Question: When do cancer scans shift from disease monitoring to routine checkups? Answer: You decide.
A month after my husband and I were married, he was running for a bus, tripped on the curb, hit the pavement, and thought he’d broken a rib. He'd broken ribs before and didn’t think he needed to go to a doctor about it, but after a few days, when the pain seemed to get a bit worse, he decided to get it checked to make sure it wasn’t anything more serious.
That decision saved his life ... just not in any way we expected.
The initial reading of the X-ray confirmed that he’d only broken his rib with the additional pain likely resulting from the stiffness and soreness of the bruising. Several days later, though, we got a phone call saying that a more comprehensive reading of the X-ray revealed a spot on his lungs that merited further investigation. A month later, after additional scans and a biopsy, the diagnosis of small cell lung cancer was confirmed. Without that X-ray (and the careful reading by the radiologist), we would never have discovered the cancer as early as we did, and this is a particularly bad and aggressive cancer: At the time my husband was diagnosed, we were told the two-year survival rate was roughly 40 percent and the five-year survival rate was less than 5 percent. (Recent data suggests only a slight improvement, with the five-year survival now ranging from 5 to 10 percent). We shifted from celebrating our recent nuptials to planning our cancer attack.
My husband immediately started the rigorous regimen of simultaneous chemotherapy and radiation, which was followed by prophylactic brain radiation. Scans conducted halfway through the initial treatment showed the cancer was getting significantly smaller and those conducted at the end showed it to be in remission. This was a great result. Some people don’t even make it through chemo before the cancer returns because this cancer tends to come back quickly — and when this cancer comes back, it comes back with a vengeance.
We started to live our life two months at a time — living in the interval between the follow-up scans necessary to monitor the course of the cancer. We’d try to live as normally as possible, packing in as much as we could. The night before the scan we’d be a little anxious and nervous, afraid of the news that might come the next day. And then there was the relief as the scans revealed the cancer was still in remission. We’d celebrate and then go back to living life as best we could for the next two months, under the shadow of the next scan.
As the results continued to be favorable, the interval between scans was lengthened to three months. And then I realized that the longer this cancer remained in remission, the greater the chances were that it would stay in remission, so every negative scan meant the odds were getting better.
I realized this meant we could change the way were living our lives. Instead of living in the intervals anticipating the cancer axe falling at some point, we could live a regular, continuous life again, punctuated by the regular checkups you would have to monitor any ongoing condition. We could shift from “sickness” to “health” just by saying so. Nothing in the medical treatment or monitoring schedule had changed — this wasn’t a moment that had a medical definition or was discussed by our doctors — it was purely a self-created shift in outlook. This wasn’t positive thinking, hope, optimism, or wishing for a good outcome, it was simply a change in the way we thought of the scans. We knew there was still a chance the scan results would show the cancer returned, but we’d deal with it then. In the meantime, we were back to looking forward to a future — one that could be lived more than a few months at a time.
It’s now been almost five years to the day of my husband’s diagnosis. The cancer is still in remission, and we're living life.