Ok brains trust / hive mind, I need your opinions here please.
Last scan (PET and CT) was generally good. The liver looks completely fine (a couple of areas of non-specific low-level activity, but almost certainly related to the past PVE and healing from recent SBRT).
Nodes - nothing specific. Again some mild activity in the retroperitoneal area that was operated on only a few months ago (and is still sore).
Lungs - here’s the issue. There are a handful of tiny (TINY) things, most less than 1mm. There are a few (maybe 2-4?) that are a nudge larger (2-3 mm) and with features more suggestive of metastasis.
CEA is sitting right on 5.0, down slightly since November (was 12 at original diagnosis, and <2 when NED).
The consensus of 3 oncologists (and the radiologist) is that at least some of the lung things are likely mets, and nothing else. No idea how many or which ones however. They’re too small to characterise or biopsy at this stage. In short: “no measurable disease”.
My disease has been quite indolent since far (2 years NED with no maintenance, followed by 5 months of a largely stable recurrence without any chemo while we did other treatments). I had 11 celiac nodes removed in March of which 5 where positive, so residual lymphatic disease remains fairly likely (I think we can safely call this systemic now anyway). I’ve basically been given the choice of another surveillance period (2 months), or to a start a maintenance regimen of Xeloda+Avastin and see what happens on the next scans.
I have 2 oncologists recommending the chemo, and 1 recommending surveillance. Interestingly the 1 recommending surveillance is by far the most experienced of the lot, and has been my primary onc since day 1 almost four years ago. His clinical skills are uncanny. He does not believe there is any evidence supporting chemotherapy improving OS at this stage, and also that another scan in 2 months would likely tell us more about the biology and what we should be going after now (eg with ablation or SBRT) - a result which could be obscured if I was on chemo. He argues there is no life-threatening/limiting issues right now to justify a harsher regime, which should be saved for if/when needed. He indicated he would not object to me doing maintenance chemotherapy now if I wanted to, but the overall long-term benefit is likely to be negligible.
I’m truly on the fence here and appreciate your thoughts!
Thanks,
Rob