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The appointment with Dr. Hoff yesterday was not routine. Chemo is again postponed. But this time it is because of good news...
The tumor in my liver has again shrunk drastically due to the last two rounds of chemo. So much so that Dr. Hoff believes I am now at a state where surgery is feasible. The actual decision will come from Dr. Nicolas Vauthey, my surgical oncologist, who would perform the liver surgery. I would have met with him yesterday, but he is in Europe for an international meeting and does not return until next Tuesday. I will go back to meet with him Wednesday, Dec 18.
The decision that Dr. Vauthey must consider is:
1. I still need chemo to reduce the tumor more, or
2. I am ready for surgery.
If (2), then there are two options for the surgery:
2a. A one stage approach. In this case, there would be one major surgery to cut a large chunk out of my liver. Even though the tumor shrunk, they like to take out every part of the liver that was ever cancerous to better prevent the cancer from returning. So they are talking about resecting more than half of it. This surgery would likely be on Dec 22 (a visit from St. Nicolas Vauthey?).
2b. A two stage approach. If the portion to be removed is large enough, Dr. Vauthey will do a two stage surgery that he has pioneered at MD Anderson. The first stage is called portal vein embolization (PVE). In this stage, they go in and place artificial clots in the liver vein such that the good remnant is fooled into thinking that it is carrying all the load of the liver, so it starts growing. Thus, we get a head-start on the regeneration process. Then, at the time of the actual resection (about a month later), the percentage of liver removed is actually smaller, decreasing complications and increasing chance of recovery. If we do this option, stage one will probably be next Thursday, Dec 18, and stage two will be in mid January. The first stage is not too traumatic - usually requiring only one night in the hospital. The second stage is major surgery. You can read about PVE here.
I asked Steve Wei, Dr. Vauthey's assistant, what he thought Dr. Vauthey would decide. His reply was that he couldn't say because "we don't see this very often." By that he meant they don't see such initially large tumors shrink so much from the chemo. Steve emailed the CT scan report and the digital images to Dr. Vauthey. If the decision is obvious to him, I should hear this week what to expect. But if it is a tough decision, there will be a doctor's conference on Tuesday where Dr. Vauthey will discuss the case with other oncologists and radiologists involved with my case. I get the feeling from the medical team that this is somewhat unchartered territory. I don't think anyone expected that as advanced as my cancer was in June, we would be at this point today.
Because surgery is likely on the near horizon, Dr. Hoff decided that I would not have chemo now. (yippee) I need to be as healthy as possible for what is coming. So after the meeting, I turned around and drove back to Dallas. Mark Dishman accompanied me. Christine unfortunately missed all the excitement due to the bad cold she has. This was very disappointing to both of us.
So what does all of this mean for my overall prognosis? If this surgery is successful (success is declared if they remove all the cancer in the liver and see no other cancer elsewhere when they go in), then my chances of survival are drastically improved from what they have been. Dr. Hoff told me "most of the time" it is successful. However, statistically there would still be a greater than 50% chance that the cancer would come back. I say this not to be pessimistic, but to let you know the urgency of continued prayer. I am continuing to be hopeful. This is now mixed with much thanksgiving. I thank the Lord for the remarkable shrinkage of the tumor. I am thankful for being at MDACC and for having insurance and finances to get all of this expensive care. And in the short term, I am thankful for getting another week off from chemo!
Posted by Greg at December 09, 2003 11:16 AM | Comments (13)