Good News - Not-So-Good News

Doctor’s Visit and Test Results
We met with Dr. Ratner today, Kevin’s oncologist, to review the results of blood work (for tumor markers) and a CT scan that Kevin had this week in preparation for Tuesday’s surgery. We had some good news and not-so-good news. First the good news:

Tumor Markers
Levels were normal indicating no malignancy present. These test are indicators and not 100% conclusive, but the results certainly are very encouraging.

Now the not-so-good news:
The CT scan:
• Chest – lungs, heart, etc. completely clear
• All lymph nodes appear normal except one (in abdominal cavity), which is just slightly enlarged (may just be result of inflammation).
• A “low density cystic mass along the peritoneal surface on the right lower quadrant”
-- 7.1x5.7 cm
-- Appears to be fluid filled
• “Scalloping” appears around Kevin’s spleen, indicating that there are possibly tumors growing on the outside of it

What does all this mean?
• The CT scan is inconclusive:
-- All we know is that there is a cyst and scalloping around the spleen that indicate PMP. This is our main concern right now.
-- CT scans don’t always show all cysts and tumors. We have heard of times when the surgeon opens up the patient and finds more tumor than what was indicated on the CT scan. We are praying that this is not the case with me.

Basically, there’s a lot we won’t really know until Dr. Sugarbaker completes the surgery on Tuesday.

• Carcinoma unlikely, or This doesn’t necessarily mean the cancer is back:
-- PMP is not always carcinogenic.
-- Carcinoma usually occurs as older tumors mutate. (Kevin likely had this disease for 6 years prior to the October emergency, his triple hernia being the first symptoms.) Any cysts/tumors there now developed only since the February surgery.
-- The tumor markers are negative and Kevin had two more rounds of systemic chemo post surgery (which kills cancer cells, but not PMP)

We will receive conclusive results of pathology reports about one week post-op.

• Not “new” PMP. Sometime vestiges of PMP (muscinous tumors) hide in the “nooks and crannies” of the abdomen. Dr. S. gives heated chemo during the surgery to kill whatever is “hiding.” Even so, sometimes there are too many layers for the chemo to fully penetrate; new cysts and tumors grow from whatever wasn’t eradicated.

The Goals of the Upcoming surgery (9:00 a.m. Tues. 7/6):
1) Exploratory. Dr. Sugarbaker will be able to have a real look and see what is going on.

2) Removal of the cyst and likely the spleen and enlarged lymph node along with adjacent lymph nodes and surrounding blood vessels (for pathology testing). The strange thing about the spleen is that last surgery, Dr. Sugarbaker said he was going to take it, but during the surgery said it looked fine and decided to leave.

3) If PMP confirmed, heated chemo wash will be administered (though not the intense melphalin Kevin had last time).

4) The ostomy reversal is expected to take place as planned -- Regardless of whether PMP is present, both Dr. Ratner and Ilsa feel as though Dr. Sugarbaker will likely still be able to reverse the ileostomy. We FedExed the CT scan films today. Roni is going to call Ilsa tomorrow to see if after reviewing them Dr. Sugarbaker feels that there is a possibility of delaying the ostomy reversal. (Please pray specifically that the reversal will take place.)

Recovery:
• If chemo is administered during surgery then longer hospital stay (2-3 weeks in total, barring complications).
• Possible additional chemo -- Dr. S. will decide post-surgery about standard five days of heated chemo pumped directly into the abdominal cavity
• If what appears on the CT scan turns out not to be PMP (or miraculously disappears!), then no chemo and a hospital stay of 5-7 days.

Please pray:
• That this will be the last battle in this war (which we are confident we will win), and that the cyst would even disappear, along with the scalloping on the spleen
• For wisdom and skill for Dr. Sugarbaker, his surgical team and all of the hospital’s care givers
• Pathology reports would show no cancer
• The ostomy will be reversed
• Comfort and peace for us and our family members, especially Kevin’s parents who are not able to come from Oregon.
• Safety for Roni’s parents as they drive up from NC to be with us
• Safety for our trip down (and blessings for the Valois who are driving us there!)
• Quick healing
• No complications
• Kevin to experience minimal pain and discomfort from all of the tubes (especially NG tube), needles, leg pumpers and everything else they do to poor hospital patients – also that he would get sleep, despite the daily and nightly parade of nurses, etc. that come through the room.