這場與腫瘤的戰役自2012年 9月開打,至今仍持續激戰,看來是場長期抗戰無誤。

去年中因為敵軍入侵要塞(腦部),我方以地毯式轟炸來對應(全腦放療),本以為敵人已被全數殲滅。。。

卻又發現還有餘黨殘留,該怎麼對應??又再一次考驗著我方的智慧......


昨日回放射科許醫師門診,一進診間就感覺許醫師的臉色較為凝重,不若平常那樣笑臉迎人。

我隱隱感覺山雨欲來風滿樓的氣息,詢問:「上星期腦部MRI的片子有怎麼樣嗎?」

「大部份的腫瘤都縮小了,只是有一顆腫瘤有變大。」許醫師開門見山告訴我。

可惡!!上次全腦放療沒有殺乾淨嗎?腫瘤也實在太頑強了....

「長多大了?在什麼位置?」我壓抑內心的驚恐,繼續詢問。

「在顳葉的位置,現在大小差不多1cm,建議以電腦刀來處理」許醫師說。

註:顳葉主要功能聽覺,而且主管語言與長期記憶,尤其是語言的長期記憶  

IMG_3763

「真的確定是惡化嗎?可不可以等到下一次檢查結果,再決定如何處理?」我問。

「影像上是變明顯了,當然也有可能是腫瘤發炎導致看起來變大,但電腦刀處理1cm以下腫瘤副作用較小,所以我會建議下個月就用電腦刀處理掉;我有把你的片子拿去和其他放射科醫師討論過了,他的看法也一樣。」許醫師回答。

「電腦刀副作用沒有全腦放療大,對吧?!」我又問。

「照理來說是這樣沒錯,不過有5-10%的人會引起腦水腫、發炎及頭痛的副作用」許醫師說。

「下次檢查是3個月後,腫瘤如果真的惡化的話,會長很快嗎?」我再問。

實在不想又對腦部做放療啊!!儘管這次是局部放療,但每做一次就是傷害一次,好掙扎啊!!

「這很難講耶!狀況差異很大,如果你要等下次檢查結果也是可以啦!只是我想下個月就抓你來打(電腦刀)」許醫師笑笑說道。

「我覺得先排三個月後的檢查,要不要做電腦刀我還要再和廖醫師討論看看。」我說。

「好啊!你再和廖醫師討論看看」許醫師答道。


走出診間,正在煩心該不該做電腦刀時,突然有人走過來:「不好意思!請問妳是Cincia對嗎?」

「是!我是Cincia~」我說。

「可以請妳幫我簽名嗎?」說完從包包裡拿出我的書。

「也太厲害了,妳竟然隨身帶著?」我驚訝問道。

「平常比較忙,來醫院等候看診比較有時間看書,所以就帶了。」她回答。

簽了名,拍了合照,走之前該名癌友家屬說:「妳是我們的精神領袖,一定可以活很久的。」

我內心在苦笑,這位精神領袖正陷入苦惱當中,還不知道怎麼做決定呢......

真是頑強的敵人,該怎麼來對付呢?

【3.10 最新消息】

廖醫師來電,告知他已經研究過我的片子,也和其他醫師討論過,覺得應該不是惡化,建議暫不處理!

另外他也擔心再用電腦刀下去,對我腦部的傷害很大。

所以結論就是繼續觀察~暫時先按兵不動囉!

(真的很感謝廖醫師這麼用心照顧病患,不虧是我的守護天使XDDD)

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  • 林美麗
  • 天佑Cincia~加油
  • 謝謝~:)

    Cincia 於 2016/03/11 10:50 回覆

  • Andrew Chen
  • 電腦刀的副作用是隨著腫瘤越大越多而增加,只有一顆,趁還小就處理掉,副作用會很小的,加油。
  • 廖醫師有給建議囉!感謝~

    Cincia 於 2016/03/11 10:50 回覆

  • 重感冒
  • 加油 加油 加油
  • 一陣子沒跟妳碰面了,希望你一切都好,一起加油喔!

