Well, it seems that metastatic cancer is not the same as localized cancer. The doctor talked about the many different types of chemo that are available for breast cancer, and she's still deciding on which is the best. But the the difference here is, since this is metastatic, there's no point in resecting the tumor. Even if you got all of the tumor out (unlikely), there are still malignant cells floating around in the blood stream and lymphatic system. Not only that, in the past with her cancer treatment, we saw a round of chemo treatment that lasted 16 weeks, then radiation to finish off any bad cells, then just monitor the area to make sure it doesn't come back. But that's not what's happening here. Marye is going to start chemotherapy and it will not end. She's going to have chemo for the rest of her life. In eight weeks they'll do another CT scan to see if the tumor is responding. As long as it does, she'll stay on the same drugs. When (not if) the tumor stops responding, she'll be switched to another drug. The doctor says that even if the tumor shrinks to the point that they can't see it, she still needs treatment to chase down the cancer cells that are moving around. There is no question that the cells are there. Not only did the cancer move to her liver, several of the lymph nodes around the liver are showing signs of malignancy.
Now, regarding the treatment... what Dr. Riley is concerned about is the liver function. Removing a breast (or two) is no problem to anyone. And even though the liver is so critical, it is filled with redundancies. What I mean is, it is much larger than it needs to be for us to survive. You can have 75% of your liver removed and still get along just fine. But because this tumor is right between the two lobes, and it's already causing problems with her bile ducts, the doctor is concerned about the liver function, because the chemo will only exacerbate whatever complications she's having. So they'll do blood work before each chemo treatment to make sure that her liver is healthy. If it's not, then they have to back off the chemo treatments to allow her liver to recover. That will only slow down the treatment.
The bottom line is, up until now we've been treating the symptoms of the tumor blocking her bile duct. The stents are in place, allowing her bile to drain and her liver is generally functioning ok. But since she's been so sick, she hasn't been able to eat, and she's very weak. This is also a problem for the chemo treatments, but until they can shrink that tumor and relieve the pressure, she's not going to feel good. Kind of a Catch-22 at this point. The best course of action right now is to start the chemo and see if she can handle it. Hopefully then the tumor will shrink and she'll start to feel a little better.
Ok, I've got some pictures from the CT and PET scans.
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Again, the tumor is the glowing part in her liver. This is at the extreme far right of the liver, so the tumor doesn't really appear that large. I included this pic mostly to demonstrate the detail of her spine. (I hope she's ok with me posting these.)
This picture is a transverse slice of her abdomen. Again, the glowing areas indicate cancer. The large area on the left of the picture is the tumor, the smaller area to the right of it is some of the lymph nodes that are also reacting to the PET scan contrast solution. The smaller areas at the bottom of the picture (on each side of the spine) are her kidneys. They are not cancerous, but they are collecting the radioactive glucose they use in the PET scan. Quick-metabolizing organisms (like cancer) show up on the PET scan, but other areas, such as the kidneys and bladder, do too, since they quickly collect all fluid we drink.
Ok, I know this was a long post, but there was a lot to say. I hope it made sense. If you have any questions, please let me know.
-Chris
