Susan received her weekly dose of topotecan today. It was uneventful, and she only had to be at the doctor's office for about an hour. Although she said she felt "shaky" in the afternoon, she nonetheless went out and planted about 100 pansies in the front yard in our annual rite of Fall. (I can't stand pulling out those beautiful begonias while they're still thriving. I stuck to the back yard and planted asian jasmine and carissa hollies.) We appreciate your continued prayers for minimal side effects.
This evening our neighbor Roxanne came by and Susan recounted the story below. However, she had a slightly different version. She is sure that she heard Dr. Mirtsching not only ask for our prayers for the nurse, but indicated that we were in his prayers. "I intend to follow up on this," she says.
As she sat there on the examing table in her new brown slinky knits from Chico's and her gorgeous new hairdo, Susan looked more like a movie actress waiting for her picture to be taken than someone suffering a major disease. In due course Dr. Mirstching arrived and began discussing her case and various options. In contrast to Dr. Munoz on Saturday, he was much more upbeat. (This reminded me that doctors are people, too. Dr. Munoz was obviously having a hectic day on Saturday, while Dr. Mirtsching was fresh back from a vacation and much more relaxed.) In his view there is no evidence to prove that Susan is no longer sensitive to topotecan. He wants her to have a full month's treatment with the drug, and then evaluate her CA-125 and CT scan to see how the recurrence is responding to the therapy. If topotecan is not working, than there are several other alternatives including doxil, more carboplatin (given on a desensitizing schedule) and several others that he named. Finally, there are clinical trials that can be used if all other alternatives no longer attack the bad cells. On a positive note he and Susan agreed that the topotecan was having very mild side effects, so if it continues to work it will be a much better quality of life than when she was taking cisplatin.
Susan raised the question herself: "what happens if none of these work?" This obviously pained Dr. Mirstching, who was trying to be as positive as possible--particularly in contrast to Dr. Munoz's comments on Saturday. He outlined the likely scenario, but then went on to remark that the only way he was able to talk to patients like this was when he began to realize as a doctor that "he's not in charge of their cancer, just like they aren't in charge." His role, he said, was to be as helpful and encouraging as possible to help them on their journeys, but not beat himself up--nor his patients--when his best efforts were no longer good enough. We got an inkling of who he thought was in charge as we got up to leave. The conversation turned to one of his nurses who is in the hospital with a serious illness. "Please remember her in your prayers," he said. Looking intently into his face, we said that we surely would.
Our visit to the surgeon today was somewhat discouraging. He didn't bother to examine Susan (Saturday was apparently a catch-up day and he was trying to get through his patients rapidly), but simply looked at the various reports. His conclusion: "the topotecan didn't work. It was probably the surgery that put you into remission. We've got to try something else, and pull out all the stops." His proposal is to use a new agent called gemzar along with alpha-interferon to help the body fight the cancer. On Monday we'll visit with the oncologist and see how he reacts to this proposal.
Today
We've just returned from Susan's first chemo in this new round of therapy. She received a dose of topotecan 3 times larger than what she received during the last round. This is the so-called "standard dose" which was reduced last time because she was taking it in conjunction with cisplatin. The combo is known to really zap the white cells, hence the lower dose of topo previously. The nurse today indicated that nausea should be less of a problem compared to the cisplatin. So far, except for feeling a little spacy this afternoon, Susan is feeling well enough to do some baking. Even now I hear her rattling some pans in the kitchen. Crunch time will come this evening when the anti-nausea drug starts wearing off and she has to take more. Please pray for minimal nausea as she recovers over the next few days. She will now get her chemo on Tuesday afternoons.
I know that several of you are awaiting a report from Susan's visit to her surgeon scheduled for today. Apparently the good doctor was required to do emergency surgery this afternoon, so our appointment has been postponed until Saturday (which is a little out of the ordinary). Susan remains stable as far as discomfort is concerned, and we had a good several days in the wilds of SE OK with Dan and family. Tomorrow, she starts topotecan. We'll update this page about this time tomorrow.
The radiologist's report from yesterday's CT scan came in today. Overall it is consistent with a recurrence. However, the good news in the report is that only a single suspicious anomaly is seen. Here is a quote from the radiologist:
" There is a new small focal fluid density noted adjacent to the capsule of the right lobe of the liver anteriorly. While this could be a small loculated fluid collection, given the patient's history of ovarian carcinoma, it is worrisome for peritoneal carcinomatosis."
In the margin the oncologist has written: "this is consistent with her referred shoulder pain."
We believe this means that if the cancer has returned, it is in peritoneal cavity near the liver, but not on the liver. As a result the oncologist has scheduled Susan for weekly topotecan treatments beginning next Weds. As Susan says: "it is comforting to have a plan." Our relief that the cancer does not show up more extensively is tempered by the fact that the scan right before her last surgery did not pick up on the extent of the spread throughout her abdominal cavity. We would appreciate your prayers for:
* the effectiveness of the topotecan
* minimal side effects from the chemo
* reduction in pain
Susan drank that awful stuff and had her CT scan at Medical City. She did better with the scan than usual: the pre-scan drink didn't upset her digestion so much this time.
We had an email exchange with the oncologist and he has gone ahead and authorized a resumption of chemo (using single-agent topotecan) starting next week. Hopefully this will start beating back the cancer and reduce Susan's symptoms. We will know more once the CT scan report comes back in a few days.
Dear Friends,
I regret to inform you that Susan has experienced a setback in her fight against cancer. Several weeks ago she began experiencing more intense discomfort and pain, requiring more frequent use of pain killers. Last Thursday we got back the result of her latest tumor marker test (CA-125). It showed that the marker had skyrocketed from the normal range of 20 all the way up to 123. The combination of symptoms and marker strongly indicate that the cancer is recurring and remission has ceased. We will confirm that this week with a CT scan on Wednesday, and a visit to the surgeon on the following Tuesday. We would appreciate your prayers for wisdom regarding the treatment options we will be facing. Please pray for Susan' pain to be moderated also.
We do not want you to be uninformed, brothers, about the hardships we suffered in the province of Asia. We were under great pressure, far beyond our ability to endure, so that we despaired even of life. Indeed, in our hearts we felt the sentence of death. But this happened that we might not rely on ourselves but on God, who raises the dead. He has delivered us from such a deadly peril, and he will deliver us. On him we have set our hope that he will continue to deliver us, as you help us by your prayers. Then many will give thanks on our behalf for the gracious favor granted us in answer to the prayers of many. (II Cor. 1:8-11)