Indolent nodules

We met with my oncologist (Dr. Villaruz) and radiation oncologist (Dr. McCall) at UPMC in Pittsburgh yesterday en route from visiting family in Grand Rapids, MI. The main nodule we were watching grew by another millimeter or so. Dr. Villaruz described it as “indolent.” I asked what that meant and as she started to say “growing very slowly,” I recognized the word and blurted out “lazy!” I remarked I’d never heard indolent used in a medical context, and Dr. Villaruz said she’d never heard of it outside of medicine. So we both learned something.

She and Dr. McCall said that there is no urgency, but that within the next 9-12 months, they would want to radiate the more clearly defined nodule and another one close to it. A third one looks like “ground glass,” a term for something that is hazy and not quite solid, but you can’t radiate something that is ill-defined and can’t be clearly imaged.

It will be much easier to do radiation in the summer than during a busy semester or the winter break, so we decided to go ahead and get those lazy-ass nodules radiated in August (likely the second or third week). What Dr. Villaruz said is also true: it can be easier not to continue monitoring and worrying about the nodules. I’d rather just zap them now and get it over with.

I will have an initial appointment to do the body mapping and then 4 or 5 treatments on consecutive days in Altoona, about a 50-minute drive from our house. Mt Nittany Hospital (3 miles away) also has SBRT (stereotactic body radiotherapy) radiation technology, but I haven’t met with their radiation oncologist and I didn’t want any delays or hiccups trying to get the two medical systems to coordinate. I’ve only got a 3-week window to schedule this before the semester starts. Plus, it is very difficult to get ahold of anyone at Mt. Nittany these days. 

My blood biopsy in March didn’t show any blood cells with the EGFR mutation, so I had wondered how Tagrisso could still be working if these nodules are also growing. Dr. Villaruz explained that they are very small and slow-growing, so they are not shedding enough DNA to show up in a liquid biopsy. I am not happy to have cancer still lurking – albeit indolently! – in my lungs. I was envisioning an all-or-nothing scenario: “Tagrisso is working” meant no new EGFR-driven cancer would appear at all. I am learning that I am learning that the reality is more nuanced. Dr. McCall said that radiation will help me get more “mileage” out of Tagrisso. I can't help but wonder how long until more nodules pop up and I need more radiation or another treatment plan. I am thriving on Tagrisso...but I am also always waiting, consciously or unconsciously, for the other shoe to drop. 

In sum, the bad news is I have nodules that need to be radiated. The good news is they are indolent and there is a very effective technology to treat them. I hope the radiation side effects will be as minimal as the doctors described (possible fatigue, ahem, indolence).

This is Finnegan, a therapy dog at Hillman Cancer Center whom I met for the first time yesterday. I love his little mohawk.