Signatera™
(NOTE: I have no relationship with the company Natera, or their Signatera™ product, other than I am a cancer patient using this blood assay).
I have been through a lot, including surgeries, chemotherapy, and more scans (CT’s, CTA’s, X Rays and MRIs) than I can remember—in this three year journey. And tonight I believe the chances of still having microscopic cancer cells is better than 50/50, even after thoracic surgery less than five weeks back.
One person on my medical team said there is a lot we don’t understand about how cancers metastasize. But we can still talk about possible ways they spread because that can be useful in planning future responses. And giving a tiny ray of hope when there are no guarantees.
As I write this we know of no visible (to scans) cancer in me. The thoracic surgery took out the 2cm nodule in my lung tissue. During a ‘by the book’ lung cancer surgery there are standard procedures that surgeons follow that include how to sample a few lymphatic nodes after the main tumor (or nodule) is removed. My cancer is PSCC that embedded itself in my lung tissue… And once it was resected there were 6 additional nearby nodes resected that gave us a wider look at this area.
PRIMER: For lung cancer types:
Non-Small Cell Lung Cancer (NSCLC) (about 80–85% of cases)
Small Cell Lung Cancer (SCLC) (about 10–15% of cases).
NSCLC grows slower and is subdivided into:
adenocarcinoma,
squamous cell carcinoma, and
large cell carcinoma.
Back to my recent surgery—in addition to the main 2cm nodule, one of the six lymph nodes was also malignant with PSCC. Penile Squamous Cell Carcinoma in a lung is different than lung squamous cell carcinoma.
The meaning here is that my cancer that started a couple of years ago was able to survive a partial and full penectomy, and then four cycles of TIP chemo given over three months. And surviving these treatments it then spread up to my inguinal nodes, and on to my left lung and at least one adjacent lymph node. This MAY have been one main event, or it could have spread over time, we don’t know.
Remember I mentioned that my PSCC-infected lymph node was part of a standard lung cancer resection procedure… It was not visibly different than my other nodes, it was just in the location that surgeons (following standard procedures) will take a node from. So I know I had the main event, the 2cm in my lung tissue and also the nearby node (both removed).
New Questions:
Why didn’t any of the scans “see” the PSCC-infected node that was near the 2cm nodule?
Are there more unseen infected nodes in this same area?
Can we treat what we cannot see, just go in with chemo again, or immunotherapy (both systemic treatments)?
Good questions. I had to look up the first question—CT scans “see” structures, not individual cancer cells. You need a clump of cells roughly 5mm-10cmm for a scan to register it. Something under 5mm, even though it could be millions of PSCC cells, likely won’t show up. That’s why the 2cm nodule appeared and not the smaller lymph node.
For the same reason, the other nodes in the area don’t show anything that is large enough to make a mark on a scan, not yet! We now wait and see if other sub-5mm nodes in my body (not just in my lung area) show up.
I feel like a cancer garden in Spring, waiting to see what might grow.
The third question has an unsettling answer--at least for me. Oncologists “don’t treat shadows.” They have phrases that are a short-hand way to say they don’t treat something they only suspect is there. And there are good reasons for this. As I said in one of my YouTube PSCC awareness videos, ‘the cures can be so much badder.’
You don’t want to give a ‘chemo survivor’ more chemo, this can add cumulative side effects like additional neuropathy. You don’t just administer toxic meds because you suspect little PSCCs are in the blood stream or lymphatic system. That can be frustrating to hear if you feel you likely have cancer cells still in you.
I want this monster out of me now, and I don’t wanna’ play Whac-a-Mole for the next five years! *^%@•¶¢£!
I was feeling my grasp on the small bit of hope I had was loosening up.
But wait—there’s more. A company named Natera created this amazing capability to personalize an assay of a person’s blood to see if there is any dead DNA from their cancer. Yes, cancer sheds DNA into your blood.
So off to Natera went my tissue and blood samples, and they created a PSCC DNA test for me. This is not just some hope, this is revolutionary medical tech in the best way.
We can only see cancer cells that are large enough for a microscope to make out. We can’t see a fragment of a PSCC DNA chain. But Signatera can “sense” a fragment in my blood. The assay takes a few weeks, and Natera will send my Oncologist a report of what they “sensed” in my blood. If we get a positive result (there is PSCC DNA) then we can plan our next steps, which might be to speed up the times between scans (which we already have done). We might start looking to see if I am a candidate for the new immunotherapy treatments that would try to boost my immune system to recognize and attack my PSCC. I might need a Buck Rogers’ tattoo if this is successful.
We will see what the Signatera™ assay shows, and that will make an interesting blog post. Watch this space!
If you want to know more, you can go to www.Natera.com and learn about Signatera as well as other tools for illnesses besides cancer. This is information you might want to bookmark and share with friends and families that are impacted by cancers. I am not giving this as medical advice, I am simply sharing my journey in case it helps you ask more informed questions of your medical providers. One other resource I found was some YouTube videos on Signatera. I hope this points you in the right direction to learn about ctDNA tools.
Check out my different PSCC videos on YouTube and send them to everyone you know, including medical professionals, so we can prevent this monster disease from impacting men and their families. Early Eyes Save Lives. Spread the word, save a life.