A little clarification

Thankfully, the nurse called me back today to answer our last few questions. Official wording on pathology report: infiltrating astrocytoma with some signs of anaplastic transformation (WHO grade 3).

The pathology report was discussed at the brain tumor board meeting on Monday morning. The consensus of the multi-disciplinary group was that treatment was not necessary right now because it was a "gross total resection" meaning that there is only microscopic cells left. That being said, some of the cells in my slides were showing rapid growth, or mitosis, which is indicative of stage 3, which is why they say it's grade 2 approaching grade 3 astrocytoma. We don't want to treat it now because radiation is only done once, so if there's any changes in the scans, they want that in their "back pocket" in case we need it.

There was one test that was still pending earlier this week, the mgmt methalation test, which indicates how well the cells would respond to chemo. Mine is positive, which is, well, positive. They still use the same treatment either way, but the positive result means it will work well on my type of tumor if/when we need it. Will I need treatment eventually? Yes, we just don't know when which is why we are watching closely with frequent scans. At first it'll be every 3 months, then maybe stretch to 4 depending on how stable it is, probably never more than every 6 months. Because this is a "borderline lesion" between 2 and 3, they are likely to never space it out to the 2 year interval it was back when I was younger.

If there are any changes, we would do treatment. There is pretty much just an empty hole of spinal fluid there right now, but changes on the MRI would include increase in the "flair" view of the MRI or enhancement around the edges of where the tumor used to be. If there are changes, the standard treatment is 5 day per week radiation, 7 day per week low dose chemo oral pills, for 6 straight weeks. Then 1 month break and re-scan. Then 5 days of high dose chemo, 23 days off. Repeat that cycle for 6 cycles or as long as the body tolerates it and frequent MRI scans.

Even though I don't need treatment now, or even after the 3 months MRI scan (thinking positively), I am still going to have a consult with the oncology team at Hopkins in the next few weeks. I would be able to gather more information then and become an existing patient, someone familiar to the team and vice versa.

The one remaining question is whether this is technically considered cancer or not. The answer is yes. The report says "anaplastic transformation (WHO grade III)" which means according to the world health organization, it's a stage three tumor which is cancerous. I'm still very thankful we had such a skilled surgeon who got more than 99% of it. And while it doesn't need treatment now, grade 3 makes it more like to reoccur. We just need to be vigilant, and then treat appropriately.