As the sun rose yesterday morning, I found myself headed to the hospital once again.  Yes the cancer is back, but I’ve known for a while now.  I had the usual CT and MRI scans the week before Thanksgiving which came back with a “suspicious” spot on the liver.  This just days after we had announced to our friends and family through social media that I had my port removed following 5 long years of various treatments and surgeries.

My doctors (and there is no shortage of them) all circled the wagons to discuss what our next steps were.  The Wizard presented my case to the tumor board while the liver surgeon reviewed the results.  The good news is that there is only the one spot on the liver.  The bad news (aside from the obvious that the cancer returned) is that it is located in a bit of a difficult location – just under the diaphram, next to the vena cava – making traditional surgery a more complicated solution.  My surgeon suggested that he would be able to resect (surgically remove) the tumor, but that going with chemoembolization first to shrink it would improve the margins he would have to work with.  Unfortunately, I had already failed out 2 regimens of chemo – the first two in the standard line of defense (folfox and folfiri) – so I wanted to know that I wouldn’t lose my window of opportunity to have a successful resection in the event that chemoembolization failed as well.  Two things led me to making my decision:

  1. Even if the tumor doubled in size, he was confident that he would still be able to remove it.  That being said, it is unlikely that the tumor would double in a month when it took 5 for it to get to it’s current size.
  2. He felt confident that we could “get surgically creative” if necessary, though he didn’t feel that would be needed.

Fortunately there was good news in there too.  Stereotactic Radiosurgery (SRS) – aka “CyberKnife” – was another option for me to address this single tumor.  It is actually a very good option considering that I had such great response to radiation the first time around.  Best case scenario, it will completely kill off the cancer and we go back to scanning.  Next best would be that it only shrinks it, in which case I go into surgery with better margins.  In the worst case, it has no effect (highly unlikely) and I go to surgery anyway.

The doctors will place a gold pellet in her liver and use this as a marker for targeted radiation called “CyberKnife” which oddly enough does not use the internet or a knife.

~ Ed Gallagher

The tumor board came back with the determination that this is in fact cancer.  Considering that my previous scans have been clean then with the change this time around, it is unlikely to be anything else.  Even so, before chasing anything down bunny holes, we first need to dot our i’s and cross our t’s.  So a PET/CT scan was ordered to confirm that there was only 1 spot that would light up as well as to give the docs better images to work with.  In the meanwhile, my case was sent along to an SRS convention that happened to be taking place at Stanford.  Some of the best minds for this converged in one place, looking at my file?  Yes please!

It was a whirlwind of a week from my PET/CT scan to yesterday’s sunrise.  During that time I was astounded again and again by how quickly things happened and how everything fell into place.  Dr. Care Bear called me on New Year’s Eve to go over the results and to have the gold fiduciary placement scheduled asap in preparation for SRS.  He confirmed that there is only the 1 spot and pending insurance approval, we were clear for the procedure.  Once I got the procedure and diagnosis codes from the onc’s office I received approval with one call.  I went in on the same day to have my bloodwork done and then had the gold fiduciary placement yesterday.  This is all that is left as evidence of it.  Just a little hole under a band-aid.

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I’ll go into the day’s events and the actual procedure under another post since this is already lengthy, but suffice to say that everything has gone exactly as planned and I am quite pleased with progress thus far on my treatment plan.  Thank God for good insurance and great doctors!

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