So on Sunday, 7 August, 2011, she went to the local clinic. The doc started some tests, including liver tests, and noticed that she was jaundiced. I didn't notice that. The blood work indicated that her liver funcion was bad, and the jaundice indicated that she had a blockage of bile. The doctor thought it was gallstones and admitted her to Clark Memorial Hospital in Jeffersonville, IN. So she was in the hospital.
Over the course of the next 24 hours, she got a CT scan and more blood work done. The initial CT scan indicated that there was a "sludge" in her gallbladder that was blocking the bile duct. This made sense, given her symptoms, and we were thinking a laparascopic procedure to remove the gallbladder.
However, on Monday, the doctors told us that the CT scan actually showed a large (8 cm) mass on or in her liver. This what was likely causing the bile duct blockage and her discomfort. So the plan was to perform an ERCP to try to place a stent in the bile duct and allow the bile to drain. Unfortunately, the ERCP was unsuccessful, as the doctor was unable to get even a wire-- let alone the stent-- into the severely blocked duct. Her discomfort continued. In fact, it got worse, as the ERCP likely caused a bout of pancreatitis by irritating the pancreas.
On Wednesday, she got a needle biopsy done on the liver mass, and the doctors said that the tumor markers were high, indicating that it was malignent. This is when I first heard the term cholangiocarcinoma-- bile duct cancer. And after doing some research, we were distressed to discover that it is a very aggressive cancer that has a very poor prognosis due to the advanced stage at which it is first diagnosed.
Ok, so she was pretty sick through the week, and we were waiting for the pathology reports. But they released her from the hospital on Friday, and the doctors were pretty confident that it was cholangiocarcinoma. End of Week 1
On Monday, August 15, 2011, we got a call from the Brown Cancer Center in Louisville and she had an appointment that afternoon. At the same time, Marye's cousin, Barbara Jean, was northbound to come see how Marye was doing. Well, Barbara Jean arrived and we all headed to Louisville where we met Dr. Martin, who convinced us that he is the right guy to treat this cancer. Seriously, check out his resume.. Also, Dr. Martin was very confident that his partner, Dr. Vitale, would be able to successfully place the stent during another ERCP. After some more research, I see that these two guys have been working together on this very condition since at least 2000, so we're thinking that we're in the right place to treat this cancer.
So, the plan is to get a whole new set of CT scans and blood tests to determine exactly what kind of cancer this is. He was very confident that it was cholangiocarcinoma, and the only treatment is to shrink the tumor with chemo, if necessary, then surgery to resect the liver and tumor. On Tuesday, she got the CT scan and bloodwork, and we went home. On Wednesday, after some back-and-forth with Dr. Vitale's office, she had the ERCP and he was able to insert the stent into the common bile duct. It was late at this point, so he admitted her into Norton Hospital in Louisville. Anyway, I was expecting some kind of miracle as far as her discomfort was concerned, so I was very distressed to find that it can take 48-72 hours for the irritation to subside. No such luck. She was sick all day Thursday and Friday, with elevated liver enzymes. However, on Friday evening, the liver numbers looked better and Dr. Vitale discharged her. She still feels lousy, but we're hoping that that will change in the next day or so.
In the meantime, the final pathology reports came in and -- surprise-- it's not cholangiocarcinoma at all, but metastatic breast cancer. Oof. So, here's the deal. On the one hand, this is good, since breast cancer, even metastatic, is much easier to treat than the rare and aggressive cholangiocarcinoma. On the other hand, cancer that has spread to the liver is scary. (Where else has it spread to?) And in any event, the size of the tumor is still troublesome. However, Dr. Martin says that no matter what the type of tumor it is, it's more the location (interhepatic) that will make this tricky.
So the plan is to get a PET scan on Saturday, August 20, 2011, to see if there are any other tumors. That will determine the treatment plan. If there is no more cancer, then we're anticipating chemotherapy to shrink the tumor in her liver before they try a resection. If there is more cancer, then I don't know what will happen. We have an appointment with Dr. Martin (the surgical oncologist) on Monday morning.
Current status: as of Friday evening, August 19, 2011, Marye is home and in bed. She is still having a hard time eating and has a lot of pain in her abdomen. The PET scan is tomorrow, and I'll post an update after that.
Sorry this post is so long, but I want everyone to know how she's doing and what's been happening. Future posts will be more regular and shorter, and hopefully more positive.
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| Barbara Jean |
