Wednesday, December 16, 2009

Surgery before Christmas?

Karen's doing well. Earlier this week Karen managed to get a cancellation at the surgeon's so we met with Doctor Chamberlain today. We are a few steps closer to a concrete plan.

The location of the tumor is above a critical vein in Karen's liver. Normally you'd have 2 or 3 veins going in and out of the liver but because of Karen's resection she has only 1 left. That's not a big deal but the location of the tumor is fairly close to this vein and that makes surgery very difficult.

Our best option is Radio Frequency Ablation which involves burning the tumor with radio waves. The radio waves must heat the tumor to 70C for a 14 mins in order to get a good kill. The vein will act as a heat sink since blood is flowing through it, cooling the cells. It is also likely that the radiologist will not want to burn that close to the vein.

To get the remaining cells we'll resort to Cyberknife which is targeted radiation. This can get close to the vein which will tolerate the radiation pretty well. On the flip side the liver doesn't tolerate radiation very well so we're trying to minimize the amount of radiation by using the RFA first.

The game plan is yet to be confirmed but Chamberlain is trying to get us in next Monday or Tuesday (21st or 22nd of December). The RFA would involve a night or two in hospital but overall be non-invasive. The Cyberknife would not be done until a few weeks into January.

Appointments are still being made and hopefully we find out tomorrow what the schedule is.

Thursday, December 10, 2009

Evaluating Our Options

Karen's doing well. She's amazing actually, considering the few weeks we've had. Her mental fortitude would put Navy Seals to shame. More stress than I care to mention.

As the last post indicated, a PET scan showed cancerous activity in K's liver. We had a subsequent MRI. The MRI machine "broke" so that had to be rescheduled. Moriarty had some vacation which made scheduling difficult but we figured it out.

The MRI says there's a 2cm X 2cm sized tumor in Karen's liver above some veins. This is not good news considering this was an area already treated.

We do have some options, one of which we investigated today. Dr. Moriarty referred us to Dr. Schwartz, a radiation oncologist (someone who treats cancer with radiation). With tremendous luck we were able to get an appointment.

Schwartz walked us through the radiation option which amounts to a thing called the Cyberknife. Sterotactic Radiotherapy. What would happen is that 3 or 4 pieces of gold would be placed in Karen as markers. Then a special cushion of her body would be made. After the gold has settled (about 1 week) the surgeon would perform a very very fine CT scan of her abdomen. Then as Schwartz said, "the physicists take over" and they build a plan to shoot radiation into the tumor from every angle. Imagine an orange stabbed with a hundred knitting needless.

There's a 70-80% chance of the tumor being responsive to this and dying. That said there are better options; surgery first, RFA second, radiation being third in the list. If the radiation is done and cancer comes back in the same area, radiation cannot be used again and it would make future surgery more complex.

We will meet with Chamberlain (our surgeon) on the 23rd to explore surgery as an option. Rest assured, we will get to NED again.