The Results Are In

We are disappointed because it appears that Mom's cancer has returned. The biopsy they took from the enlarged area/tumor above her left clavicle shows evidence of transitional cell carcinoma (TCC) which we first saw in her ureter way back in November 2007, then again November 2008 in her ovary.

What continues to be so unusual and unpredictable about this cancer is that it travels in patterns her doctors could have never predicted. Dr. Donadio said today that she was actually surprised not to have seen any evidence of cancer in her lungs, since that is a more likely place for cancer to spread, but rather it's tucked itself nicely below her neck. It is not confined to an organ as it had been before in her bladder, ureter, and ovary, therefor surgical removal is not indicated. There would be no "margins" to measure, and the risk of surgery again versus reward simply does not match up.

The pathology reports were inconclusive as to whether this cancer is in the surrounding lymph nodes, but it's likely that the cells have been traveling through the lymph system the whole time, we just don't know why they plant themselves where they do. The subsequent swelling she's experienced in her neck, arm pits, and breasts, is a direct result of this mass blocking the surrounding lymphatic flow. It's a lot like a traffic jam. All the hasty little lymph cells dying to get to Target before it closes, but some idiot (the tumor) is trying to take a left hand turn across three lanes of traffic. 

There are not a lot of options for third line (meaning this is our third attempt at beating the same cancer) treatments for metastatic TCC. After discussing the options presented, Mom's decided to go back to Dana Farber Cancer Institute to learn about a clinical trial being run there for patients with metastatic TCC that have failed prior treatments. Our appointment is tomorrow at 3pm with Dr. Chouieri who we've seen twice before for second opinions. When we last saw him in November, he stressed that if measurable disease returned, that Mom should call him right away.

I fancy myself a perpetual optimist, and want nothing more than for this clinical trial to once and for all teach this cancer a lesson, however the clinician in me coupled with what Dr. Donadio said to us today, realizes that Mom is now living with cancer. Chance for a cure after a third recurrence is very rare, but certainly, not impossible.

Mom is understandably overwhelmed by the vast unknown ahead of her. She has a lot to think about right now, but I'm happy to report that as I type, she's gone to just close her eyes and nap for a bit. She handled today like the model patient she has been all along, identifying every staff member by name and greeting them with a hug and a smile.

I'll update tomorrow after we've seen the team at DFCI. Until then, thank you for everything, especially to Marilyn for delivering dinner on the porch for us to come home to, and to Joy for doing the same on Monday. Mom has built an incredible network of people around her.