BEST NEWS:
Per yesterday’s very fine-slice CT scans: there is no tumor on my pancreas! No pancreatic cancer!
OTHER NEWS:
We need to move on to treatment without delay to relieve my liver of the burden of the many neuro-endocrine tumors already there growing at an unknown rate.
There are cancerous growths in my thyroid that may or may not be related to the existing cancer. That can be determined by a biopsy which can be done here in Houston or in Virginia.
TREATMENT PLAN:
Chemotherapy to start within the next couple of weeks. Two successive Mondays followed by one Monday off; repeat for 12 weeks total. Take another CT scan to observe any changes. Adjust the treatment plan accordingly. Hopefully, the tumors will have shrunk or at least stopped multiplying and growing.
DETAILS:
Working diagnosis: High grade Poorly Differentiated Neuro-Endocrine Carcinoma, primary site unknown; metastasized to liver with heavy load of tumor growth; no pancreatic tumors observed; thyroid anomalies present. Interpretation: This is the worst case situation for this type of cancer that does not show its symptoms until the very latest stages of the disease. Thus the need to move on the treatment as soon as possible.
Further diagnostic tests: 1) examination of liver biopsy tissue for confirmation of “high grade poorly differentiated” status of liver tumors, and 2) ultra-sound guided biopsy of thyroid right lobe to determine if this is a separate cancer site or is a metastasis of the neuro-endocrine cancer.
Treatment: Chemotherapy recommended by MD Anderson to start at earliest opportunity. We have decided to have that happen in Virginia where we can be comfortably at home in our own house with our local cancer center team. The standard treatment of this is Irinotecan (Camptosar) and Cisplatin (CDDP, DDPPlatinol, or Platinol-AQ), both administered IV requiring about 6 hours on two successive Mondays, skip a Monday and repeat the cycle for 12 weeks before measuring status of tumor growth.
Typical side effects for a full dosage include loss of hair (eek!!) as well as other things less obvious but potentially much more serious. This was a very tough decision. We do not love chemo. It is scary. But we are now convinced of the need to slow and hopefully stop any further liver deterioration because you cannot live without your liver! The dosage recommended for me is 50% or less than the full dosage, so perhaps the symptoms won’t be as severe as the worst-case reports.
After this treatment course is completed we will have a total re-evaluation of my overall condition. Then we will plan the next phase of treatment. Several possibilities have been evaluated by us already, but we need to stabilize my liver before we move on.
Copyright 2007
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