I met with my surgeon today for my six-month follow-up. Looking at front and side views on the x-rays from today, my lower back looks pretty good with the screws seated as they should be and actual fusion between the vertebrae in my lumbar spine. I hadn’t realized until today that during surgery they implanted a synthetic bone graft substitute between the vertebrae that they hoped would grow and fuse the two vertebrae. Finally, we have fusion.
The area in my thoracic spine where the cancer entangled the spinal column and spinal cord also looked not bad. The screws at the very top of the titanium bars are detaching from the bone, which we really don’t like. That is reason enough to continue wearing my TLSO brace to minimize the movement and further loosening of the screws. I guess we’ll deal with it at some point if the screws continue to loosen. How will I know? Pain.
We talked about the surgery a little more, and my surgeon said that during surgery he had to peel the tumor away from the spinal cord. It sounds like everyone on the surgery team was surprised that I could walk around and that I didn’t have to wear bags to eliminate waste.
He also showed me x-rays of my spine that showed the lytic lesions in the vertebrae and even the tumor that encased that part of the spine. Today was the first time I wanted the details; now I have to digest the information. One thing that was clear after looking at the x-rays from last year and from pre-surgery in January: the cancer was there eating up the bone, collapsing the vertebra into mush. Why didn’t the radiologist see it? I guess many people with degenerative disease show collapsed vertebrae, so it was not called out as cancer. Even though I had a history of breast cancer. Many questions now arise in my mind.
I think we need a lot more work on methods for finding cancer that has returned. I have read a lot of stories about my sisters in breast cancer learning too late that their cancer had progressed, undetected, to Stage IV; often, their diagnoses happened by chance or only after overt symptoms presented themselves. It appears to be a huge challenge to detect recurrent cancer. In my case, I did present with symptoms; still, those symptoms were confused with benign conditions typical for someone my age.
Looming large over the issue is the control of insurance companies over what tests are allowed. Between the unreliability of some detection tools (tumor markers, for example) and the expense of other imaging tests, insurance companies are loathe to approve these tests. I wonder, though, how that cost compares to the cost of treating advanced cancer in patients whose cancer might have been detected earlier. Maybe there needs to be a shift in the paradigm for follow-up of patients who have had earlier stages of cancer that put them at a greater risk of recurrence.
Currently, the reigning method of detection for returning breast cancer is waiting and hoping that, by chance, we’ll find it snooping around. It seems like we really need more studies to find cancer that is still lurking around after everyone’s gone home from the party.
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