Procedure

We checked in for E.'s procedure at 8:30 a.m. and they took him to the operating room at 10:15 a.m. They told me to be back in the waiting room within thirty minutes because they anticipated the surgery to take between 30 and 60 minutes.  Imagine my anxiety when the doctor did not emerge until after 12:30 p.m.!  Obviously the surgery took A LOT longer than they thought.

The good news of the day is that they were able to place the stent.  It was extremely difficult.  They actually had to place two stents.  One stent went up into the pancreas and then they worked backwards to get one stent into the bile duct.  The one into the bile duct has anchor, whereas the one into the pancreas does not, so the thought is that it will eventually just slide out (because it doesn't really need to be there).  The stents are plastic, so they are temporary and only good for three months.  After that, they will need to be replaced with another temporary plastic stent or a more permanent metal stent.  (Metal stents are considered for more palliative care and not generally used when treatment options are still being considered, is my understanding.)  The bile is draining, which is great.  The bilirubin level should be going down in the next few days.  His yellow skin and yellow eyes, on the other hand, will take weeks to improve though.

Here's where I get a bit confused.  Remember that mass in the small intestine at the base of the stomach?  In the original endoscopy last week, the verbal preliminary pathology report said it was NOT cancerous.  (We still haven't heard about a final pathology report.)  Now, remember the MRI said there was a group of enlarged lymph nodes that basically clustered together to form a mass or a tumor?  I think maybe these two things are the same.  I'm confused on this issue.  The doctor who performed the procedure today said he was able to get samples from the "celiac axis lymphadenopathy" which were definitely cancerous.  Basically, I'm not sure if we're talking about two separate masses or just one mass (and the original report was just wrong).  This cancerous mass is extending into the pancreas, but no one has made it clear to us if the pancreas is involved.  Until the final pathology report in back, we cannot confirm what kind of cancer this is.  Everyone is assuming that this is spread from his esophageal cancer.  We need to know specifically what kind of cancer it is, because every kind of cancer is treated differently.

The doctor was unable to reach the liver to biopsy the spots (cancer) on the liver.  Again, it is assumed that this is spread from his esophageal cancer.  As he explained to us, if the pathology report comes back from the lymph nodes as esophageal cancer, they may go ahead and accept that the liver is also esophageal cancer mets.  If they want further confirmation, they will need to stick a long needle in E's side by his ribs to reach his liver and pull out tissue to biopsy.  There could be a possibility that this is a different cancer, for example, liver cancer.  Everyone's assumption though is that this is all metastasis from the esophageal cancer.

E. has not yet had a PET/CT scan, but obviously needs one.  We are waiting to hear the plans with MD Anderson.  The insurance company will not pay for two PET/CT scans back-to-back.  We know that MD Anderson will want to run their own scans, so we are holding off getting a scan here.  We are trying to play the insurance game right.

E. is still in significant amounts of pain and sleeping on and off most of the day.  He has finally relented and taken a pain pill now and then.  (He is not on high dose pain medication at this point. He is simply taking Percocet.  The same stuff I took when I had a toothache.)  Eating is still problematic, unfortunately.  I wish there was more I could do for him.

S.

P.S.  A big thanks to MAPper for the delicious dinner and the fixings for tomorrow as well.  It was hugely appreciated after the long day at the hospital.  Big hugs.