    Cincia 於 2016/03/11 10:51 回覆

  • 悄悄話
  • 小強
  • 很掙扎的決定,不過建議還是速戰速決,腫瘤不會等妳猶豫的。認真的女孩最美~ : )
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:51 回覆

  • Ah Gel
  • 我也覺得速戰速決。約身體能承受便做吧。
    請好好加油!你也是我的精神領袖!
    一定會好好的!
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:52 回覆

  • na
  • 加油
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:52 回覆

  • Mrs. Rabbit
  • 加油!!!加油!!!
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:52 回覆

  • surisun
  • 加油,你也是我的精神領袖啊
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:52 回覆

  • ymk
  • 加油!加油!加油!再加油!妳一定可以將敵軍打它個全軍潰敗的!
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:52 回覆

  • 原點
  • 妳有一個很好的醫師為妳把關,相信所有的難關都可以突破的。
    今天我帶媽媽去台大骨科門診,心情也沒像以往緊張,抱持著「該面對的還是要勇於面對的心」,這也是我這二年所學到的,感謝所有曾經幫助過我的每一位戰友,因為有妳們,才讓我有更平靜的心去面對挑戰。
    加油!加油!再加油!
  • 我每次看門診都不緊張啊~只是有時候醫師講出來的話會讓我緊張而已XDDDD

    Cincia 於 2016/03/11 10:53 回覆

  • Sandy
  • Cincia~ 偶也在腫瘤門診追蹤ㄝ(跟妳不同癌)。不過我是星期二下午,要不很有機會遇到妳呦 !! 大家各自加油努力~
  • 也是許醫師嗎?

    Cincia 於 2016/03/11 10:54 回覆

  • 悄悄話
  • H20
  • 好希望妳沒事唷
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:54 回覆

  • 訪客
  • 林先生故事人
    斬草不除根春風吹又生
    版主加油
    你一定可以度過
  • 廖醫師有給建議了,感謝MR.林。一起加油~繼續努力!!

    Cincia 於 2016/03/11 10:56 回覆

  • 路過
  • 先觀察看看~
  • 廖醫師有給建議了,感謝!

    Cincia 於 2016/03/11 10:54 回覆

  • David
  • Cincia 卡特總統的腦瘤 就是用放療配合anti pd1 治愈的
    原理我不再贅述
    世界上有許多科學家研究人員醫生致力於癌症治療
    每位主治醫生用的方法大不相同
    沒有那種方式一定有效
    治療效果也是因人而異
    但若是放療能配合anti pd1
    則有機會激起anti cancer免疫反應
    跟卡特總統一樣腦瘤全消
  • 我現在的狀況沒辦法用(還參加試驗計畫),謝謝David。

    Cincia 於 2016/03/11 10:55 回覆

  • David
  • Understanding Jimmy Carter’s Surprise Cancer Turnaround: A Conversation with Jedd Wolchok

    This week, former President Jimmy Carter announced that he is “cancer free” after receiving treatment for metastatic melanoma — a type of skin cancer that often spreads, or metastasizes, to other parts of the body. Mr. Carter’s cancer was discovered in his liver and spread to his brain.

    In addition to surgery and radiation, Mr. Carter received a new immunotherapy drug called pembrolizumab (Keytruda®), which releases the brake on the immune system, empowering it to mount a stronger attack against cancer.

    To get a better sense of what Mr. Carter’s surprise announcement means — especially for patients in a similar situation — we spoke with Jedd Wolchok, Chief of the Melanoma and Immunotherapeutics Service at Memorial Sloan Kettering.

    Mr. Carter received three types of cancer treatment: surgery, radiation, and immunotherapy. At this point, can we say which was most responsible for his cancer-free outcome?

    That’s a great question. My colleagues and I were just discussing this. I think it’s probably a contribution from all of the above. I don’t think it’s possible to ascribe the very favorable result to just one intervention. As time goes on, if he continues to have durable control of his disease, then I think we can be confident that immunotherapy played an important role.

    Can the combination of radiation and immunotherapy work together in a synergistic way to provide added benefit to patients?

    There is that possibility. The hope is that when you kill a tumor with a tool like radiation therapy, you release cell debris that can trigger an immune response — similar to a kind of vaccination. Then, by blocking an immune checkpoint — in this case PD-1 — you allow that immune response to really take off.

