It is 3 weeks after the last NGPDT treatment. This is a series of Ultra Sound scans showing progression of the tumor. Images captured on 30th June (before NGPDT treatment), 13th Aug (1 week after NGPDT) and 1 Sept (3 weeks after NGPDT).
The doctor in Singapore is alarmed with the 1 Sept Ultrasound report. The same reaction from another Oncologist with the 13th Aug report. Both doctors use the SIZE and SPREAD of the tumor as the indicator of severity of the cancer condition. Both recommended immediate SURGERY, Radiation and Chemo therapy. None of the doctor wanted to analyse the content of the ultrasound besides size and spread of the tumor.
I asked them about the peripheral vascularity and the shade (dark or lighter) of the tumor images. Both adamantly refuse to consider any other factors besides size and spread. If you look at the first 4 photos below, notice the tumor has increased in size (about 25% increase). And notice the shape of the tumor has also changed. I don't know the significance of the dark or lighter or irregularity of these shapes, but I am sure there is a reason for these changes.
I asked the surgeon this question: "What is the intermediate response of the tumor during a chemotherapy? Would the size of the tumor increase before it starts to shrink (assuming that it respond to chemo treatment)?" The surgeon replied: "We don't know what happens to the tumor in the interim because we do not monitor the tumor growth so closely. When we do chemo, we wait 2-3 months and observe the tumor size. If it shrinks, then we continue the chemo because the tumor is responding well (ie dying). If there is not change, or increase in size, we will have to take more serious course of action to remove the tumor. We don't look at the tumor in between these period".
NGPDT: The doctors told us that for a tumor to shrink, the process of killing the cells in the Tumor (a process call necrosis) will result in intermediate swelling of the tumor. It could swell up to 20+% before it starts to shrink. In this period, the tumor cells walls burst (by the Singlet Oxygen) and the WBC and Lymphocytes and NK cells starts to attack it. This process will result in the Tumor growing before shrinking. Also, the blood vessles leading to the tumor would have been severed (cut-off) and would not supply blood to the tumor. This cannot be seen in the Ultrasound report.
Next step: Tomorrow my Mom is going to the NGPDT treatment center for her 2nd NGPDT treatment for the next 10 days. We will ascertain the whether this treatment is working. Also, it is likely that we will do another ultrasound doppler scan within a week to see if there are any vascularity damages (blood vessels) as a result of this treatment. Also, we could start seeing the shrinking of the tumor on the 4th week onwards. So I am keeping my fingers cross. We will see good results. I know it will be!