Plot Twist: PET Scan, Anemia, and a Transfusion

This week I had a third PET scan, the second since I started treatment. The results show continued progress in shrinking the tumor even if the results are not as dramatic as the last PET scan.

Looking at the results:

From the original PET scan:

Large intensely FDG avid approximately 6 x 11 x 12 cm (AP, TRV, CC  dimensions) in the anterior mediastinal/level 3 soft tissue density mass  resulting in moderate mass effect and displacement of the heart and great  vessels. Relatively homogeneous tracer uptake, SUVmax = 25.

From the second PET scan:

Interval significant decrease in size to known anterior mediastinal  mass with heterogeneous and discontinues moderate to intense peripheral  tracer uptake, SUVmax = 6. It measures approximately 2.8 x 6.4 x 7 cm  (AP, TRV, CC dimensions).

From the third PET scan:

Decreased size and FDG avidity of anterior mediastinal mass measuring 4.6 x 2.3 cm with SUVmax 4.3 (yes, I noticed that there are only 2 dimensions this time. I don’t know what that means, but I will be asking).

So, the tumor lost another approximately 2 cm and is not as hot (or bright).

This is progress.

On another front, the chemo is catching up with me in the form of anemia. I have blood drawn every week if not more often to monitor for all kinds of things. Measuring the level of white blood cells and neutrophils determines if I can tolerate the next round of chemo. To make sure these levels stay within an acceptable range I get a shot of Neulasta at the end of every round of chemo. Another thing they monitor is hemoglobin levels. These are the red blood cells that help carry oxygen through your body. When the level of hemoglobin drops below certain levels you are mild, moderately, or severely anemic.

I have had lowered levels of hemoglobin since I started treatment. The chemo drugs attack fast growing cells – like cancer cells, and hair follicles, and blood cells. While the Neulasta has kept my white blood cells in a good range, my red blood cells have been on their own. My hemoglobin dropped to 7.5 and then a week later to 6.3 – severely anemic.

Anemia makes you feel tired. Very tired all the way to no energy at all. It also makes you feel weak, may cause mouth sores (got those, not fun but treatable), bruising, and the list goes on.

The treatment for severe anemia is pretty simple. You get a blood transfusion. I spent the better part of a day receiving 2 units of blood. The procedure itself was not a big deal. Afterwards I experienced mild fever (expected). And I feel better than I have in a couple of weeks.

The truth is that my hemoglobin would probably recover on its own given time. The transfusion is faster and keeps me on track for the next round of chemo starting Monday. This also means that my doctor will probably not increase my dose for the chemo this next round. I am ready, but I can’t say I am looking forward to it.