I finished my third cycle last week. Again, things are getting marginally worse each cycle. My doctor put me on a little more aggressive anti-nausea regimen as we get into the later cycles – still no sickness, but my appetite was non-existent late in the treatment cycle and into the next weekend.
On the blood count front, my levels again dipped pretty low on Mon (0.7 ANC) but again bounced back later in the week (5.5 ANC). Tests from my follow-up visit this past week show the same pattern, so I can expect another dip into my last cycle – so while I still need to be careful, it's not something that will affect my treatment schedule (nor do I need I Neulasta).
As I mentioned, I also had a CT scan prior to the third cycle. According to the report, "the previously described, minimally enlarged, left periaortic lymph node appears smaller on today's exam, currently measuring 1.5 x 0.8 cm, previously measuring 2.0 x 1.1 cm. Previously described additional shotty retroperitoneal lymph nodes are unchanged. No new lymph nodes are identified in the abdomen or pelvis. No evidence of metastasis throughout the chest".
One thing my oncologist mentioned is that the actual reduction in the cancer cells is probably larger than those numbers suggest. The CT scan only shows the size of the lymph nodes and doesn't differentiate between the type of cells present. What's likely, I'm told, is that some of the cancer cells have turned to teratomas. Teratomas are mature germ cells which can grow; they are not malignant by themselves but can turn into late-stage recurences particularly as a muscle cancer.
Ultimately, this means that the chemotherapy is working, but I will definitely need the RPLND surgery when it's all over. (There was only a very small possibility I wouldn't, but I was still holding on to that chance!). There's also a very, very small chance I may need an additional two cycles of chemo after the surgery, but given the reductions my oncologist said that's unlikely – but we won't know for sure until after the surgery.
Other than that, things are moving forward. I start my fourth and final cycle the day after Easter, and then will probably have the surgery sometime in mid-late May or early June.