STATE OF MY CANCER---AN UPDATE

B.RAMAN

(Medical history. Will be 77 in August next )

 

27-9-2009—Heavy blood in urine after I returned from evening walk. Only one episode.Underwent cystoscopy in Apollo Main, Chennai. Urologist—Dr. Murali Venkataraman.Biopsy result: “ Bladder biopsies superficial and deep and prostatic chips showing features of a high grade carcinoma. The morphology is suggestive of a prostatic adenocarcinoma. Immunobiochemistry is advised for confirmation.”

Gleeson score test was not done. At the time of bleeding my PSA was around 4 only.

Full body PET CT scan was done on 3-11-09. Its conclusion:

“ Known case of high-grade carcinoma of the prostate.

“ Enlarged prostate with hetrogenous increased metabolic activity predominantly in the left half of the gland and in the intravesical component involving the bladder base. No obvious involvement of seminal vesicles. Metabolically active left obturator and internal illac lymadenopathy--- metastasis.

“Hypermetabolic skeletal metastasis involving the right aia of sacrum and left inferior public ramus.”

Severe urinal bleeding on the night of November 1,2009. Stopped on its own

Dr. Murali Venkataraman and Dr. I Raja, Oncologist of Apollo, Chennai, advised me to undergo total androgen blocade. Was given one Lucrin  depot injection once a quarter from November 18,2009. Took one tablet of Calutide 50 daily.

My PSA level, which was already normal, came down below one.Dr. Venkataraman stopped the Lucrin depot injection from November 18,2011. Felt  after two years of injection, it could make my bones fragile. Continued taking Calutide 50.

My PSA level started going up from Feb 11,2012, ( 1.67) and reached 14.28 on November 27,2012

In November,2012, started feeling weak, legs swollen, pain while walking, gasping.

My haemoglobin level was taken in Apollo Main 5.9.

Ultrasound scan in Bharath Scan showed:

“Bladder diffusely thickened measuring 4.8 mm.

“Presence of multiple polypoidal growths noted within the urinary bladder, largest measuring 78 + 50 mm.

“ Significant postvoid residual urine in the bladder vol 205 ml”

“ Volume of prostate is 17 ml.

“It shows altered echo pattern.

“ Evidence of calcification. “

Admitted in Fortis Malar, Chennai, hospital under care of Dr. Pari, Urologist on Dec 3,2012. Cystoscopy , CT scan and biopsy were done. Cystoscopy  conclusion :

“  Bladder tumour.

“Prostate fossa—Normal

“Large tumour from anterior wall of bladder 7 cm extending from bladder neck.”

Biopsy conclusion:

“Papillary urothelial neoplasm---high grade.

“Extent of invasion – Lamina propria

“Lymphatic/vascular invasion---Not detected.

“Histological type---Usual.

“Pattern of growth---Nodular.”

The CT scan in Malar Fortis did not indicate any abnormality in liver.

Overall diagnosis of Dr. Pari:

“ CT whole abdomen showed enhancing bladder growth with dilated and thickened perivesial lymphatic.Large hiatus hernia”

On his recommendation underwent 36 doses of radiation in Apollo Cancer Hospital under care of Dr. Ratna Devi, Radiologist, from January 2,2013 to Feb 23,2013.

On her advice, a PET CT scan of the  abdomen was taken in the Apollo Cancer hospital, Chennai, on April 29,2013. Observations:

“Multiple hypodense lesions are seen in both lobes of liver, largest in segment V measures 3.5 + 4.7 cms. No focal lesion seen. Portal vein is normal. Intra hepatic biliary radicals are not dilated.

“Enlarged retroperitoneal, retro crural and bilateral common iliac nodes noted, largest paraaortic node measures 1.9 + 1.4 cms.Ne mesenteric or peritoneal deposits. No ascites.

“Hypodense lesion noted in right adrenal gland measures 2.0 + 0.8 cms.

“ Prostate measures 3.8 + 2.6 + 4.2 cms.No focal lesions.

“ Bladder wall irregularly thickened. The seminal vesicles are normal. No significant pelvic adenopathy.

“Paraoesophageal hiatus hernia noted.

“Multiple subpleural and parenchymal nodules are seen in visualised lung bases.

“Hypermetabolic hepatic, right adrenal, retroperitoneal and bilateral common iliac nodal and marrow metastases.

“ No other demonstrable, significant metabolically active disease in rest of the abdominal and pelvic regions.’

Side-effects of radiation that still continue 10 weeks after radiation was completed:

(a)      Burning sensation while passing urine. Urispass of no benefit,

(b)      Periodic constipation aggravating a long-standing piles complaint.

(c)      Severe flatulence causing discomfort in lower part of abdomen all the time.

(d). Severe & frequent belching. Sucrafil and Domstahl of no benefit

Dr. Sankar Srinivasan, Oncologist, Apollo Cancer Hospital, has been my consultant since May 9,2013.

 

B.Raman, 11-5-2013. Will be 77 in August.