    We’ve certainly seen isolated examples of this phenomenon, called the abscopal response, with other immunotherapy drugs. I wrote a paper about this a couple of years ago with my MSK colleague Michael Postow. We’re now about to open a study using a combination of two immunotherapy drugs, ipilimumab and nivolumab, along with radiation for patients with melanoma. A lot of folks are really interested in this, and you can build a strong rationale for why it makes sense to use them together. But it has to be tested.

    Are there times when it’s not possible to receive immunotherapy because of brain metastases?

    We have a lot of issues yet to settle here. We know that the same medicines that can have a favorable effect on disease outside of the brain can have a favorable effect in the brain. There was a clinical trial that I participated in and published in Lancet Oncology about two years ago that looked at ipilimumab treatment in melanoma patients with brain metastases.

    The challenge with brain metastases is that sometimes patients require corticosteroid treatments [which can suppress the immune system] to control swelling and symptoms. In the trial I referred to, the benefit of ipilimumab was seen only in the patients who were able to come off corticosteroids. So that’s an important consideration.

    That’s why it’s good to do exactly what Mr. Carter’s physicians did, which was to control the brain metastases to the best of their ability — in this case with stereotactic radiosurgery — get him off the steroids as quickly as possible, and then initiate the immunotherapy.

    Is Mr. Carter’s experience representative of patients with metastatic melanoma and brain metastases?

    It’s becoming more and more common. Mr. Carter’s case is a great example of how far the field has come in a relatively short period. If you turn back the clock ten years or so, people with melanoma and brain metastases had life expectancies that were measured in weeks and months. Now, there are patients in my practice who have had brain metastases and have been alive for years. And of course we hope the same is true for Mr. Carter.

    I find it very inspiring that he’s been able to continue the important work that he’s engaged in without any side effects from treatment.

    It’s also inspirational to patients, who can see that a devastating diagnosis doesn’t necessarily mean that you’re going to die immediately, or that the treatment is going to incapacitate you. Here’s a 90-year-old person not just living but fully active and engaged in activities that are making the world better for the rest of us.

    https://www.mskcc.org/blog/understanding-jimmy-carter-s-surprise-turnaround-conversation-jedd-wolchok
  • David
  • 重點提示:

    The challenge with brain metastases is that sometimes patients require corticosteroid treatments [which can suppress the immune system] to control swelling and symptoms. In the trial I referred to, the benefit of ipilimumab was seen only in the patients who were able to come off corticosteroids. So that’s an important consideration.

    That’s why it’s good to do exactly what Mr. Carter’s physicians did, which was to control the brain metastases to the best of their ability — in this case with stereotactic radiosurgery — get him off the steroids as quickly as possible, and then initiate the immunotherapy.
  • lin
  • 有這麼多守護天使,你會沒事的,加油
  • 謝謝你的祝福,我也相信我會沒事的。:)

    Cincia 於 2016/03/13 10:09 回覆

  • Sam Kao
  • 美女,加油~~~
  • 謝謝鼓勵!

    Cincia 於 2016/03/13 10:09 回覆

  • ccfax
  • 妳也很頑強呀 !!!
    現在打的是"攻防戰",有攻 有守 辛苦些,請放寬心維持平衡就好,等新標靶或新療法(免疫.....等)援軍來時,再把小腫瘤殲滅吧!
    我70幾歲的老爸也正和標靶副作用攻防中(肝指數高高低低循環中)
  • 嗯嗯~我就聽廖醫師的建議吧!三個月後見分明....

    Cincia 於 2016/03/13 10:08 回覆

  • 宇
  • 雖然廖醫師是這樣建議,不過妳最好想好方案萬一等三個月後回診發現該腫瘤又變很大,甚至其他腦部腫瘤若也變大時妳該怎麼辦? 拖到三個月後照發現變很大時那時妳的語言長期記憶甚至聽覺可能已經大受影響,到時你再想因應方式就來不急了。因為那時的妳跟現在妳的思考能力已經大為不同。腦癌非同小可,絕對不是樂觀等待就可以當作沒事的。
  • 我不是樂觀等待當作沒事啊!廖醫師既然有找其他醫師討論過,就相信他阿!幹嘛沒事找煩惱阿?
    廖醫師也是擔心現在做對我的傷害很大,能不做就不做,除非覺得有必要,我也不想腦袋變笨還是受到影響阿~

