My Battle with Merkel Cell Cancer

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My PET scan results
Friday, April 22, 2011
I went for my PET scan today. I have been having increasing discomfort in my lower
chest and anticipated that my posterior mediastinal mass would be larger and pressing
on my distal esophagus causing the symptoms. I was hoping there would be no evidence
of new disease. This Merkel Cell carcinoma can grow as fast as any malignancy I know
about.
I had to be on a sugar-free diet for 24 hours prior to the examination. Last night, we had
Gary, Dana, Eva, Sara and Bel over for a mini-Seder. I could not enjoy much of the
cooking, but everyone had a good time.
No breakfast this morning. I arrived for my scans at 8:15. They put me in a very cold
room with a heating pad on my arm to start the IV. Of course, in the cold, your veins
constrict, but the IV was started without incident. My blood sugar was 105, a good
number. They injected the radioisotope without incident and then I had to wait 1 hour for
it to spread through my body. It concentrates in areas of high metabolic activity, such as
tumors, healing surgery sites, brain and kidneys. There was alot of activity in my brain,
probably, like Cassius from Julius Caesar, I think too much.
After the hour, it is 35 minutes to be scanned with the warning to stay perfectly still to
avoid image degradation. Of course, as soon as the scans began, my ear and my nose
began to itch. I needed to clear my throat, and the blowing of cool air over me for
ventilation made my face itchy and gave me the urge to sneeze. 35 minutes seemed like
hours. I left at about 11:30 AM and returned at 2:00 PM to review the results with Dr. Dan
Stobbe. He is a longtime colleague and friend.
Below are sample images from the scans.
The image on the bottom right is a coronal image. The areas in black show high levels of
activity. The brain at the top, the bladder at the bottom, and the tumor in the middle. The
image at the top left is a color rendition in the axial plane showing my heart in gray, my
lungs in black, and the tumor in yellow in front of the spine which shows up in white. The
esophagus shows up on other images, pushed to the left. This is the cause of my
symptoms.The tumor now measures 5.8x2.6x5.0 cm. On March 17, it was 2.6x3.8x3.7.
The original measurements last November were 4.5x3.7x3.5.
There was no other convincing evidence of tumor growth.
So what does this mean to me?
The good news is that there is no new disease. This mass is causing my symptoms and
there is no unexpected finding. It can be followed with serial PET scans to monitor the
effectiveness of treatment.
Should the chemo shrink the mass, it might be removable by laparoscopic technique
assuming no new disease develops during the chemo.
My Battle with Merkel Cell Cancer