More Questions Rather than Answers

Today we met with the local radiation oncologist. We had a list of questions for him, most of which he couldn't give us concrete answers to.

* Is the growth in the brain cancerous? It is hard to tell. It could be. It could be scar tissue. It could be necrosis. Because it is in the brain, it is not easy to figure out. You can't biopsy it as easy as you could if it were in other parts of the body.

* If it is determined that the cancer is growing back, is surgery a possibility again? Is cyberknife a possibility again? Yes, they are both possibilities. Of course, both are high dependent on various factors, such as the size of the growth and where the growth is exactly located.

* What about chemotherapy? Is that an option? There are very few drugs that penetrate that blood-brain barrier, but that is something we need to discuss with the oncologist.

* And what about whole brain radiation, which the "brain lady" in Texas implied would be the next step? Dr. T. said that whole brain radiation is really saved until it is absolutely needed because of the fact that it radiates the whole brain, healthy cells as well. The long-term impact of neurological and cognitive functioning is significant.

* If we know there is growth, why aren't we treating right now? Why are we waiting? A few weeks isn't going to make a difference. It is better to make sure we need to treat than to treat something we didn't have to (especially if we're talking whole brain radiation).

Dr. T. and his medical student then reviewed the CD of the MRI we brought with us from Texas. They agreed that there was "more fuzzy white stuff" that wasn't there before. "Fuzzy white stuff" is not good. But it is also not clear. The "enhancement" around the cavities (where the tumors once were) were previously a well-defined border, which is more indicative of treatment effect. When there is new cancer growth, they are looking for more "nodule" looking growth. "Fuzzy white stuff" is neither. It is not a well-defined border, but it is not clearly nodular either.

Of particular concern was the proximity of the "fuzziness" in the front of the brain to the left ventricle of the spinal cord. If this is in fact cancer coming back, there is serious worry about cerebral spinal access. Thankfully, right now there are no signs of this (physically or medically), but if any signs present themselves, an MRI of the spine as well as a lumbar puncture (or 3) would be required to determined if the cancer has "seeded" into the spine. If we come up against that, in Dr. T.'s words, "we're in big trouble."

Dr. T. commented what a unique case E. was. Most Stage IV Esophageal Cancer patients aren't around three years later cracking jokes in his office. Rarely does esophageal cancer spread to the brain. Other places, yes. The brain, no. And if Dr. T. were made to guess where E. would have a recurrence, he would have said anywhere in the brain BUT the two areas around the cavities. After the two tumors were surgically removed, they were treated with cyberknife and Dr. T. was confident that nothing would grow back in those areas ever again. But here we are. There is re-growth in those exact same two spots. As unique as E.'s case is, that uniqueness has served him well. He is defying the odds. He makes people stand in wonder and awe.

As it stands right now, we're sort of in a "watch and see" mode. E.'s case will be presented to the brain tumor review board on January 11th to receive more input. He'll meet with the local neurologist on January 10th and he's scheduled for that follow-up MRI on January 16th. He'll then meet with the oncologist on January 19th, and I'm assuming there will be a follow-up with the radiation oncologist as well.

As far as E.'s feeling, he's feeling pretty darn good. He's getting occasional headaches, especially when the weather changes or the fronts move in. His balance is a tad off, as is his short-term memory (that's his excuse anyways, although it still might be selective hearing ... haha). Speaking of hearing, his hearing has been effected, and unfortunately it is not just selectively. Once in awhile, he gets fatigued, but it's nothing an afternoon nap can't help. And hey, retired folk are supposed to nap, aren't they? :)