    Cincia 於 2016/03/13 10:08 回覆

  • 路人K
  • 我贊同23樓,腦部的瘤越小越早處理較好,大到影響都很難處理,我也有買書
  • 感謝支持。
    腦部腫瘤的問題就交給廖醫師了,既然他說沒事就沒事啦!:)

    Cincia 於 2016/03/13 10:10 回覆

  • music
  • 請問你做腦放療以後~記憶力有衰退嗎?
    或是 記性變差等等之類的 或是其他影響
    謝謝
  • 全腦放療後我覺得短期記憶力好像變差了,其他沒有太大影響。

    Cincia 於 2016/03/13 10:05 回覆

  • 悄悄話
  • mason168
  • add oil !! 知道事情的發展很重要,但也要積極放心去做自己,我也是在努力活著,一起加油!
    放心+開心=>不勞累, 我們才可常見燦爛的笑臉!!
  • 有的有的,Cincia有很認真、開心去過每一天。
    但可能最近真的比較勞累一點,我要放慢腳步了,不然身體怕承受不住。

    Cincia 於 2016/03/16 09:33 回覆

  • peichen
  • 可能最近太累了,
    多休息放鬆...
  • 嗯嗯~最近常放空...:P

    Cincia 於 2016/03/16 09:30 回覆

  • 訪客
  • 腦部放療是很傷腦的,有人一年之中可以做兩次腦部放療嗎?

    醫生應該不會贊成一年之中做兩次腦部放療,因為對腦傷害很大。
  • 反正現在就是再觀察看看,我真的也很怕影響腦袋阿....

    Cincia 於 2016/03/16 09:31 回覆

  • 訪客
  • 何不採用折衷作法,下個月再檢查一次,看情況再說,畢竟三個月感覺有點久
  • 有在考慮,我再和廖醫師討論看看。

    Cincia 於 2016/03/16 09:31 回覆

  • 訪客
  • 之前類似狀況...醫生有提供一個思考方向...1cm..3個月後就算變化應該也在電腦刀可處理空間.所以如果肴望等待,風險是有限的.

    ...重點是即然已經做了決定..就要放宽心..不要太在意..縮小的機率也是有的...為妳祈禱
  • 我還在思考可能一個半月就再去照MRI,怕三個月後腫瘤變太大不好處理,再和廖醫師討論看看。

    Cincia 於 2016/03/16 09:36 回覆

  • 大陆哎呦
  • Cincia,我是来自大陆的哎哟!看了你的文章,真的像一剂一剂的强心针打在我们身上~患有脑转已经四年了,其中做过两次伽马刀,不知是不是你们说的电脑刀。两次接连的放射真不是一般闹着玩的,因为肿瘤在脑干位置,所以第二次的剂量让我们留下了偏瘫的遗憾~肿瘤不可怕,在大陆很多医生也已经转变观念建议保守治疗。你很幸运有一位负责任的医生,其实这样就足够了~很羡慕~
  • 感謝你的分享,也辛苦你接話兩次的放療。
    加馬刀和電腦刀機器不一樣,不過都是放射治療的一種,你應該不是兩次全腦放療吧!?這樣也太傷了....
    我的醫師真的很細心,讓我可以無條件地信任他。

    Cincia 於 2016/03/16 09:23 回覆

  • 悄悄話
  • 悄悄話
  • 訪客
  • 雞精少喝一些吧!
  • 我是喝媽咪愛心牌滴雞精(放山雞),補充蛋白質很好啊!為什麼不行?

    Cincia 於 2016/03/25 10:00 回覆

  • 嗯~
  • 這張應該是"打藥"片, 所以看到很多支白色的血管~ 可是"水"呈現黑色;
    (玻璃體是黑的); 瘤實在太亮了~ 所以大家會認為是發炎吧??? 其實它離頭蓋骨很近, 萬一電不成, 台大還有一個號稱可以插尿管連續開刀開36小時的神外醫師能幫你把它挖出來..那位醫師姓杜..
  • 悄悄話
  • Ming
  • 加油...加油...