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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 trepidatious 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.

After several anxious weeks, Mom went in this morning for a cat-scan to see how effective the summer’s chemo and radiation treatments were.  Dr. Diggs, her oncologist, reviewed the cat scans, and he said that while the May cat scans showed the size of the tumor to be 5.5 cm by 5.5 cm, the current cat scan showed that it has shrunk to 4.3 cm by 2.2 cm.  That’s about 30%!  He’s not sure if it has shrunk enough to be operated on, but we’ll find that out when we meet with her surgeon on Thursday morning.  For now, the possibility for surgery is still open!

The illustration below shows the difference:

October 18: I’m happy to report that Mom’s chemotherapy and radiation treatments ended last Wednesday (the 12th), and she’s now done for at least the next three weeks.  Her body will get a good hiatus to rest and recuperate, and hopefully she’ll be feeling better and better.  The chest pain problems she was having have begun to subside.  It sounded pretty painful, but the doctors ran all sorts of scans and couldn’t find anything wrong with her.  So we’re guessing that the pain could be related to the fact that her chemo port is in her upper chest and maybe having continuous infusion of nasty drugs for six weeks irritated blood vessels in her upper chest.
As of Monday, Mom said that she is still experiencing some nausea and malaise, and she is sticking pretty close to home.
The next step (after three more weeks of recovery) is to get a CAT Scan on November 8.   Check out this site for a fun explanation of how CAT scans work.  On the 8th, they’ll be looking to see how much the tumor has changed.  Our fervent hope is that the treatments that were so hard on Mom’s systems were also really hard on the tumor and it has shrunk to the point that it is removable with surgery.  As a reminder, the primary reason that the tumor could not be removed in June was because it  involves about three centimeters of the superior mesenteric vein.  Here’s a site that talks about the Whipple Procedure, the surgery Mom will have if the tumor has shrunk enough that it is not surrounding her superior mesenteric vein.  Here’s a 9-page PDF for those who really want to learn more about the surgery.  The superior mesenteric vein drains blood from the small intestine, and because it is such a vital and delicate vein, it is very difficult to operate on.   Hence, we really want the tumor to BACK AWAY from the vein.
So that’s the current update.  Should be quiet for a while!
~Althea

Oct. 10 afternoon:
The doctors did a series of tests and weren’t able to determine the cause of Mom’s chest pain.  She’s going to be taking 800 mg of Ibuprofen (which can cause nausea…great), and she went home this afternoon.  I found a website that has some info on the connection between chemo and chest pain (chemocare.com).
Oct. 10: Mom went to the hospital this morning because she’s been experiencing chest pain over the last 12 hours or so.  As of 9 am, the doctors have done an EKG and ruled out a heart attack, but they’re doing tests to check for fluid around the heart sack and blood clots.  I talked to Mom on the phone this morning, and she said she’d been uncomfortable if she moved in certain ways, and she spent the second half of the night sitting up.  They gave her a couple baby aspirin, and she said that helped.  “Just another bump in the road,” she said.  I’ll give more updates as I hear them.
Oct 9: Four days left!
Mom started up on her chemo treatments again on Tuesday last week, and she only has (I think) four treatments left this week until she’s done with this round.  They decreased the chemo dosage, so hopefully that will help her avoid getting as sick as she wraps up.  Then we wait four weeks or so before they scan to see how much poco the tumor has shrunk.
That’s the update for now!

Oct 3:  Sorry to be belated in posting this…I tried last week and had technical difficulties…  Mom is feeling better and came home from the hospital on Friday afternoon.  Healing is always somewhat slow, but she’s on the mend.  That Fluorouracil is just a pretty nasty drug.  Mom has an appointment with Dr. Diggs (her oncologist) this afternoon, so she’ll find out then when she’ll resume her treatment (she has about a week and a half left of radiation with continuous infusinon of Fluorouracil).  That’s the update for now!

It seems like every time Mom goes in to the hospital that she stays quite a bit longer than we expect.  This time is no exception.  Mom checked herself into St. Mary’s on Wednesday the 21 because the chemotherapy and radiation were having such nasty effects on her systems.  She was feeling better at first, but then over the weekend she took a step or two back, and her digestive system still hasn’t calmed down enough to allow her to go home.
Fortunately she has a lovely view of Lake Wingra and the sunset from her hospital room, and she has as many visitors as she wants.
Chemotherapy and radiation treatments have been postponed until she’s back up and running, and unfortunately, since she has over a week left of treatments, she’ll probably start to get sick again once those start.
Since she’s been off chemotherapy, her hands and feet are hurting her less and her mouth sores are healing.  So that’s been nice.  The down-side is that the radiation has caused some abdominal pain (zapping your gut doesn’t occur without some side-effects) and her alimentary canal is still very much out of wack.
So that’s the update for today.  Mom is still in good spirits (if a little tired sometimes).  She has a room full of flowers and sometimes family and friends, and all these conditions are caused by the treatment, which is hopefully leading us toward the removal of that pernicious tumor.