Thursday, April 7, 2011 – Today Jacqui and I visited Dr. Greer at the Vanderbilt Ingram Cancer Center in Nashville.
Dr. Greer was very nice and had obviously taken time to carefully review my record before my arrival. After chatting with us, he went to review the actual PET-CT images we had brought and to talk to the pathologists, who had been busy reviewing my biopsies and performing their own stains and analyses.
In the end, Dr. Greer had nothing to report that differed from my oncologist Dr. McCachren’s conclusions. They, too, could not find any the Reed Sternberg cells, so they couldn’t definitively say it’s cancer. Good news? Not really. Something is growing and causing my PET scans to light up HOT. And if it’s not the cancer, what could it possibly be given the biopsy results?
Jacqui asked Dr. Greer this several times. We really would like it to be something besides cancer, because ‘residual disease’ does not have the best outcome. Only about half of people with residual Hodgkin lymphoma live to the 5 year mark, and that is with really aggressive therapy. Obviously, this means we need to start fighting as soon as possible if it is still the cancer, and we need to make sure we have the A Team. Unfortunately, Dr. Greer could not come up with any other possibilities. All he could say was, “That’s a valid question. Based on the PET-CT results it would be very reasonable to argue that it is still Hodgkins. Unfortunately, we just can’t prove it.”
Dr. Greer plans to discuss my case with his team over the next week to see if they have any other ideas and then will confer with Dr. McCachren to decide on a final recommendation for our course of action. Basically, we have 4 options:
Option 1: Get more tissue. – This would involve another more invasive surgery to get more samples to see if we can find the Reed Sternberg cells. Since we already have huge (3cm) samples, this is probably not going to change things and so is probably not a good choice.
Option 2: Add on Radiation. – Radiation has become more effective and less dangerous over the years with the development of involved field radiation. However, it has a very low success rate on its own for residual disease.
Option 3: Salvage therapy followed by High Dose Chemo and Stem Cell Transplant. – With this option, the first chemo is used to shrink the enlarged lymph nodes (and maybe indirectly ‘prove’ cancer is still there). Then I would get shots to mobilize my marrow so they can harvest my stem cells. After that, zap my body with high dose chemo, put my stem cells back in, and wait for them to ‘engraft’. Finally, just in case any stupid little cancer cells didn’t get the memo, follow with radiation. [This is what Dr. Greer thinks they are going to recommend – but they reserve the right to change their minds.]
Option 4: Do nothing. – This option would involve taking a wait and see approach. We feel like we’ve been doing this since January, and in that time the tumor has more than doubled in size. If it gets too big before more treatment, that can decrease my chances.
We’ll find out the doctors’ final plan in about a week.
In the meantime, we are renewing our total commitment to this fight against cancer. We’re gonna win. That’s all there is to it. We’re too stubborn to quit. Too positive to doubt. Too loved and in love to sink. Too competitive to lose.
Really, this cancer doesn’t stand a chance. Period.
Comments