Thursday, January 10, 2013

A New Plan

Fortunately, the radiologist at Stanford got back to me the follow day. He'd been on vacation, and returned my call and my oncologist's the day after he got back.

Essentially, the radiologist wasn't expecting to see too much dramatic shrinkage, as there's typically some swelling/inflammation still present this close to the radiation being administered. He doesn't think there's been any progression of the tumor, and both he and my oncologist believe that the disease has stabilized. My oncologist did a tumor marker test (CA-19) and it's now in the normal range. When I first did had the marker taken it was 142. Then it dropped to 97, then 67, then 69, then 40, and now 14.

What does this mean?

For starters, this all suggests that the disease is stable, and that the radiation is working to kill the tumor. There aren't any apparent metastases elsewhere. The radiologist indicated that the radiation will continue to work for a while longer to kill the tumor and its cells. I'm going to continue to do chemotherapy to try and shrink the tumor. My oncologist indicates that we're too soon in the process to immediately start changing drugs and that we should do 2 more cycles, and I believe her. We're going to try not doing these shots that are supposed to counter effect the chemo wiping out my white blood cells (WBCs), since the shots make me feel horrible. We'll do blood work to monitor counts. After these cycles are complete I'll do another PET/CT scan (most likely in February) to determine both activity and size. If there's no change in the tumor, then we'll see about introducing another drug (or drugs).

After the scan I'm hoping that we see minimal activity, no metastases, and shrinkage or melting of the tumor away from the blood vessels. I'm coming to accept that there's a very real possibility that I might not be able to make it to surgery if the tumor doesn't respond to the chemo. I'm hopeful, but I need to be realistic, and I'm not one to bury my head in the sand. I'll need to remain cognizant of the situation, so I can make pragmatic decisions.

I'm going to do the aforementioned test that involves me providing a blood sample, and them testing to see if there are certain chemotherapy agents that cause the tumor cells to have a dramatic reaction (i.e. die). The results of the this test could be instrumental in finding the right drug(s) to use. I'm on Gemzar and Abraxane right now, with Gem being the backbone of PC treatment.

I feel a bit better with this plan. Since I'm tolerating the chemo treatment pretty well, I'm even considering going back to work. I'm not quite sure on the timing, and there are a lot of "ifs" to still be worked out. I'm going to have to spend some time talking with my employers and others to see how to handle. I don't want this option to blow up in my face if I end up needing to take time off again.

Sidenote: this week has been crazy. I had an ERCP to replace the stent in my pancreatic portion of the common bile duct, then chemo, with blood work kicking the week off. I also need to do more blood work on Friday, as this chemo really wipes out my platelets. Since I'm not doing the shots for my WBCs we're also watching those numbers. I might have to go back on them if they get too low. I have the next week off, so all my counts should go back up.


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