Here ya go:
- Transplant is out. Criteria must be met for a transplant because it's a last-ditch effort for people with liver or bile duct cancer. The tumor must NOT be resectable to meet that criteria, and the committee has determined that mom's tumor IS resectable. They are also concerned about her tumor growing extensively during the year it would take to get a liver. If that happens, she'd be dismissed from the transplant program and unable to receive a resection. There is one way the transplant could re-enter the picture: if mom's cancer has spread into her stomach lining -- we don't think it has. More on this below.
- Total resection surgery is in. The initial treatment diagnosis mom received was that her cancer had spread too far to be a resection candidate. In a resection, they take portions of the biliary system, accompanying vessels and arteries, and liver. They initially thought her portal artery, which humans cannot live without because of it's important partnership to the heart, was encased with tumor. Now, even if there is some tumor in it, the lead surgeon feels confident that he can reconstruct the artery. Her case has been debated at length by the GI and Hepatology staff, and the top-of-the-line surgeons on both the transplant and resection side have agreed that resection is the best option with the best possible outcome.
- Why the backtrack? Just par for the course? Kinda. We're grateful they didn't make a hasty decision on treatment and pleased that despite the run-around, a sound decision has been made and each small point, from post-surgery quality of life and the reality of how long it takes to get a liver, have been discussed. At the very least, we've all been heavily educated on transplant procedures.
- What does a resection mean? Mom's new surgeon (described by head of GI and Hepatology as one of the top 3 surgeons for cholangiocarcinoma [bile duct cancer] resections in the country) feels confident he can remove all of the tumor. One member of mom's healthcare team told us that if he had this disease, he would want mom's surgeon to complete his resection surgery. He has also been described as one that would not take on a case unless he knows it's something he can do to perfection. I would by lying if these statements did not provide supreme comfort to all of us. My dad's cancer surgeon was also top of his field. And, well, that surgeon saved his life.
- The liver is made up of two, non-equal sides: the right side is typically larger, making up around 60% of the liver. The left side makes up the remaining 40%. The majority of mom's cancer is within the right side of her liver and biliary tree. It does not appear the cancer is on the left side. Because her entire right side will be removed, her remaining left side must encompass at least 25% of liver functioning during surgery and one week post-op. During the first week post-op, her left-side liver will regenerate itself by 80% and hopefully, she will be cancer-free (I screwed that up initially, but editor mom fixed it post-publication!).
- What next? The docs are having 3D computations rung up on mom's liver size now. Once the surgeon consults on the results, they'll likely move straight into surgery if her left side is big enough. If it's not, they'll perform an embolism where the right side will be shut down via catheter through her leg. Then, the right side will begin to shut down and shrink. The left side will automatically grow larger and become sustainable enough for the surgery.
1) Determine size of left side of liver.
2) If left side is big enough, we go straight to surgery steps. If the left side isn't big enough, the right side will be shrunk and the left side will grow larger. Once it's big enough, we go to surgery.
3) Surgery is a two-part process: first, a laparoscopic procedure will take place to scan for cancer cells in the stomach lining. If the stomach lining appears cancer-free, the surgeon will move to step two: immediate resection while still in the OR. If cancer cells are found, the resection will not take place and transplant will again be up for discussion.
4) Initial recovery from the resection will be around 1 to 2 weeks, but it will take months for her to fully recover.
5) There will be no chemo/radiation prior to the resection b/c they would destroy the bile duct. They would only occur if transplant takes place.
This changes our scheduling for the remainder of May and all of June, but perhaps we'll be bringing her home healthy faster than we thought. There is a lot of risk in the surgery, but... it is what it is.
I know all of your thoughts and positivity and yellow-ness will help her move through each stage of the coming days with success and good health.
Take a breath. Go yellow!