My 76th. Birthday Today

Today was a beautiful day and I was very blessed to be able to enjoy a birthday full of love, family and friendships.  So many facebook greetings, cards and good wishes plus we ate a delightful lunch at "Trios" with our long time close friends, Nathan and Brenda Brooks.  Tonight our family came over and we celebrated with cake and the usual noise and laughter.

Since I have not posted anything about the recent consultation at UVA, I would like to relay some notes our Ruthie took last Friday at UVA...Sept. 29.  She does such a fine job in taking notes, I would never be able to remember everything discussed.  So, here goes:)  In the room with the doctor and me were Kathy, Agustin and Ruthie.


We met with Dr. Jose Oberholzer who just moved to the UVA Hospital last March from Chicago.   He recently did an emergency liver transplant on a friend of ours and she asked him if he would talk to us about my situation.   I was very hopeful that I might be eligible for robot-assisted surgery, but alas, I am not.  This was a consultation only and he hadn't seen any of my scans or reports!

https://uvahealth.com/findadoctor/profile/jose-oberholzer

Our beginning discussion started out like this:   Dr. Obertholzer said we have to ask ourselves 2 questions!
1.   Will surgery help?
2.   If surgery will help, what kind?

Normally when disease (cancer) has spread, surgery is NOT a reasonable option.  Removal of the local tumor would be done in a radical way because it's a systemic disease meaning it's one that affects a number of organs and tissues, or affects the body as a whole.   It may not be simple because of the vessels by the tumor.  
The portal vein (blood vessel that carries blood from the gastrointestinal tract, gallbladder (don't have one:), pancreas and spleen to the liver) is in close proximity to the tumor.   The only way to truly see this is through surgery, so not necessarily a technical problem.

There are 2 main arteries that have to be pulled away from the tumor.  The Celiac Artery (trunk) provides oxygenated blood to the foregut.  IT supplies blood to the stomach, liver, spleen and part of the esophagus that reaches into the abdomen.  It also supplies the superior (or upper) half of the duodenum and the pancreas.  The celiac trunk is a critical blood source for the gut, since the other major arteries aren't connected in such a way that these organs can receive adequate blood from them.   Therefore, any obstruction of the celiac artery is extremely dangerous for the organs it supplies.

The Superior Mesenteric Artery (SMA) arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum through 2/3 of the transverse colon, as well as the pancreas.   When these  arteries get infiltrated by a tumor, you can remove the tumor but it won't guarantee to prolong your life. 
Because of the complexity of these  vessels, Dr. Oberholzer would not recommend robotic-assisted surgery!

I asked what the tumor marker means?  It tells how much cancer is in the body but that's only part of the story.  It is impossible to cure the tumor with just chemo because it is solid!

This surgery would be palliative, meaning it is designed to relieve symptoms, and improve quality of life but not a curative treatment.  The chance that this surgery would cure is very low.

At some point the tumor cells throughout my body will come back even with chemotherapy.   Surgery would give longer life but it also might weaken me.  It would temporarily reduce my immune response which would make the tumor come back quickly!!!

He told me "the time I have now, will not be taken away with the treatment I am doing currently".

Surgery would take 3 months recuperation.  Hospital stay would be 4-10 days with a  6 hour surgery!

I would continue with chemotherapy, however, the biology for the tumor after its removal would tell them which chemo to use.

I was told that I have achieved the most I can out of  the chemotherapy treatment and my WINDOW is NOW to do the surgery!   Once the chemo stops working, it is aggressive and I will not have this opportunity again.

My case is being presented to the chemo board at UVA his week.   

So, this is my situation and I keep weighing my options as to whether I can physically take a surgery of this magnitude considering it is not a "cure all", could take down my immune system or just wait it out and continue the chemo until it doesn't "work" anymore!  

I am praying that I will be convinced beyond a shadow of a doubt that I really want or don't want to go through this surgery.   I will wait until I hear what the UVA tumor board says.  I realize they will probably focus on the same things that JH tumor board  did.  

I have thought a lot about this the last few days.  In my limited way of dealing with the "facts", it would seem that getting rid of a tumor that is cancerous would be the way to go and trust God for the rest. (recuperation, no infection, no complications, no cancer left, etc, etc, etc:)