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.