Dr. Curly seemed to be pretty positive about the potential future possibility of maybe having a chance at thinking about performing a potentially curative operating procedure called a liver resection. That’s such great news. We’ve been told for so long that because Maggie’s liver was so consumed with tumors and because of where these tumors were that she’d never have this option. Up until now our only real hope was chemo which served merely as a delay tactic for the inevitable given the seriousness of our situation. Now, for the first time since this Great Cancer Adventure has started we’ve got a glimmer of hope of a life beyond the diagnosis. And that just makes my heart leap with joy.
A liver resection is a conceptually simple operation. The liver is the one and only organ in the body that can regenerate (thankfully, because of all the damage I’ve done to mine since this Cancer Dance has started!) Its regenerative power gives doctors the option to operatively remove bad parts of the liver like those that contain nasty tumors. Once those bad parts are all cut out, the liver will grow back to it’s normal size in about five weeks and everyone is happy again. Except the tumors, of course. But we never really cared too much about their feelings. It’s true.
The chemo has been doing it’s job – thankfully! (Although it’s questionable if it’s still working – see my entry “School Starts, MDA Calls, and The Cancer Grows.”) But Maggie’s tumors need to shrink further before a liver resection is an option. The maximum liver tissue that can be removed, and only in exceptionally ideal cases, is 75%. The key to success is finding a good, tumor-free 25% to leave behind to grow back into a nice, healthy “new” liver.
Dr. Curly told Maggie that despite the obvious problems, her liver is in wonderful condition. Her life of eating healthy, staying in good shape, and avoiding too much of the Devil water has probably given her this opportunity. He said that if she was 50 lbs heavier that this would not be an option. He also said that yes, chemo has been proven to pickle* the liver and thus make the surgery too risky but he’s seen this primarily in patients who didn’t abide by such clean living standards or who were older. Maggie’s health and young age continues to give us fighting chances. Attitude may have something to do with it, too. 😉
* pickle is my word, not the doctor’s. Surprising, I know. I just thought it was a nice visual. 🙂
He believes that oxaliplatin, a different chemo drug, will continue the process of shrinking up those stubborn tumors enough to where in January we may be able to have the surgery. If not, he’s pretty sure that by March-ish we’ll be in good shape.
“Why can’t he just go take out as many tumors as he can right now?” you ask? Good question. So did we. Apparently when the liver is in regeneration mode it releases an enzyme or protein as part of that re-growth phase which is what actually causes the growth. Tumors loves this stuff and will grow very rapidly in response. So, if they remove some of the tumors and leave some, when Maggie’s liver begins to grow back, the tumors that remain will grow aggressively, effectively canceling any benefit of the procedure, and likely leaving us in a worse position (few but bigger tumors, more percentage of the liver consumed… blah.) So this is truly a go big or go home opportunity.
It probably doesn’t surprise you to know that turning 75% of someone’s liver into pâté isn’t a simple surgery. What may surprise you (it sure surprised me!) is that it’s a pretty low risk procedure! According to the few studies I’ve read, the risk of The Big Sleep is just around 6%. Fantastic! I had thought it to be much, much higher. Of course, the hospital stay will be around 5 days (still less than we had in January when this mess began) and a complete recover takes about 5 – 6 weeks (or 2 – 3 weeks, Maggie time.)
The plan going forward is to change her chemo to oxaliplatin on Monday and work our way through a whole new set of nasty side-effects and reactions. While it will be tough to re-learn our chemo dance (complicated by my extremely demanding school schedule), we’ve got a goal. We’re going to make it through this so that in January weeeee’re….. (come on, sing with me now), weeeeee’re… off to see The Wizard, The Wonderful Wizard of Cancer (yeah, I know it doesn’t really have a ring to it – it’s the best I could do this early.)