Why is it never straightforward?

We met Dr. Fisher today, the Oncology doc. A very nice and calm gentleman. He basically went through Mary's history and then gave us an information dump on how he sees the next steps for Mary. The only problem with the good doctor is that the nature of his practice apparently makes his office appointment system seem like airline schedules--lots of fiction. Our 11:30 appointment resulted in finally seeing his nurse after 1:30PM and the good doctor himself was about 2PM. Its a good thing we brought food for Mary!

Mary is set for a PET scan on Wednesday ordered by the radiologist. However, the Oncology doc needs a new high resolution CT scan as well. The equipment that does the PET scan cannot do the hi rez CT scan so that means she needs another round of tests at Stanford. They will call with proposed dates for her.

Once the radiation doc and the oncology doc have their necessary pictures, they then have a confab with the surgeon and all three of them agree on a course of action. There are two outcomes as we understand it--so far.

If the result of all these images is that no additional cancer sites are determined, then they will continue with the plan for radiation to start soon (in a week or two), followed by mild chemo after the radiation is complete. If cancer sites are detected away from the liver and area of surgery, then chemo comes first and depending on what they see, it will be "mildly aggressive" or "aggressive." After chemo, they may or may not decide to apply the radiation therapy but its likely they will do it.

In other words, the radiation therapy is specific to a location--even if its her abdominal area between the bottom of her rib cage and her belly button. Chemo therapy can attack cancers located throughout the body, hence the need for a full body, hi rez CT scan.

One good thing about Stanford. The doctor was citing recent medical publications from Europe--less than 8 weeks old--addressing some of Mary's issues. These guys are current!

The bottom line is that we have choices: bad, worse and worst. And really, there is not a choice. Frankly, the cancer free margins on the removed liver and bile duct materials were not adequate leaving Mary open for a re-occurrence. And, remember, the original confirmation was found in a lymph node which is the first proof that it has started to metastasize.

On the good side, putting her back on the Roxi has brought back her appetite, her level of activity and her general feeling that she can beat this thing. We'll do a step down over multiple weeks to help her stop the Roxi.