Marshall's Health Updates #1: Diagnosis and Treatment Plan

Emerson Lake

For Friends and Family:

I wanted to update everyone on health issues that have come up for me recently. Over the last few months, I've been diagnosed with metastatic lung cancer, beginning with an abnormal chest x-ray in early December, which has led to a number of follow-up scans with my PCP in January, the pulmonology team at the cancer pavilion in Grand Rapids in February, and finally in the last few weeks of March with the oncologist and radiologist in Reed City. 

On Thursday, March 30th, I met with Dr. Kirkland, the radiation oncologist at the Lemmen Holton Cancer Pavilion in Grand Rapids, and he says that all test results are in: X-Rays, CT Scans, Bronchoscopy, PET Scans, Biopsies, biomarkers, more CT Scans. The multidisciplinary treatment team at the Lemmen Holton Cancer Pavilion in Grand Rapids, Michigan has gone over the case, determined the diagnosis and staging, and worked out a treatment plan. The diagnosis is conclusive and the current plan is more aggressive than earlier plans I may have shared with a small circle of friends and family.

The technical diagnosis at this point is Stage 4A oligometastatic non-small cell adenocarcinoma lung cancer (NSCLC), with a solitary right humeral metastasis. That means that I have a 4 cm malignant tumor in the right lower lobe of my lungs and a 3 mm metastatic lesion in the bone in my right proximal humerus which has recently become quite painful. However, all other lymph nodes and organs and other areas of the lung are currently clear of disease. 

What’s significant with this diagnosis is that it is Stage 4A rather than Stage 4B and oligometastatic rather than polymetastatic, meaning that it it has metastasized from the lung to only one other region (the humerus) and has a much better prognosis than Stage 4B/polymetastatic, which is where most of the statistics on Stage 4 NSCLC come from. The treatment team is going to approach the cancer aggressively with curative intentions. 

At this point, the cancer is too far advanced for surgery such as a lobectomy. The current, updated treatment plan consists of a week of intensive radiation -- 5 consecutive days of radiation to tumors in the lung and arm at high doses beginning in a few weeks -- followed by 12 weeks of chemotherapy plus a year of immunotherapy. Biomarker testing showed that the cancer is highly responsive to immunotherapy, which is not usually the case.  Chemo/Immunotherapy will consist of a high dose treatment session every 3 weeks by IV for 4 cycles (12 weeks),  followed by 1 year of immunotherapy, also given once every 3 weeks by IV. 

All of this will take place at the Wheatlake Cancer Center in Reed City, MI, about a half hour away from where I currently reside -- a lovely house on Emerson Lake in Branch, MI. Grand Rapids is 90 minutes away from the lake house, so driving time will be much shorter while being treated in Reed City. While Corrine and I typically travel between an apartment in Chicago and the lake house in Michigan, we'll spend most of our time in Michigan while undergoing treatment. Corrine has been incredibly supportive throughout all of this and is taking a good bit of time off of work to be with me in Michigan.

The treatment plan will include chemotherapy drugs (carboplatin and paclitaxel) in addition to monoclonal antibody immunotherapy (bevacizumab and atezolizumab). This therapy will be administered once every 3 weeks for 4 cycles (12 weeks total), followed by a year of "maintenance therapy" meaning the chemotherapy stops and the two additional immunotherapy drugs continue for one year. This is more aggressive than they initially discussed and they believe it is a better protocol for my circumstances. The initial radiation should help to alleviate the weakness and pain in my right arm as well as my shortness of breath. Common side effects of the chemo include hair loss, weight loss, fatigue, achiness, and nausea. 

Next Monday (4/3), I’ll have a port installed in my chest at the hospital in Big Rapids for the chemo infusions, as well as the immunotherapy. I have a low-key meeting with the chemo oncologist on Friday to go over the timeline and procedures for upcoming treatments. At some point during the proceeding week (4/10-4/15), I’ll go in for a “simulation” for radiation where they tattoo my arm and chest to pinpoint the sites to be radiated and will create structures to hold me in place while I’m being radiated. Then the actual 5 day radiation would start 2 weeks later (the week of the 24th possibly). The chemotherapy and immunotherapy will start shortly after that, once every three weeks at a moderately high dose. I will also be fitted for a new cpap.

During this time, I'll mostly be staying at the lake house. We have a few trips planned over the summer if I am well enough to travel, and a week or two planned to spend in Chicago. Feel free to get in touch if anyone would like to visit. 

I've been lucky to be largely symptom free until recently. I'm on opiates for pain and ativan for anxiety, which make me a bit groggy and forgetful. I'm easily fatigued and short of breath and have limited mobility in my right arm. Otherwise, though, I'm doing fairly well. Luckily, I'm on sabbatical this semester and not teaching in the summer. Corrine is able to take FMLA as needed for doctor's appointments and such and largely works remotely from the lake house. The lake house is a lovely place to recuperate. 

I'll update this blog on occasion as the treatments progress. Feel free to share this with anyone who might want to know. You can get in touch over email, text message, or social media if you like. My mailing address is 14 S. Emerson Lake Dr, Branch, MI 49402. I can also be reached at mwkitch@gmail.com.

Sunrise over Emerson Lake