#y90

It first showed up in late 2013, and it was pretty apparent immediately what it was. The dermatologist I went to in January of 2014 knew it as soon as he looked at it. He sent my biopsy results and information over to the University of Michigan because they’re one of the leaders in melanoma treatment.

Melanoma, if you don’t know, is the worst kind of skin cancer. My melanoma is a particular kind called “nodular melanoma”: instead of spreading out along the skin, it goes vertical, which means it not only raises up from the skin, it goes deep down into it as well. Nodular melanoma is the worst kind of melanoma (thus making it the worst kind of the worst kind of skin cancer). But if mine hadn’t been nodular, we might not have known it was there. Y’see, I had a mole growing on the back of my head, in my hair. I kept whackin’ it with my hairbrush. That’s how I knew it was there, and growing quickly. I couldn’t see it without mirror assistance.

A couple of surgeries followed: to get the rest of the “initial site” cleared (the dermatologist had known this was the sort of thing that would follow and deliberately didn’t take as much off as he could have, because taking more would have required a longer healing time before I could be treated and he wanted me treated ASAP), to test the local “sentinel” lymph nodes, then to clear out all the lymph nodes on the left side of my neck, because the cancer had already spread to there.

After that, we discussed options and decided to wait and watch. It meant scans twice a year at U of M (we lived all the way across the state, near Lake Michigan), but that wasn’t so bad. And so, for almost exactly five years, that’s what we did. And every time, the news was good. No Evidence of Disease (NED).

In February of 2019, my scans turned up something on my liver. We did a biopsy and, sure enough, The Cancer Was Back. Not only that, it had progressed to be farther away from its initial site (the back of my head). I had already been diagnosed at Stage IIIC before; now I was Stage IV.

Stages I, II, and III break down into As, Bs, and Cs (so you could be Stage IA, IB, IC; Stage IIA, IIB, IIC, etc.,or whatever, depending on the criteria). Stage IV is just Stage IV; it doesn’t break down into letters. There is no stage after IV.

I was - and am - officially at the worst stage of the worst kind of the worst kind of skin cancer. The cancer was on my liver, in a couple different spots, and on my spleen.

But I wasn’t worried, because I kept up with things and I knew about a great immunotherapy treatment for melanoma that was a combination of two drugs. And that was, indeed, what my oncologist at U of M wanted to start me on. I’d need to have treatments once a month. It would be the combo of both drugs at first, and then I’d move to just one of them.

We moved to Ann Arbor (where U of M is at), and I started the combo. Side effects weren’t bad in the short term, but I developed adrenal insufficiency during the course of the combo treatment. That complicated matters a bit, but I went to just the one drug and my side effects eased. We began to talk about surgery to cut out the liver tumors. The liver surgeon asked for an MRI instead of the usual CT I would have gotten.

The MRI showed a lot more liver spots. As well as an increase in the size of the spots we already knew about. Y’see, some of the tumors were so little that they just hadn’t shown up on the CT yet. The MRI is a more precise (and expensive) scan, and it caught the ones too small to show up on the CT.

My oncologist basically said he didn’t have anything else for me. Immunotherapy is the big dog in the melanoma world, and I had progressed (gotten worse) while on it. He suggested I go to this place called START where they do clinical trials and studies of new and upcoming drugs. It’s not in Ann Arbor though, it’s over in Grand Rapids.

So we moved to Grand Rapids.

I’ve been through one clinical trial but I progressed while on that, so I was taken off of it. We’ve run into the same problem here that we had in A2, really: most of the studies for melanoma are immunotherapy-based. It’s hard to find something that isn’t.

In the meantime, my liver is being literally replaced with cancer. My entire left lobe and a good portion of the right is just tumor now. My oncologist at START recommended me to an interventional radiologist who is going to pump my liver full of Yttrium 90 (Y90), which is a radioactive isotope that is administered via little beads so tiny that they’re 1/3rd the size of a human hair. This targets only the cancer and, over the course of months, should help shrink the tumor(s).

It’s a treatment, not a cure. But it will hopefully buy me time for START to find something that could cure me, or at least work better than the last study did for me. At some point, my spleen may be removed entirely, but that’s not a vital organ. The liver is the big concern.

I also have some melanoma on my scalp (and a spot in my freaking ear), but those are potentially useful for future studies. Anything I take for the cancer at this point - other than the Y90 which is specifically and only ever for the liver - has to be systemic: it has to fight the cancer EVERYWHERE. So if my little scalp spots start to shrink, that means the treatment is working. And it’s a lot easier to biopsy a bump on my scalp than it is my liver or spleen.

WHEW! That’s a lot, and it really is the quick version. I have times when it seems hopeless but I’m doing pretty good at staying positive, overall. Still, I’ve come to the conclusion that liver cancer is how I’m going to die (unless I get struck by lightning or hit by a bus or something random like that). It’s just a question of when. That’s what I’m fighting for: time.