Saw Dr. Moran today. His demeanor was... guarded. He told us that the Lymphnodes and tissue that Dr. Jones removed were all positive for malignancy and were the same cancer as the breast cancer she'd most recently had. The tissue was, and he thought this odd, basically fatty tissue.That's the bad news. The good news is that he considers this an extension of the breast cancer and thus Kris is not, I repeat NOT, stage 4. She's got a rather difficult case of stage 3. He said that there is no immediate danger as they are confident that Dr. Jones was able to pull out all of the tissue. However, there is concern in that the disease is obviously still running around in her system. I'll take each consideration one at a time:
Radiation: The Boulder panel was discussing our case and they still feel they can not use radiation as a treatment plan due to the radiation she received with her first bout of breast cancer. Even though the lymphnodes in question were in her neck, she was radiated from about mid neck to, effectively, just above her heart and generally on the left side of her body. There have been recent commercials about a radiation technology used called 'cyber knife' which is supposed to be able to irradiate very discreet and precise areas of the body. Dr. Moran said that the concern about preexisting tissue damage due to the previous radiation treatment is still a concern with this kind of technology and the fact is that because of the surgery, they simply don't have a tumor to aim at. This problem is... I'll use the word systemic but, I feel I need to explain that so no one panics over it. Which I will do in explaining the next thing the Dr. said.
Chemo: Ok, a short lesson in cancer. However it is begun in a person, cancer is essentially a set of cells gone rogue, however, they are still cells of the body. Thus, liver cancer is essentially a liver cell that mutates into something that is like liver tissue but not and has a voracious appetite for copying itself and it grows... by normal growth patterns it grows very fast. The body isn't sure how to respond to this since it thinks that it's one of it's very own liver cells, just one that's more productive than most and it reacts in a way that is not truly helpful. Note that though my example starts in the liver, the cells of the body do not all stay in place, they can break off and wander the system. So, much like a virus or bacteria, some of these rogue cells go roaming and can cause problem with cells in other locations. One of the ways for these cells to move about is through the lymphatic system, which is why it can get infected first and why a localized infection of the lymphatic system does not, in and of itself, raise your stage from 3 to 4. Remember: Stage one is cancer of a localized organ and a tumor of a small size (I don't have the size numbers at hand). State 2 is a larger tumor. Stage 3 is multiple tumors in the same organ and local lymphnode infection. Stage 4 is infection of multiple organs or of the lymphatic system outside of the region of the infected organ. So, in the liver example, one tumor with traces of the livers cancer in the breast lymphatic system would be stage 4.
So, where does that leave us? Kris apparently beat her breast cancer into submission but it looks like it was still in her lymphatic system floating around. It's possible that the Herceptin treatments were suppressing the cancers ability to express itself but not eradicating it. Thus, when her Herceptin treatments stopped last May, the cancer was free to latch on and do it's thing. One of the possible ways to address this is to just sit back wait and watch and see where the cancer builds a new tumor giving us a target to attack. Dr. Moran thinks that this is unwise (and I very much agree) and that we need to treat this at the cellular level through drugs. The reason I say this is 'systemic' is that when you take drugs they don't know where to go, rather they go to the whole system and the fact is that we want to kill, or at the very worst suppress, the cancer from getting away and getting anywhere and we simply to not know where it is.
Thus, Dr. Moran has asked us to return in two weeks. During that time he will be researching ways to attack this new threat and Kris will be getting a brain scan. That raised a bit of concern for us. One of the places that breast cancer will tend to roam to when it leaves the breast is the brain. He has every confidence nothing is there but he wants to rule that possibility out... and we agree with that. He actually said he wants a brain scan to make sure nothing is going on up there... which caused Kris to laugh and point out what he'd said. He laughingly replied, "that didn't come out the way I wanted it to." I've also asked him to take a look at the question of 'what is causing this to happen.' I am concerned that there may be something in our environment causing this to occur and if we don't find a way to remove that, we'll just be back in this boat again in too short of a time and it should be obvious that we don't want that. I want a happy and healthy Kris.
Note: Kris's demeanor is strong and happy, as evidenced by the joke in Dr. Morans office... if anything, I've been the bleary eyed wimp this time around.
So, now you know why I titled this entry: Cautious Optimism. There is a new threat on the horizon but, I have to stress this as it's important: not stage 4 and we don't have any tumors to attack. Right now I take this as a positive and I'll take any positives I can get... and yes, we'll do research with places like the Cancer Centers of America though we have full confidence in Dr. Moran and the Boulder area team (panel) that is involved.
I'm getting wordy but I feel I need a bit more on that. Apparently there is a team of Drs that meet in the Boulder area every Tuesday to discuss interesting or problematic cancer (and I'm sure other) situations. I noted that whenever we see a Dr. for Kris' cancer, we hear 'yeah, I remember discussing your case at panel', even with Dr.s we've never previously seen before. It lends a sense of community and support amongst the Dr.s that gives us more confidence than I think we'd otherwise have... and, I like it.
That's enough for now. I'll keep the mail list going as we move forward to keep you all posted.
