As the Chemo Treatment with Oxaliplatin for me is approaching my maximum dosage tolerance, I am quickly facing a management decision point. I have consulted my 1970 Johns Hopkins Medical School classmates as to their collective expertise. Surprised me that none of us went into pancreas as a specialty. Of course many suggestions were offered. The most logical and intriguing suggestions have been a simultaneous treatment of Trans Arterial Chemo Ablation (TACE) i.e. ablation thus clogging of the arteriole vessel supplying the metastatic liver tumor lesion and combine that with the new strong Proton stereotactic body radiation therapy (SBRT) to the growth.
October 31st, I checked in at Virginia Mason while Linnea transported my Mom to spend the day with my cousins at their home in Lynnwood and then return to accompany me through my chemo infusion. The nurses accessed my ‘port’, drew blood for tests and sent me to get my CT scan at 10:00. My Chemo Rx was to begin at 2:00 so I had time on my hands. After my scan, I filled my prescriptions and then I went to my surgeon’s office hoping that even without having any appointment if he had time, he’d see me for a few minutes. Dr. Helton was very obliging; he called me into his office almost right away. We discussed the possibility of surgical removing part of the liver with the metastatic tumor. Dr. Helton was totally against that idea. He used to do just that, but discovered that the success rates of survival were very bad. Patients’ quality of life drastically deteriorated. Surgery dramatically alters the immune system which in me seem to be holding the tumor in check. We looked at the CT scan just taken and found that the size of the tumor had not really changed. He will not do surgery to/for me and he is the Chief Biliary Surgeon. If I really want the lesion out, he’s sure I can find someone willing to cut on me. His advice for me is to continue living life as I am doing and enjoy good quality as long as possible.
I met up with Linnea, had lunch and went back to the Infusion Center. There the nurse printed a copy of my morning blood work for us. All the findings are very similar to previous tests except that the tumor marker now is at 289, indicating a continual rise over the past 8 weeks, first more slowly, now considerably more rapidly! Next Dr. Picozzi stepped into our room. He was armed with this information. Additionally he had also already consulted the radiologist re: the “fuzzy” borders now surrounding the liver tumor. The possibilities: #1. The cancer has become more active and has broken through the original ‘shell’. (This indicates the current chemo regimen is not very effective.) #2. The body’s immune system is at work and has established the area as the battle ground causing inflammation in the neighborhood. (This would be very good news!) #3. There are new lesions growing and secreting the added CA 19-9 protein that is not detected or visible via the CT scan.
Dr. Picozzi suggested no treatment for this session. He scheduled a PET scan for Friday and we will re-evaluate the situation with Dr. Picozzi on Monday November 6th. We drove to pick up Mom in Lynnwood and Melissa Ye, a young genuinely fine niece of mine, treated us and some relatives to a delightful Sichuan dinner.
This is the most up-to-date development along my medical journey. Thanks for reading this report and for your continual prayers and good wishes.
I’ll be writing another update next week.
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