Today was a busy day. First, Barbara is continuing to feel a little better each day. She still has some sores on her tongue and her taste buds are still messed up, but she seems to get a little bit of her tastes back each day. We ate at Olive Garden today and she had a good meal of salad and soup. We stopped again before going home and she had Mexican Pizza and some mashed potatoes at Taco Bell/KFC. Big improvement even if it still tasted somewhat bland.
Now for the details about going forward. We had a very good meeting with the surgeon and her team. After the nurse took some vitals and other details, we met with the PA for a half hour plus where she told us what she could and answered most of the questions we had. We then spent another half hour or so with the surgeon where she gave us more details and answered additional questions. I will try to give as much info as I can below, but I am sure I will leave some things out.
First of all, her interpretation of the results of the tests following the Chemo were as positive as we had been told by others. As far as they can tell, there is still no cancer outside of the stomach and the tumor has shrunk considerably. The results of the pathology on the samples they took on Friday are not back yet including the fluid they took from the Cyst on the her Pancreas, but they are not expecting any surprises. What the pathology of the samples from the area of the tumor may impact what she actually does during the surgery, but will probably not much if any difference unless there are any surprises.
Now for the plan. She indicated that the plan is still to go in and remove the tumor surgically. Originally, she had told us that she was fairly positive she would have to remove the whole stomach. However today, she indicated that when she goes in, she will examine the actual tumor area and depending on its size, the results of the earlier pathology on that area and the actual location, she would either do a partial or full stomach resection (removal). I think in more simple terms, once in she will carefully examine the stomach and tumor area and remove any cancer plus a large enough area around the tumor to make sure she gets all of the cancer in that area. Depending on how much healthy stomach is or would be left (and its shape, etc), she will determine whether to create a smaller stomach or remove the whole thing. If she has to take out too much to be able to cleanly and safely put something back together, she will remove the whole thing and then connect things back without a stomach present.
We clearly got the impression that her first priority was to make sure she got all of the actual tumor and cancer cells present with a good margin around it to minimize any potential of missing something that could come back. We felt very comfortable with this approach since we want the same thing. In talking before going, we were slightly concerned that if she did a partial, it would increase the risk of the cancer coming back. But after talking to her, we feel that if enough tissue is remove around the tumor, just taking the while stomach out would not improve the recurrence any amount. Of course, cancer cells could still be in other places in her body and that is why she will be doing additional Chemo after surgery. But because the tumor itself seemed to react very well (shrunk a lot), that is generally a good indication that any wandering cells from this tumor would have also reacted the same. In other words, all good news for a potential good long term outcome.
As we left, we tentatively scheduled her surgery for 7/13 which is only 2 weeks away. We should know by Friday for sure if that is the case. They generally do not like to do surgery any sooner than 4-5 weeks after her last Chemo treatment and this will be about 5 weeks after, so they are doing it as soon as reasonable.
As a side note, everyone in this doctor's office has been great. They are clearly very busy and it can be difficult getting something scheduled, but they have so far been able to handle our needs very well. On the very positive side, when we get with anyone there, we are never rushed and they spend as much time as needed to explain things and answer any questions we may have. When we left today, all three of us (Coleen was with us) felt very comfortable with the doctor and PA, her plan for the surgery and her explanation of what was happening and why.
For the surgery, it should last about 2.5 hours with recovery room about the same. Average stay in the hospital is about 5-7 days, but could be longer if needed. The first 3 days, she will be fed through a tube up her nose and into intestines (coming out past the surgery area) to allow her to get nutrition while the surgery area heals. Once that has healed enough, she will start liquids and then a soft diet and then real food. The full recovery is generally about 4-6 weeks although adjustment to a new diet will likely last a lot longer. We would likely go back about 2 weeks after the surgery to be checked and have the staples removed.
Chemo could start again probably 5-6 weeks after the surgery. We will likely meet with the Oncologist about 4 weeks after the surgery to go over his plan for the next set of cycles. I believe at this point, it will be an easier to take set of drugs, but cannot be sure until then.
One other note: according the surgeon, whether she ends up doing a complete or partial resection, Barbara should eventually be able to eat whatever she wants- a regular diet although smaller amounts. I believe the main difference would be how much she can eat at one time. In either case, it will be less that she can now, but she could be almost normal once she adjusts. This is all very good news from our perspective.
I hope this all makes sense and that I did not forget anything. If something does not make sense or you have any questions, please do not hesitate to send me an email or leave a comment.
PS to Debbie David- Barbara asked that you please let your mother know when the surgery is scheduled.
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