Since his November 2022 diagnosis of stage 4 lung cancer with malignant lesions and lymph nodes in both lungs, WTOP's Neal Augenstein has received a crash course in the wonders of modern medicine, technology and multidisciplinary treatment.

An MRI machine is seen in this stock photo.(Getty Images/iStockphoto/Valerii Apetroaiei)

My eyes were closed during my recent brain MRI, but were wide open as I quickly scanned the results that popped up on my phone: There was no evidence lung cancer has spread to my brain.

Since my November 2022 diagnosis of stage 4 lung cancer with malignant lesions and lymph nodes in both lungs, I’ve had a crash course in the wonders of modern medicine, technology and multidisciplinary treatment.

My one-pill-a-day targeted therapy began in December and killed most of my EGFR-mutated cancer by March, which cleared the way for a robot-assisted lobectomy in April, and my oncologist saying I have “no evidence of disease,” or NED.

When I reached that milestone, my oncologist told me “the surveillance plan will be similar to someone with active cancer, given that we have to remain vigilant.”

Why look for lung cancer in my brain?

According to the American Lung Association, “Brain metastases (sometimes called brain mets) occur when cancer cells spread from their original site, in this case the lung, to the brain,” and form one or many tumors in the brain.

It’s common for cancer cells to break off from the original tumor and travel through the bloodstream to other organs. In the case of lung cancer, one of the organs it most commonly travels to is the brain.

According to the American Lung Association, about 25% of lung cancer patients will have a brain met at diagnosis, and there is a lifetime risk of approximately 50%.

A major upside of having cancer with my EGFR mutation — 19 deletion — is that it responds very well to targeted therapy. The downside is with stage 4 EGFR cancer, the risk of brain metastasis is higher.

Lucky for me, and other lung cancer patients taking osimertinib — with the brand name Tagrisso — the targeted therapy also has proven to be successful in shrinking brain mets and preventing recurrence.

While scans show I no longer have active cancer in my body, there’s a possibility remnants of my original tumor are still in my bloodstream. Every three months I have CT scans — less regularly, I have PET scans.

The MRI on Monday was the first since the one I received a few hours after I was initially diagnosed with cancer, during the staging process, to determine how far it had spread. In my case, it was limited to both lungs.

MRI: My least favorite (but important) scan

Magnetic resonance imaging — or MRI — produces high-quality images of the brain and brainstem, without the need for the radiation in X-rays or radioactive tracers.

MRI machines are large tube-shaped magnets, according to the Mayo Clinic: “When you lie inside an MRI machine, the magnetic field temporarily realigns water molecules in your body. Radio waves cause these aligned atoms to produce faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread.”

The MRI is painless, but it’s my least favorite scan — mostly because it raises my anxiety levels.

Once lying on the table, the technologist positions a helmet-like device around your head. I put in foam earplugs, and additional pads are tucked in to keep the head in place before the scanning bed slides into the scanning machine.

Over the next 20 or 30 minutes, the machine produces a variety of loud knocking, banging and clicking sounds. To avoid claustrophobia, I keep my eyes closed.

The technologist is able to see and talk to you at all times, and you also have a call button in your hand to push if you’re having any problems or concerns.

Personally, my anxiety is probably higher than most people because I have a pacemaker implanted in my heart. For decades, it was considered unsafe for patients with a pacemaker to have an MRI because of the threat of the magnetic interference with the device.

My pacemaker is MRI-compatible, which means it has to be set to a specific mode, to allow it to continue working during the MRI. Between us, that’s the scariest thing for me — that my pacemaker will suddenly stop working when it’s adjusted.

Not to worry — the MRI facility coordinated with my cardiologist, and had a specially-trained technician from the pacemaker company on hand for my MRI. I never noticed as the pacemaker was switched to the safe mode.

And, whatever concerns I had were alleviated when the results showed up on my phone, Thursday as I walked to my car after my pulmonary rehabilitation session: “No intracranial metastatic disease is detected.”

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