Cancer of unknown primary (CUP) is a quite common - but little-publicised - form of cancer that has no findable primary tumour, and jumps straight to metastatic stage. It's not curable, and generally has a very poor prognosis: median survival rate is 3-4 months after diagnosis. However, I got lucky (or, at least, as far as can be lucky under the circumstances). Some forms - such as the lymph node type I have - are less aggressive, and respond well to chemotherapy. It doesn't alter the outcome, but it can 'wind the clock back' considerably, with potential survival time of a few years rather than a few months. I had a good response to cisplatin / docetaxel treatment just over a year ago, got a decent period of remission, and the progression since has been very slow. I'm still thoroughly well, and used the year productively to write a book - A Wren-like Note - among other projects. You'll find previous details of the saga archived at It ain't that kind #1.
However ... my latest CT scan showed (confirming my own observation of) some new lymph node enlargement, and following a chat with the oncologist today, I'm scheduled for 'second-line chemotherapy' - a course of another combination treatment, GemCarbo - starting in a couple of weeks. It's not a shock or reason to panic; there's no immediate danger, and it was inevitable that I'd need more treatment sooner or later. A year's good health has been abundantly worth the price of a few months' unpleasantness, so I'm content to try for the same again. It's a shorter course, and apparently GemCarbo's not as taxing a treatment as cisplatin/docetaxel. So the plan is to take a break, have the chemotherapy (I have plenty to work on), and look forward to summer. First treatment is on 11th April.
11 April 2014
GemCarbo. I just had the first session. I'll have to wait and see what the untoward effects might be, but the actual procedure was a breeze compared to the cisplatin/docetaxel, which took eight, sometimes nine hours, and needed aggressive hydration and drug pre-loading. Today's took about three hours overall. I'll reserve comment until the first cycle's done.
1st May 2014
After one cycle at least, this second-line chemotherapy has continued to be a breeze overall, in terms of overt external symptoms: minimal side effects (very slight malaise and tiredness, slight indigestion and backache for a couple of days, that's all). And it's working. The oncologist confirmed today: an estimate of 50% reduction on some lymph nodes, and some have even ceased to be palpable. (Sorry, I promised not to be a lymph node bore, but this is a major result). To quote the understated line in Babe: that'll do. However ... the seriousness of chemotherapy isn't to be underestimated, and the hidden symptoms are substantial. Gemcitabine is particularly toxic to the bone marrow, so despite the good results so far, I'm having to take a break from treatment to let that recover. I get another scan at the end of May.
29th May 2014
It's looking good. Scan and general examination confirm the improvement, and I started my second cycle today. Unfortunately I had an allergic reaction to the carboplatin - not at a life-threatening level, but it was pretty unpleasant: suddenly hot, all-over itching, pins-and-needles, short of breath ... a general "Oh, shit" feeling, and I gather I turned very red. But they quickly gave me steroids and an antihistamine, which cleared it up in 15 minutes or so, and finished the carboplatin at a much lower infusion rate. It's apparently very common - and no harm done.
24th June 2014
Finished the second-line chemotherapy after four - well, three and a bit - cycles. They decided not to give me carboplatin again; had to delay the remaining gemcitabine because of blood counts not being great; and have cancelled the last one (I started running a temperature, and had a couple of days in hospital on precautionary antibiotics - and unpleasant magnesium supplements). However, I feel pretty good, and I'd call it a successful treatment overall. Now it gets into "watch and wait" again.
It's a trifle unnerving to be moving out of well-charted territory (not that CUP is well-charted at the best of times). After second-line chemotherapy, things start to get rather ad hoc - maybe radiotherapy, maybe 'worth a try' chemotherapy. I have another scan scheduled, and we see where things go from there.
28th July 2014
Good news: scan shows no significant differences. No current treatment needed - review in three months.
- Related reading: The Journal of a Disappointed Man.