The doctor's report

This evening, Dr. Visser and the entire surgical team came to visit Mary in her room. Reenie and I were both there so we both heard what the good doctor had to say. Basically, it comes in three parts.

The easy part first:

They removed her drain tube so she is now free of the last tube hanging off of her body. No IVs, no drains, all free and clear.

Pathology confirmed klatskin's tumor, cholangiocarcinoma was present in the removed tissue. The tumor was classified as at T3 tumor (on a scale from T0 to T4). And, there was no evidence of cancer in any nodes or evidence of any metastasis. So the only external finding of cancer was the node removed during the gall bladder surgery a month ago. Which says we were damn lucky it was in that node (the canary in the mine node) because it was the only confirmation we had that cancer was present.

Mary's liver is performing quite well. There was a short period of jaundice but it snapped back to normal quickly.

The surgical team is willing to send her home on Friday.

Overall, the surgical treatment is as good as it can be!

The harder part:

The renal doctors are not sure of her sodium stability and are not ready to send her home on Friday. They want more days knowing that her system is stable and working and she won't crash in an unrecoverable way at home.

The roxicodone dose (5mg every 3 hours) is comfortable for Mary although it leaves her just a little bit 'out of it' compared to yesterday when she was really out of it. We didn't discuss how long she will stay on the painkiller.

The hardest part:

The pathologists went back and forth as to whether there was good margin in the bile ducts in the direction of the remaining liver. The conclusion is a questionable margin leading to radiation and possibly chemo sooner rather than later.

As a result, Mary will be in for radiation treatment in about 3 to 4 weeks (rather than late summer as I reported some weeks ago). Dr. Visser placed gold drops (fiducials) in the liver so the radiation team can accurately target the bile ducts.

The bottom line is bittersweet.

Yes, they were as successful as this very high risk surgery can be. But, they may not have been able to remove all the cancerous material. Yes, the cancer is contained. But, they need to do more to do to be certain they have stopped this damn cancer. Radiation (cyberknife?) may provide the answer needed.

So where are we? Step 2 is not yet complete because Mary has not yet regenerated her liver and that should take 6 to 8 weeks from the date of surgery. However, because of the uncertainty of cancer in the remaining liver's bile ducts, they are starting the Step 3 treatments as soon as possible. The limitation is Mary's overall strength and recovery. Hence the expected radiation in 3 to 4 weeks which means Step 3 treatment (radiation) is overlapping in in the 5th to 6th week of the Step 2 recovery program.

Disappointed? Yes. Surprised? No--we had been fully briefed that this could be an outcome. Next steps? Not clear but we see Dr. Visser in the office on Friday next week.