Results Day - End of Cycle 5

We had our big meeting with our Oncologist today. This is a really long post, so if you need the cliff notes... The bottom line: Lauri's tumors have shrunk compared to the baseline CT scan taken on May 24! We will proceed with the 6th cycle of chemotherapy, followed closely by surgery to remove the nodules. Now for the details...

Our Oncologist showed us the CT scan images taken yesterday along with the images taken right before we began chemotherapy (May 24), and we could all see visible reduction in size of the three tumors. The tumors are not melting away, but they are gradually shrinking. The official report from the Radiologist says there is no visible change, however they typically only compare the current images to those take most recently (3 to 6 weeks ago). The short term change in the tumor size is very little, but the cumulative change, which is what we looked at today, is more noticeable.

Since the tumors are not shrinking dramatically, the Oncologist sees no additional benefit of continuing chemotherapy past the 6th cycle. Therefore, the 6th cycle, which begins on Monday, will be the final cycle! As we have seen with Lauri, the longer she is exposed to chemotherapy, the longer it takes for her blood counts to recover. Adding chemotherapy cycles increases the risk to Lauri by extending the time with low blood counts, during which time she has an increased risk of infection, fatigue, and uncontrolled bleeding. Since we have gotten the disease under control, as is exhibited by the fact that her tumors have shrunk compared to when we started, our Oncologist decided the chemotherapy has done its job, and there is no need for any more cycles after cycle 6.

As for the "stuff" in the left lung, I am very pleased to announce that the "stuff" was indeed due to infection. Lauri's left lung is completely clear of the "stuff" in the CT scan we saw today. This made the Oncologist very happy, claiming that we nearly gave her a heart attack when we had that stuff show up the first time on Lauri's CT! We agreed that our heart attack was probably worse than hers when she told us it might be additional tumor growth... Thankfully, it was only an infection that has been eliminated with antibiotics.

Where do we go next?

Lauri will proceed with cycle 6 of chemotherapy on Monday. This will be her final cycle of chemotherapy. On Wednesday (9/12), our Oncologist will meet with a group of Thoracic Surgeons to discuss Lauri's case and possible surgical options. We expect to get the results of this conference on Thursday (9/13).

*The following is what we expect to happen next based on our Oncologist's experience. Be advised, we have NOT received confirmation from the Thoracic Surgeons yet, so nothing has been scheduled, and all plans are subject to drastic changes...

Our Oncologist expects to clear Lauri for surgery 4 weeks after the beginning of her final round. In terms of dates, Lauri will be ready for surgery as soon as October 8. Typically, the Thoracic surgeons work on one lung at a time. This process is referred to as a "Stage Thoracotomy."

For a Stage Thoracotomy, the surgeon will work on lung "A" first, sew everything back up, and allow around 6 weeks for healing. After 6 weeks, a second surgery to address lung "B" will be conducted. About 8 weeks after the second surgery, we would meet with our Oncologist to see how things are going. If we prove to be cancer free, then we return to the 3 month checkup schedule we were on before (i.e. return to normal life...).

As for the operation(s) itself, we don't have details yet. We have been told that the surgeon typically goes in from the side of the torso, as opposed to the front (break the chest bone, similar to open heart surgery). Our Oncologist added that two of the three nodules in Lauri's lung may be "tricky" to remove, but should be possible. The one nodule of concern is located on the outside edge of the right lung, attached to the "pleura", which is the sack that surrounds the lung. Nodules located here can be tricky to remove, according to our Oncologist. The other nodule of concern is located within the left lung, just behind the heart. The issue for this nodule is access, trying to get the "nodule plus margin" without damaging the heart.

You may recall from emails sent during Lauri's first surgery that in order to remove a tumor, the Surgeon must take not only the tumor, but also the surrounding tissue. The surrounding tissue is removed in order to guarantee that all of the cancer cells are removed. Leaving only one behind provides the chance for the cancer to return. In Lauri's case, the surrounding tissue may mean just a few centimeters of lung material surrounding the tumor, or perhaps an entire lobe. Unfortunately, we won't likely know how much tissue the Surgeon will take until the surgery is over. This decision is made during surgery, with the Surgeon doing everything he or she must to remove all of the cancer.

The surgery will undoubtedly be very dangerous and full of risk. However, we are confident since these Thoracic Surgeons do this literally every day, and are some of the world's best. This is also our only hope for being cancer free.

That's about all we have right now. Overall, Lauri and I view the day as a win for the home team. We got what we wanted: shrinkage of the tumors, and a chance to be cancer free. The alternative to doing surgery is to find a way to live with the cancer, having to endure chemotherapy in varying dosages and varieties for the rest of her life. Chemo is not fun, so we choose to take our shot and deliver the final blow to this disease. This is what we have wanted from the beginning, a chance to win...