bless all of you fighting this MONSTER!! MarkB. March 2010 The CT guided Biopsy came back positive for adenocarcinoma... His will be done. May 2010 latest scan show reduction in size and definition... Praise God! August 2010 Last weeks scans have proclaimed me NED again! I will finish this cycle of chemo and one more, have ab MRI, and (if all is the same) drop the infusion drugs (Gemcitabine and Taxotere) and continue with just the Xeloda for a few cycles and re-evaluate. Time for Thanksgiving!! Thank you Lord God!! |
Diagnosed in 11/2007. Patient had multiple liver metastases at that time. The nodule was identified between the uncinate process and the SMA which was biopsy-proven as adenocarcinoma on 03/19/2010. The patient resumed chemotherapy. Restaging. Technique: MRI of the abdomen was performed with and without gadolinium according to pancreatic protocol. Comparison: 03/04/2010. Findings: Previously identified 1.3 cm nodule in the most medial aspect of the uncinate process is noted again, decreasing in size to about 1 cm. The signal intensity and enhancement pattern of this nodule currently becomes identical to the rest of the pancreas. Without knowledge of previous location and biopsy-proof of this finding, it would be very difficult to identify it as abnormality on the current exam. This nodule is best seen on the axial FIESTA on series 9, image 53 and on the LAVA on series 8, image 416. There is no evidence of liver metastasis. There is no focal abnormality in the spleen, adrenals, and kidneys. The gallbladder shows diffusely thickened wall suggestive of chronic inflammatory changes. There is no ascites. There is no abnormality in the visualized bones. IMPRESSION: Nodule medially to the uncinate process representing either metastatic lymph node or an exophytic portion of the primary pancreatic cancer, currently measures 1 cm versus 1.3 cm in March, with more uniform enhancement pattern suggestive of response to treatment. Again, there is no evidence of liver metastasis or other distant metastasis. |