As I wrote about scanxiety in cancer crap, I was thinking about how much more I’m terrified of the MRI scans than I am of the CT scans and then I realized something. I bet you don’t know why I have two oncologists. It’s not like I’ve explained it or anything. So here goes…One is a medical oncologist, Dr. Vanessa Bernstein. The other is a radiation oncologist, Dr. Isabelle Vallieres. Each continues to be part of my medical team not because of the medications I’m on and the radiation I’ve undergone, but because each one takes care of a different part of my metastases.
Dr. Bernstein gets the cancer below the neck, in my body. It’s that metastases that she is treating with Ibrance and Letrozole. This is the cancer checked by CT scans. And if the first line of treatment stops working, there are others that can be used.
Dr. Vallieres gets the cancer above my neck, in my head. This is the cancer checked by the MRI scans. And it’s the more complicated of the two metastatic locations. Brain metastases sucks because of the blood-brain barrier (BBB). The BBB’s role is to protect the brain from threats like infection, but it also stops helpful medication (e.g., chemotherapy) from getting to the brain. As you can tell, the BBB isn’t infallible. It did let cancer cells into my brain. Drug treatment is used for symptom and pain management: steroids and anti-seizure drugs. Though, depending on the cancer type and if the BBB can be breached, chemotherapy can be used but not usually. Depending on the oncologist you speak with, targeted therapies may or may not have a role in keeping the brain metastases at bay. The only true tools are surgery and radiation. Could I have brain surgery again? Yes. Could I have more radiation? Yes. Everything depends on when and where tumours grow. I choose to believe that the targeted therapy is working on ALL my metastases. Mind over matter.
So now you know why MRIs freak me out the worst.
One day at a time.