My latest round of MRI results were definitely good news. If you read my last blog you’ll know that good news basically means ‘not as bad as it could be’.
I like and trust my neurologist, and when I see him he’s friendly, smiling and as clear as he can be (which is not always very clear) about the different parts of my brain and what they’re up to.
When I don’t understand what he’s saying, I feel confident enough now to stop him – as I did this time around – and say: “That’s great. Now can you say it in English.”
The plain English version of what he had to offer was as follows: the tumour is stable, so only growing within the margins of expectations for my type of tumour; he still considers me a low-grade patient; there are bits here and there that are of very mild concern, but nothing I’m going to get excited about; how’s your cycling career coming along?
(The NHS, it seems, has the idea that I am a professional cyclist. It’s not an idea I’m in any rush to correct.)
The small area of concern is the apparent clustering of some cells towards the bottom of the tumour. He suspects that some of the tumour cells are gathering together more tightly in a small area, presenting blockage to fluid. It’s a watch and wait issue, and not something he wants to act upon.
Following my last blog, I was intrigued to pin down exactly how much growth was ‘within the margins of expectation’. For the first time since my first MRI scan I asked for a copy of the scans to examine in depth.
I have this neat piece of software that allows me to upload my scans, then scroll through each MRI slice, looking at my brain and the tumour inside it. I can also upload previous scans and compare the two.
Imagine my head as a loaf of bread. If you cut the loaf, horizontally – from the top to the bottom – into around 26 equal slices, you can look at each slice in turn. That is essentially what an MRI machine does: it takes pictures at slightly deeper depths, to build a loaf from which you can pick your chosen slice. You can also cut the loaf from front-to-back, and I have those scans too.
I’ve uploaded the images from my very first scan in April 2012 and the images from last Monday. With a bit of guesswork and experimentation, I’ve matched up a slice for 2012 with its counterpart for last Monday. Once matched, you can scroll up and down the loaf comparing the brain, slice by slice.
My findings are exactly what I tried to describe in my last blog. The tumour is indeed growing, and has been since that first scan, and probably for many many years before that. In the last two and a half years, there’s probably been over 1.5cm growth in some areas. Doesn’t sound like a lot until you remember the skull is pretty hard, so there’s only so much space to grow into.
Anyway, the tumour has definitely got ‘taller’, as well as a little wider and a little longer.
You can see the growth from the image below (click to enlarge). To the right is the MRI from 2012. Imagine looking down on my head from above, to a depth of about five centimetres. The middle image is the same slice, but this time taken from November 2014. To the left, imagine looking at me towards the back of my head, with the slice we’re comparing marked in green – this is also a 2014 image. (By the way, all MRIs come out reversed – my tumour is on my left hand side).
A couple of provisos. First, the 2014 image is more ‘black and white’ than 2012. So if things look more intense in some places, some of that is down to the contrast difference in the image, not the tumour itself. Second is that I’ve purposely picked the slices (vertically and horizontally) where the tumour is largest, just to make things as clear as they can be.
Let’s not kid ourselves. As my neurologist put it last week: “this is a big old tumour”. It takes up more than a third of the left side of my brain and is about 7.5cm long at its longest point: the top-to-bottom height on the furthest left image. But it’s not much shorter going front-to-back either.
What’s important to remember is that the tumour is not a solid mass. You can see on the scan: it’s not pushing other parts of the brain out of the way. So don’t imagine a kiwi, or lemon or any kind of vegetable. Low grade glioma tumours infiltrate and diffuse around the brain. My tumour is like a thick jam leaking around in the air pockets of the doughnut that is my brain.
So while the total extent of the tumour is pretty big, my brain isn’t having to do much to accommodate it. (It’s when the jam starts killing off the doughnut, or pushing tasty bits of doughnut out of the way, then things get a bit more challenging.)
For another six months then, it’s jam today and hopefully only jam tomorrow.