We learned that the tumor has indeed spread to encase the portal artery and vein, thus confirming that mom is not a candidate for resection surgery. Two surgeons have reviewed her new scans. I won't speak for everyone in my family, but I think we all felt this was a very real possibility. It's just hard to hear it.
The other bad news is that mom's external drain is malfunctioning (ie, it's probably plugged or kinked internally). This means that her bile is again building up on the right side of her body, and her heightened bilirubin count proves it. There is nothing we could have done to prevent this. It was always a possibility. She will have another ERCP on Wednesday and they will try to put a stent in on the right side. Remember that she already has one stent in on the left side. The left-side stent appears to be working well.
Although mom cannot have resection surgery, she is still potentially a candidate for a liver transplant. In fact, the transplant is one reason why doctors have not yet done a real biopsy within the liver to confirm the cancer diagnosis. Having a needle poke in the liver would immediately dismiss her as a transplant candidate. She meets with a transplant team this Thursday to determine if that is a next step. If so, she would likely undergo chemo and be placed on a transplant list, which can mean months of waiting.
Otherwise, they are trying to schedule an oncology appointment (on Friday) to begin discussing chemo and phototherapy options. She cannot begin either until a biopsy confirms her diagnosis, so the transplant team must first make their determination.
The secondary key with any treatment will be to keep her bile dispersal under control. It's not easy and prevents mums from walking around or doing anything active and still be comfortable. Nobody likes a big wire going through one's liver.
No matter how you put it, it looks like we'll be in Rochester for awhile.