Note: This article is cross posted from The Kidney Cancer Chronicles.

I’ve discovered that you are not supposed to eat three hours prior to getting a CT scan. Now I’ve had an awful lot of CT scans; indeed, I’m sure if kidney cancer doesn’t get me some other cancer will due to all the toxic radiation that’s been pumped into my body with CT scans, PET scans and x-rays over the last couple of years. Despite my veteran status as a radiation-eating, CT-riding mechanical bull champion, I’ve never held off eating breakfast in the past during the many scans I’ve had at Duke and George Washington University. When I mentioned to Fabulous Alice, our trial nurse, that I’d enjoyed a bacon, egg and cheese sandwich prior to the scan, she asked if I was kidding. Do I usually kid about egg sandwiches? Surrounded by terminal illness and chemo-nauseated patients, and confronted with my own mortality, do you think I would jest about an eggs? Alice rolled her eyes at me. “That could mess up the imaging,” she said.

Which may explain the confusion that occurred next. The oncologist walked in with a grim expression and informed me that I had a startlingly large new tumor in my stomach. “It’s as big as an egg sandwich,” he said. “In fact, it looked delicious.”

[pullquote]The oncologist walked in with a grim expression and informed me that I had a startlingly large new tumor in my stomach. “It’s as big as an egg sandwich,” he said. “In fact, it looked delicious.”[/pullquote]

Okay, okay, while I made that last part up, I did indeed learn that I’m not supposed to eat three hours prior to a scan. Which raises all kinds of dilemmas: failing to eat greatly increases the likelihood of my passing out when getting stuck with a needle; due to low blood sugar, failing to eat also tends to bring out an physio-emotional state in me that is not unlike a drug addict in the throes of withdrawal, greatly increasing the chances that I will bite somebody in the liver or strip naked and dive gloriously through the cancer center’s second floor wall of sun-drenched windows; and, most alarming of all, failing to eat tends to prompt an inexcusable irritability in me and increases the likelihood of snapping at my wife, who will not hesitate to brain me with any medical instrument within reach. If I am to be killed by cancer, I prefer that it not be at the hands of my wife with a stethoscope around my neck.

But I digress. I think you had asked how the scans went.

In a nutshell: Very well.

The disease is, for the most part, stable. Considering how quickly the mets had reappeared in my lungs immediately after what we thought was a successful lung surgery in December, how the disease had moved quickly beyond the lungs and begun hopping lymph node to lymph node, that I’d wasted almost two months in between lung surgery and getting my first infusion of MDX-1106, and how immunotherapy does not work overnight … I was braced for a report that the disease had spread to at least a couple more lymph nodes and that the mets in the lungs had grown significantly. I was prepared to accept this and soldier on for two more months before drawing any conclusions. That the radiology report came back showing largely stable disease was as much as I could have hoped for, and, I believe, indicates that the MDX-1106 appears to be working.

I was delighted to have the chance to meet with Dr. Hammers, my primary oncologist, to go over the scans. Childishly, I like to think his German accent gives him a deeper understanding of the mysteries of life and cancer. I figure if I can’t always understand every word he says, it’s because my brain isn’t big enough. It’s like driving a BMW; I don’t know exactly why it feels better than driving a Chevy Citation but it must be attributable to German engineering.

Dr. Hammers was kind and attentive as always and answered all the questions Dena and I could throw his way. Which weren’t that many – for once. We were still a little stunned that we may already be seeing positive results from the treatment. We are also still digesting what might have been the most critical information that came out of our session today: A significant presence of necrosis in many of the mets.

A digression: Necrosis is just a fun word to say. I plan to work it into my daily conversations as much as possible. “Sorry, I lost my cell phone reception, just went through some kind of necrotic air space.” “You better have those reports on my desk by the end of the day or I’ll have you’re necrotic head on a platter!” “Blast it! The battery in my car just necroticized.” This phrase will enter my vocabulary along with the term “opiate naïve,” a great term I learned from Alice. She told me I needed to take more pain killers to deal with my back pain, and I said I was hesitant to start taking a bunch of Percocet or oxycodone, as I didn’t want to end up addicted to pain killers. Which is just embarrassing. If you’re going to be an addict, go for something big – heroin, maybe, or Pez candies but not pain killers. There is no such thing as suburban chic. Alice waved me off and said I was “opiate naïve.” Which at first did not go over well.

“Screw you, you are – you’re naïve, Alice,” I sputtered. “I have street cred, man. Look at these jeans. They barely stay on my hips.”

“Opiate naïve means that you don’t have a high tolerance for pain killers,” she said. “If you did, you’d have to take higher and higher doses for it to work, which leads to the possibility of addiction. You don’t. You’re fine.”

Well then. So we popped open a bottle of Oxy and slurped it down with some bourbon and traded stories about our moms. (No, sorry, that was a lie.)

Back to necrosis.

Dr. Hammers pointed out that a great deal of the mets had necrosis at their centers. As fun as the word necrosis may be to say, it’s even better when you realize what it means: death. (Literally – it springs from the Greek word for dead.) In other words, the tumors appear to be dying from the inside out. The killer T cells of the immune system appear to be swimming their way, sperm-like, through the blood tributaries which feed the tumors and are diving right into the core of these berserk cells and attacking them from the inside.

Tell me this isn’t a great concept for iPhone app game.

I don’t want to oversell this business of necrosis. It is very encouraging news, but cancer has a chilling way of adjusting course and overcoming obstacles. It’s like a biogenetic form of HAL, fully in charge whether you know it or not, chillingly adaptable and seemingly impossible to kill.

Nonetheless, we are optimistic. Not just for our own situation but for what MDX-1106 could potentially mean for the treatment of kidney cancer at large. And not just kidney cancer. Melanoma has shown promising results, and the drug is also being tested on lung cancer patients.