It is about one in the morning, and I am experiencing insomnia, thanks to the steroids, again.  Yesterday was a tough day.  I went to the Royal Marsden to see my medical team regards to my swollen chest.  I had my bloods checked, and as I anticipated, a chest X-ray before the consultation.  The doctor agreed immediately after examining my chest that I needed an emergency CT-scan to establish if the cancer was growing again.  I asked her what did she think, and she said it was very likely it was flaring up, and that I would need more treatment as soon as possible.  At that point, I burst into tears, for the first of many times yesterday.

I went for the CT-scan, which felt more significant to me than ever before.  I knew in my heart of hearts that the cancer was back, but this would confirm it, and I needed to know.

Everything went very smoothly, and I no one kept me waiting for long time at any stage.  I have to say, my team at the Marsden are so efficient, and so lovely.

Even though the radiologist’s report had not come back, yet, it was obvious from the CT scan as well as from the noticeable swelling in my bony chest that the cancer was back.  The immediate treatment plan was to put me back on steroids until Monday when I will have my first lot of the new, more intensive chemo, called GEM-P.

GEM-P refers to Gemcitabine and Cisplatine Chemotherapy, ‘an effective salvage regimen in patients with relapsed and refractory lymphoma’.  Unlike the R-CHOP, which followed the 21-day cycle guide, GEM-P will be done in 28-day cycles.  The drugs also are not going to be given to me in ‘one go’ during one day, but in three different slots a week apart.

I will have my first lot of Gemcitabine on my birthday (!) this Monday, and then the second amount of the same drug the following Monday.  The infusion of these drugs will not take very long, about half an hour.  Then on the third Monday of the cycle, I will be given Gemcitabine and Cisplatin together.  Apparently, the Cisplatin can be very hard on the kidneys, so I will need IV fluids and close observation during the infusion, which means, I will have to stay one night at the Royal Marsden.  The fourth week will be my week off.  And then the cycle starts again!  They were talking about a possible four cycles, however they are planning to keep a close eye on the developments, i.e. the cancer by sending me to frequent CT-scans.

It is a little bit harder regime than before, but so be it.  I want to kill the bugger!  It amazes me how quickly it came back, less than two days after I was suppose to have my seventh chemo…  vicious cancer.  It also worries me how will they, I, ever get rid of it?  Apparently, it is not uncommon the lymphoma to come back.  Often, if it does, it comes back after a month or two post full remission.  I am almost happy that this happened before I got completely well, as I think then it would have been even more upsetting.

There was also some talk about a stem transplant later on.  A stem cell transplant is used to increase the chance of a cure or remission, and it usually involves intense chemotherapy followed by an infusion of stem cells, my own or from a doner (usually sister or brother).

The idea behind the stem cell transplant is that you can have higher and more intensive than conventional dose chemotherapy (and sometimes radiotherapy) to kill cancerous cells. This chemotherapy also kills the stem cells in the bone marrow that would normally make blood cells. Therefore, following the chemotherapy, you are given (transplanted) stem cells which can then make normal blood cells again.

Anyway, that is not the plan, yet.  It all depends how this new chemo goes.

Enough of this medical jargon and info!  I am going to go and try to get some sleep, if that is at all possible with these steroids.

P.S.  The PET scan has been cancelled.