CT scan, ERCP, and Stents

Good morning, everyone.  It's been a busy week inside of Marye's belly.  When we last left you, we were waiting the results of the CT scan from last week and she has been suffering through pretty much constant nausea and pain caused by the aggravated gall bladder and gall bladder catheter.  Dr. Riley called me early this week to let us know that yes, the tumor has grown- but not by too much.  It went from 3.7 cm to around 4.1 cm across.  There is also a second, smaller tumor that is roughly 1.5-2.0 cm across.  That's not great news, but it's not unexpected since Marye has not been on chemotherapy in over two months and the tumor markers have gone up.  Since the cancer is growing, it needs to be addressed; but it is slow-moving, so we have some time to deal with her sick gall bladder before she goes back on chemo.

We started that process on Thursday with another ERCP by Dr. Vitale, Biliary tract doctor, extraordinaire.  First, we discussed getting the gall bladder removed to ease her discomfort and give her a better quality of life.  Dr. Vitale is not keen on removing it due to the fear of complications and the fact that it is not causing serious problems.  According to him, with the inflammation she had/has there, there will be adherences and other abnormalities that raise the risk of cutting her open.  He said it will look like "someone poured a bottle of glue all over the gall bladder" and surrounding area.  For this reason, it's not possible to do the cholesystectomy laparoscopically.  He's going to have to do open surgery, further increasing the risk.  Even with the best surgeon (himself), he estimates a 20% chance of complications, with a 30% chance that the procedure won't decrease her discomfort.  Remember, she still has a lot of other issues in her abdomen (cancer) that could be the source of the nausea/pain.

On to the procedure: he did the ERCP and allowed me to sit in the control room to observe it live on the monitors.  It helps to be educated about these procedures.  I felt like a groupie getting backstage at a rock concert.  Dr. Vitale's excellent Fellow, Dr. Barr sat with me and narrated during the procedure.  I can say it was truly fascinating.  Vitale is like a fighter pilot, navigating his way through her GI tract and sending down tools to remove and replace the stent.  Pics below!  The whole thing took about 20 minutes.  Dr. Barr says it would have taken him over an hour!

After the ERCP, I sat with Dr. Vitale again and talked again about removing her gall bladder.  Again, he said that he recommends against it "unless he really has to".  I explained to him that although it doesn't appear to be causing her any medical issues, she really is uncomfortable and we believe that taking the gall bladder will help that.  He conceded that it could be the cause of her nausea/pain and scheduled us for a consultation and follow-up surgery in two weeks.  He will do the procedure if she wants it, but he wants to schedule an entire afternoon for her to make sure he has enough time to go slow and do it right.  He also wants her to fully understand the risks involved.  The two weeks will also give her a little time to see if the new stent might ease her discomfort.  Dr. Vitale also removed the catheter from her gall bladder, so that will likely help, as well.  She might decide that she's feeling better enough to not need the surgery.  If that's the case, we'll go back to focusing on the cancer (chemotherapy).  In the meantime, the Aromatase Inhibitor should keep the tumor from growing too quickly and she can get on chemotherapy in another month or so.

On to the pics!  You can also check them out on my Picasa photo album.

One step back...

I think I've used that post title before.  Sorry.  Anyway, it's been a while since I posted, so I wanted to give everyone an update.  Since the last post, Marye has been feeling ok, relatively speaking.  She still suffers from fatigue and lethargy, but nothing concrete that she can put her finger on.  That's good in a way, since she's not really having a lot pain.  She had blood work done last week, and on Monday we found out that her tumor markers have increased to over 200.  The last number we had was 160, so it's definitely moving in the wrong direction.  This isn't exactly unexpected, since she hasn't had chemotherapy in about two months.  However, she has been on an Aromatase Inhibitor, which stops the producution of estrogen in the body, hopefully starving the tumor of what it needs to grow, but the AI usually takes 4-6 weeks to have any effect.  So the question is: do we go back on chemo or give the AI a chance to work?

We'll have an answer in the next week or so.  More important than the tumor marker is a CT scan, so we can see exactly what the tumor is doing.  We expect that to happen soon.  After that, Dr. Riley will consult with Dr. Vitale to decide if Marye is strong enough to go back on chemo.  Those conversations are forthcoming, so I expect the next week to fairly busy.  One thing about cancer, it never lets you forget who's boss.  Just when you get into a rhythm, it pokes you with a stick to get you moving in another direction.

So, that's it for now.  Marye is fairly comfortable, aside from the aforementioned fatigue.  She's eating well and her hair is actually growing back, much to her chagrin.  Of course, that won't last much longer.  I hope everyone is well, and you'll be hearing from me soon.