Archive for ◊ 2005 ◊

Dec. 30:  Wonderful news!  Mom’s surgery is
scheduled
for Wednesday, January 11 at the Mayo clinic in Rochester.  Dr.
Farnell will be performing the surgery.  Not only is it scheduled,
but she also got
approval that her health insurance will cover it.  Thank
heavens!  Mom will
have her entourage (I think there will be about nine of us) on the 11th
at Mayo.  The time for the
Whipple Procedure has come!

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Dec. 19:  We just got some amazing news…Mom is scheduled
for surgery with Dr. Farnell at Mayo the week of January 9. 
They’re going to try to get that tumor out of there!
Mom talked to the doctor who reviewed her endoscopic ultrasound today,
and he had two major points to convey: 1) the test didn’t show anything
that made them think that surgery was out of the question and 2)
although they ran a set of biopsies on the tumor and on lymph nodes and  they didn’t find any
cancer cells.
This means that she gets to have the Whipple Procedure (the surgery
they do to remove the tumor) and there is a 4-5% chance that what she
has is not cancer at all.  Here’s Mayo’s website discussing the alternative types of tumors it could be.  She was diagnosed with mucinous adenocarcinoma. Apparently it is very hard to prove a
negative bioposy, and what she has is acting like cancer, but it’s kind of amazing news. 
The doctor ended the conversation telling her to have an optomistic Christmas:)

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Dec. 17  I’m sorry I haven’t updated this earlier if you’ve
been anxious to hear the latest news about Mom.  I keep thinking
we’ll know something more soon, but each appointment leads to more
appointments.  Mom and Dad went up to Rochester, MN to Mayo clinic
on Dec. 8 for an appointment with Dr. Farnell. 
The appointment was originally scheduled for Monday, Dec. 5, but her
records (and therefore the appointment) got delayed.  Dr.
Farnell’s assessment was a positive one.  He thinks she’s too
young to have this disease, and he wasn’t as worried about the
relationship of the tumor to the SMV.  Dr. Farnell thought the
fine-grained CT scan was well done but wanted to re-run the endoscopic
ultrasound at Mayo.  So on Thursday, Dec. 15, Mom, Andrew, and I
went up to Mayo for that test and a re-biopsy of the tumor.  Mayo
is an amazing facility.  I didn’t take any photos while I was
there (hands were full of baby), but here’s a neat website that shows some great images. 
Mom’s endoscopic ultrasound went fine, but she didn’t get out of
recovery until after all the people involved in the test had already
left for the day.  Sooo, we’re waiting to hear back from
them.  Surgery is still an option at this point.  We should
hear on Monday or Tuesday…
~Althea

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Nov. 29: Mom has had a record number of doctor appointments over
the last few weeks.  We have a horde of seven of us attending them
(Mom, Dad, Mom’s cousin Paula, Michael, Joey, me, and Andrew), and we
are starting to get assigned seats as we cram in to the doctor’s
office:)
I don’t think Mom’s tumor read the part of the book where it shrinks and goes away.  It’s being far too obstreperous, and I wish there was a way to punish it.  Our meeting with Mom’s surgeon, Dr. Matzke,
yesterday wasn’t a positive one.  When we met with him last week,
after the fine-sliced CT scan, he said he didn’t think that the tumor
was resectable (removable), but he wanted to do an endoscopic
ultrasound to see if he could get a better view or find anything that
showed that surgery was a good option.  We were frustrated to
hear that the ultrasound showed that the tumor is pushing on a
significant portion of the Superior Mesenteric Vein (SMV) and has
actually invaded a portion of the vein.  In Dr. Matzke’s opinion,
the extent of the involvement of the tumor to the SMV leads him to
believe that it is not operable. 

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Nov. 17:  We met with Mom’s surgeon, Dr. Matzke,
this morning to review the results of her most recent, finer sliced,
ultrasound.  At this point, Dr. Matzke doesn’t think that the
tumor can be removed.  However, she’s right on the borderline of
resectability, so he wants her to get an endoscopic ultrasound to see
if he can get a better view of the relationship of the Superior
Mesenteric Vein (SMV) to the tumor.  She has that procedure
scheduled for Tuesday, Nov. 22 at the University Hospial.  Our
next meeting with Dr. Matzke is on Monday, Nov. 28.

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Nov. 10: Mom (and her entourage) met with Dean Care’s new pancreatic surgeon, Dr. Matzke,
today to review her recent CAT scan and to get his take on whether the
chemo and radiation treatments that Mom went through last summer
have shrunk the tumor enough that it is resectable (removable).  If you
recall, back in early June, the surgeons decided that the tumor wasn’t
operable because it was surrounding the Superior Mesenteric Vein (SMV).

When we met with Mom’s oncologist, Dr. Diggs, on Tuesday, he looked at
her most recent CT scans and thought that the tumor had shrunk by about
30%.  He did, however, caution us that the surgeon would need to be the
one to really provide a more accurate description of the tumor size and
change in relation to other organs.  We left that meeting somewhat
hopeful, yet trepedatious about what today’s meeting would hold.

Unfortunately, after reviewing the CAT scans, Mom’s surgeon, Dr.
Matzke, said he was a little discouraged at the tumor’s response to the
treatments.  In terms of size, he said that the tumor was about the
same as it was in earlier scans.  He wants to do a CAT scan with a 2 mm
slices of the pancreas area to get a better sense for the relationship
of the tumor to the SMV.  The CAT scan mom had done on Tuesday had 5 mm
slices.  To review how CAT scans work, see this website. 
From the information he had from this rougher-scaled CAT scan, Dr.
Matzke was concerned that it looks like the tumor’s relation to the SVM
has increased since earlier scans.  It appears that the tumor is
wrapped about fifty percent of the way around the SMV.  This leads him
to the following questions:

• Has the tumor invaded the SMV?
• Is the SMV open?
• Is there a clot in the SMV? (It looks like collateral veins to
  the SMV have grown in size…perhaps to compensate for the SMV not
  flowing unimpeded…)
• How far around the SMV has the tumor grown, and is there a fat plane between the SVM and the tumor for resection?

So here’s the plan for the next couple weeks:

A) Mom has a CAT scan with a 2 mm slice of the pancreas
scheduled for next Tuesday at St. Mary’s Hospital.  Dr. Matzke will
review the scans with the radiologist to try to answer some of the
questions he posed above.  We meet with him again on Thursday, November
10.

B) If the results of the finer-scaled CAT scan do not rule out surgery, Mom will have an endoscopic ultrasound
performed at the University Hospital On Monday or Tuesday, Nov. 21 or
22.  The aim is to look for reasons why the Whipple procedure (the
surgery Mom could have to remove the tumor) could not be performed.

If both these tests show Mom to be a good candidate for the Whipple
procedure, she’ll probably be looking at having the surgery in early
December.  We’ll probably also go back to the UW Hospital surgeon we
talked to in the spring to get her opinion on the results of these
tests.  I recently found a nice website that talks about the surgical considerations for pancreatic cancer.  It has sections on the relation of blood vessles to the tumor and how surgeons decide if resection is possible. 

But one step at a time.  Today, we’re all feeling rather deflated as I
know we went into this meeting hoping Mom would be a clear candidate
for surgery.  This is teaching us patience and how to maintain a sense
of inner calm amongst the storm.

The next update will probably be next Thursday.

~ Althea

PS  I should really make a note here that through this all, Mom
has been so amazing.  She’s got an amazingly positive
attitude.  She said yesterday that she thought that this was
harder on all of us than it is on her.  I’m learning a lot about
appreciating each day, each interaction.  We have such a great
family.

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