Friday, October 24, 2008

Too Many Horses in the Corral...

When I first consulted the hepatic surgeon, he described situations where “unforeseen” lesions might be discovered during the ablation procedure. This happens when he utilizes an ultrasound device—directly assessing my liver. He suggested that previously unseen lesions appear in about 20% of his cases, and wanted to know how to proceed should that happen to me. I asked that he limit any surgical intervention at the boundary of “if it makes a difference in hepatic function,” and awaken me for further discussion.

Unfortunately, he found some. They describe the cancer as “thinly veiled” lesions, rather than more substantial tumors. At this stage, “how many” isn’t an easy question to answer. My layman’s view is that 40% my liver has spider webs of cancerous cells running through it, very light and wispy. That’s why they don’t appear on CT or PET scans. Is it one large spider web? Seven small spiders with long, interconnected legs? The real answer is that “they” exist…meaning additional cancer cells aside from the known lesion on the anterior surface.

Rather than surgically remove the sizeable segment, they closed me up. The ablation procedure would scar the area, hiding any future lesions that might arise behind it, and we’d have to wait for it to heal before any other types of treatment could begin. The good news, thankfully, is that they found my liver to be very healthy. They could tell that I’d had significant chemotherapy, but nothing else should challenge my liver’s ability to heal from all this attention.

I met with my oncologist on Thursday. We’ve chosen to pursue a course of treatment that will place several/many chemotherapy pellets in my liver itself, as a “targeted response” to the spider web. I’ll consult with an interventional/diagnostic radiologist here in town before this is done. At this point, I don’t know how they implant the pellets into the liver, how many there will be, or much else. They’ll sow the seeds near the spider web, planting others near the lesion we thought we’d burn off. It would be nice to know that the ablation had been completed and things were “finished” for now, but I invited myself into this situation when I said we’d need to talk over any new diagnostics before they got out their scalpels.

Resection is a little frightening, frankly. I’ve proven that cancer cells can invade my liver. Removing a sizeable portion and leaving a healthy segment seems ripe for new invasion….reducing my future options. All of the docs I’ve seen recently agree. My oncologist agrees.

There are many reasons that additional systemic chemotherapy is uncalled for. There are no clear explanations why the multiple scans didn’t pick up the spider web. For now, I’m recovering from Tuesday’s surgical view of my abdomen and feel pretty well. The tummy is just as sore as if they HAD done the ablation, since they put me under the general anesthesia, only to button me back up after looking around. My gall bladder is fine. The adjacent diaphragm is fine.

As I mentioned in the last post, we’re confident they are confined to the corral. We thought one little pony would be involved, yet it turns out I should have been talking about a Barn and Charlotte’s Web.

My mood, frankly, is one of grave disappointment. I’m sorry that I must share difficult news with all the nice people who care so much about me, and somehow feel responsible for the work of the radiologists who simply couldn’t see more. Otherwise, I know the best course is to “just keep playing” and that’s my plan for the next month. Will I miss work? How long does it take to recuperate? All I know it that targeted chemotherapy is much less problematic than systemic, and that I’ve tolerated systemic chemotherapy quite well. I’m confident I’ll handle this just as well.

Thanks so much for the nice phone calls, notes and prayers. We’re still putting them to a test, but so far they seem to be working out just fine!


At 4:09 PM , Blogger Eileen said...


Thanks for the update. You've been in my thoughts. Keep fighting the good fight -- you have lots of friends cheering you on!



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