Oncologist Appt

We met with the oncologist this morning.

The first thing we learned was that the biopsy results weren't back yet.  What?  We were told they'd be back on Friday and here it was Monday.  Dr. B gave a call over to the lab and the pathologist gave a preliminary verbal report that she couldn't see any cancerous cells in the samples.  What???  Seriously?  Maybe this was all a bad dream after all.

The words hadn't even sunk in when Dr. B turned the page and his eyes got big.  "Hold up," he said. He was scanning the MRI/MRCP report and it told a different story.

There are "multiple low-density lesions (approximately 5)" in the liver suspicious for metastasis.  The largest mass is in the right lobe near the diaphragm and measures 3 cm.  There is small free fluid adjacent to the liver.

"Bulky celiac axis lymphadenopathy is present."  (My understanding is that this is like enlarged lymph nodes, suspicious for metastasis, clustered together.)  This area measures approximately 5 cm.  The mass extends into the pancreas and obstructs the common bile duct.

"The upper superior mesenteric vein and the portal vein are thrombosed.  This is likely due to compression of invasion by tumor."  As I understand it, these veins are clotted because the mass is pushing on them.  Nice.

Right now the immediate issue is the bile duct.  We need to get a stent in there so the liver can start working.  E. is scheduled for an Endoscopic Ultrasound on Thursday to hopefully get a stent placed to open up that bile duct.  There is concern that they won't be able to get past that mass in the small intestine.  Yikes.  If they are successful, they will also collect biopsies at the same time.  We need to know what exactly we are dealing with.  The assumption again is that this is mets from the esophageal cancer, but it might be another beast altogether.

Little can be offered for E. here in Reno.  The oncologist already explained that the only thing that Reno could offer him would be chemotherapy.  He agreed that MD Anderson might have more options and agreed it would be worthwhile to see what they had to say.  We were scheduled to head to Texas in December for a simple follow-up, but needless to say, things have changed and we are hoping to be Texas bound as soon as possible.

It was suggested that E. be admitted to the hospital for hydration and pain management.  I do believe I saw the middle finger.  E. did manage to eat a protein bar today and drink some water.  He also finally took his first pain pill, after writhing in pain for hours (days, really).  Though he's been sleeping a lot, it looks like he's finally sleeping peacefully.