Not what we were expecting

I haven't had to write a blog post like this for a while. Since November of 2009, actually. A blog post in which we report something other than good news.

We returned a couple of hours ago from Dan's follow-up with the oncologist (Dr. S). Unfortunately, the CT results were rather difficult to interpret. A few things were clear:
1. There was some shrinkage of the ablated area in the R lobe of the liver (good)
2. There are some shady areas in the liver and R lung that could be either post-treatment changes or new tumor growth (could go either way)
3. There are 2 enlarged lymph nodes that have not been seen on CTs before. One is in the chest by the lungs and the other is down closer to the diaphragm and intestines. (bad)

If all the questionable areas are just Dan's body recovering from the ablations and infection last summer, we just have wait and keep a close eye on it. However, if any of them do represent new tumor growth...well, that's a whole different story.

The only way to tell the difference is to biopsy the areas that are suspicious and see what's there. The most disconcerting areas at this point are the lymph nodes as that is a very common first site of spreading disease. So far, Dan has not really had much cancer growth in his lymph nodes. They actually removed several nodes during his Whipple and found no evidence of cancer at all. Thus, seeing these new lymph node swellings is not promising.

The oncologist was quick to get to action and called one of the interventional radiologists (IR) at our hospital to re-read the CT scan. The IR doc who looked it over said one of the lymph nodes is too close to the intestine to biopsy safely and that he wants some more information before he biopsies the other lymph node or the problem area of the liver.

Dan will be having a PET scan next week to see what (if any) of the areas are active "hot spots", meaning if any of them are metabolically active and growing. With that information, the IR doctor will be able to take a biopsy of the most active spot. We'll meet with Dr. S in 2 weeks to discuss the PET results and the next steps.

While Dan and I are trying to be calm and hopeful and optimistic about these findings being inconclusive or just inflammatory, we are also having to be realistic. Dr. S stated today that if Dan's cancer has returned, he would most likely send us back to Stanford to meet with Dan's original oncology team for options. Chemo would most likely be the first step, though other radiation or treatments could be discussed. My favorite line today was when Dr. S said that he wanted Dan to get the same treatment as all the billionaires (Swayze, Jobs, etc) going to Stanford--and he'd try to make that happen.

In being completely honest, recurrence has always been a possibility. The whipple got most of the cancer, but the surgeon had to leave some of the dead tumors in the liver. The ablations should have taken care of most of the liver tumors and insured their deadness. Yet, micro-tumors are very difficult to target without systemic treatment (chemo). Dan's last chemo treatment was in April of 2008, so the tumors have a long time to do a little sharing elsewhere in the body.

All of us (including the doctors) have been hoping that Dan's cancer is dead and that the spots we see are just dead tissue. That is still possible, but the oncologist made it fairly clear today that the enlarged lymph nodes are directing us away from that possibility.

So, what now? We wait for the PET scan results and then wait for the biopsy results. We probably won't have a plan of attack until the end of next month in all reality. Until then, we are praying and trying not to go into panic mode (as if Dan could ever be in panic mode!).

We are also going ahead with our plans to see the fertility specialist. Some may see this as unwise giving the current situation, but if Dan does have more chemo, we may lose any chance to have children of our own. Also, we do not know the future and want to live in the present. We are both anxious to begin a family and are not going to let the new "what ifs" get in the way of our plans. Trying to have a baby in the midst of this is our way of remaining hopeful and trusting God--the only One who knows the number of our days.

As for how we are doing emotionally, we're okay. I cried a little, switched into nurse mode and tried to educate Dan on what Dr. S meant, started dinner, vacuumed and filed. (I process bad news by staying busy--so I guess we could thank Dr. S for the clean house we are now enjoying!)
Dan took it all in, asked questions, interfaced with our parents and prayed with me. He is still as optimistic and calm as ever. We're okay.

Please join us in prayer. We need it. Thanks.

Prayer Requests:
1. More conclusive results from the PET scan (disappearance of tumor activity would be great!)
2. Wisdom for the doctors.
3. Ease of scheduling for appointments and procedures
4. No cancer cells to be seen in any biopsy results
5. Peace and hope for both of us and our families
6. An encouraging meeting with the fertility specialist
7. PRAY FOR REMISSION IN THE NEAR FUTURE
8. God's healing hand to touch Dan