Betty Chapman Moren

A trip to the ER is not something anyone looks forward to, but in my case it may have saved my life.   Over the years I would now and then get sharp pains in my back & side when I took a deep breath - but would pass in a matter of seconds or a minute or so.  Never thought much about them as they felt like some type of muscle spasm.  Then, on March 29th 2017 they started but wouldn't let up and after two hours my doctor said I needed to go to the ER.   Chris was home so I had him run me in to Castle Rock Adventist Hospital while Bill headed over from work.  The ER doctors in an abundance of caution ordered an EKG and CT in case I was having a heart attack or a lung embolism.  While waiting for the results the pains had already subsided and was just waiting for the all clear to go home.   By then Bill had arrived and we were both stunned when the doctor said I was to be admitted.  Almost thought he was joking - but he wasn't as the CT showed a mass in my right lung.



The next day endured a number of tests including a brain MRI and a bronchoscopy  - the latter to see if they could determine the nature of the mass and the former to see, if the mass was cancerous, had it spread to the brain.   The MRI was negative which was really good news.   The bronch was inconclusive as the mass was behind the bronchial walls and not accessible.   This meant I'd have to undergo a different type of bronchoscopy - an EBUS - which is a special one in which an ultrasound is part of the equipment that allows the doctors to take a biopsy through the bronchial walls without risk of puncturing good tissue or blood vessels.   With that I was discharged after two nights and the EBUS was scheduled for a week later.



Before the EBUS I also went in for a PET scan - to look for signs of cancer in other parts of the body outside of the lungs.



Went to St. Anthony's in Littleton for the EBUS - it requires a general anesthetic so Bill was my designated driver.   The procedure went fine and a good biopsy sample was taken for analysis.  But this meant another week of waiting for the results.  Sadly, after a week of waiting, the biopsy results did show I had an adenocarcinoma of the lungs and associated lymph nodes.  At this point the lung doctors said I now needed to be working with an oncologist.  Yet more waiting.



While a lung cancer diagnosis is awful to get, if you have to get one being here in the Denver area is a blessing.  The University of Colorado Anschutz Cancer Center is one of the top centers in the world, let alone the country, for lung cancer.  Appointments made there as well as at a different cancer clinic.   Decided ahead of time that unless we had some reason to not like UC, we'd go there given their top notch reputation.  While I liked the other clinic's doctor I decided to go with UC Anschutz after meeting Dr. Mark Hancock and staff there.



More tests ordered, and more waiting.   At least Dr. Hancock assured me that adenocarcinomas are slow growing so, in "cancer time" the weeks it has taken to  get all the tests run and the treatment plan made is short - won't change the approach nor outcome.   We did learn at this point that the PET scan did indicate the cancer was showing up in the left lung - small nodules compared to the mass in the right, but cancer nonetheless.   This meant that surgery wasn't an option nor was directed radiation.  These approaches are effective to localized cancerous tissue - that can be targeted entirely by the surgery or radiation.   Once spread, even to the other lung, requires a broader systemic approach to treatment.



Dr. Hancock explained that are over 200 types of medications that can be used for treating my type of cancer.   Ideally, either immunotherapy or targeted gene therapy would be called for as they have very, very high success rates.  But for these to be used I would need to have certain "markers" - specific proteins or genetic mutations for which these therapies.  work.   Once the results came back it was determined that I don't have the markers suitable for these treatments. 



This means a less targeted, more broad chemotherapy approach will be my treatment plan.  Dr. Hancock felt that we should expect a positive result from the chemo.  Positive means either a reduction in the size of the mass or, at a minimum, a halting to the spread.   Either of these is good.   Dr. Hancock set expectations that we aren't trying to cure the cancer but control it.   If it is under control a long, normal life is possible.  Given I hadn't any symptoms before going to the ER this does suggest that if the cancer is under control I can live just fine with it inside me.  (It is unclear what caused the back pain that made me go to the ER - it may be my gall bladder as it has stones - but none of the doctors were convinced the pain was directly related to the mass.)



The initial approach will be two cycles of chemo and then a CT to compare to the baseline I had in the ER.   Depending on the results adjustments can be made if needed.   At some point, when the cancer is under control, it may be possible to reduce or change the treatment to a maintenance approach.  But for now the chemo is intended to stop growth or reverse it. 



 On May 16th I had a "port" put in - which means I don't have to have IV's to get my chemo.  It was an outpatient procedure that puts a tube in my vein and a receptacle for the chemo injection under my skin .   Supposed to be much easier than IVs each visit.  On May 17th I started the first round of chemo - carboplatin and pemetrexed.  As of May 22nd the only side effects I've felt are fatigue; thankfully no nausea yet.   Next treatment will be on June 7th (and every 3 weeks thereafter).  Plenty of prescriptions to take along with the chemo to control side effects - if the first few days are any indication they seem to work well.  Expectations are that any side effects over the three week cycle will be the worst a few days after the treatment and then subside with time - even in worst case I should feel normal the 3rd week of each cycle.  



A big shout out and thank you to Debbie McCoy, my sister-in-law (Bill's sister) who flew in from Dallas to take me for the port and chemo appointments as Bill had to travel for work that week.   Was a huge help and made getting through the week so much easier.  She even had to deal with a late spring snow here in Colorado on her trip back to Dallas.