PET Scan Results – Cancer War

PET scan results are not what we hoped for and a renewed war on the cancer will begin.

Feb 22 early morning update

• This morning Sam will have a minor surgery to complete a biopsy of the newly cancerous site on his T3 vertebrae. Results of the biopsy are expected following this coming weekend.

• This afternoon we will meet with the radiation oncologist to discuss treatment options using radiation. I expect this will cover at least two scenarios: First, an emergency scenario should the cancer starts in Sam’s back begin to impact nerve function. Second, a scenario that could be more therapeutic assuming the cancer is slow enough growing that it does not require emergency action. … the second scenario should be less dangerous.

• Friday we will be back in clinic to debrief and complete standard health checks.

• Sam remains courageous. He understands everything that is going on. He knows his life is at risk. Yet he remains courageous, hopeful, trusting, and faithful.

Despite challenging news we had a great family day. Here we are pictured with the sea otters of the Vancouver aquarium – they are definitely a favorite.

The afternoon of the 14^th Tina and I met with Sam’s doctor to discuss the results Sam’s PET scan – completed earlier in the day. The results were not what we hoped for – the cancer remains and has spread. Though we were initially shocked, disappointed, and honestly scared, the three of us have rallied and are preparing to take on this next fight.

Feb 15 – recap

Yesterday morning started with a good friend sending us this beautiful prayer:

Gracious God, when we cry to you and feel as if you do not hear us,
grant us a tangible reminder of your promise to never leave us alone.

When we feel ground to dust, unable to sing your praises or whisper a prayer,
surround us with others who will sit with us, pray for us, and be the hands and feet and face of Christ to us.

When the night has past and we see the coming dawn,
help us to bear the light of Christ to those who still sit in deep darkness
  until we all shout alleluia on Easter morning.

Amen.

from Jill Duffield’s “Lent in Plain Sight: A Devotion through Ten Objects” (Amazon)

The previous night and into that morning I felt it. I felt ground-to-dust. And yet notes of support and care started to roll in. When you reach out and express your care, your solidarity, and your prayers, you are the hands and feet and face of Christ to us.

Please continue to reach out to us – we need you. Please ask your children to reach out to Sam so that he knows he is not alone. Let him know that he is missed and that they are praying/ caring for him despite the physical distance. Many thanks to those who have reached out already and especially to Sam’s friends for reaching out to him.

The initial feeling of having our world rocked have shifted. As a family we have spent time encouraging each other and praying together. We have rallied – we are ready to take on this next cancer battle.

PET scan results

Although busy with regular clinic check-ins, we have had to bide our time since Sam received his bone marrow transplant – 93 days ago. Imaging has had to wait as there was so much going on in Sam’s body it was not possible to get a new image of the state of the cancer. Our assumptions and our hopes were that the prior treatments would have set the cancer back and that the new immune system would then attack anything that remains. However, the PET scan revealed a more complex picture.

Original cancerous mass

Imagery of the original mass suggested that the radiation therapy destroyed much of the cancer and likely that there is an on-going war between Sam’s new immune system and the remaining disease. The imagery of this site looks like a solar eclipse – with no activity in the middle, where the radiation focused, but with high activity/avidity around the edges.

New sites

Perhaps more alarming is that cancer is now active in new areas of Sam’s body. There are three new locations, all of which appear to be within bones (something we have not seen before). Working bottom-up, new sites of cancer are located in Sam’s

• left shin (tibia) slightly below his knee
• hip (right ilium)
• back (T3 vertebrae, between his shoulder blades)

None of these are currently causing any additional impacts (e.g. bones are still strong, and no nerve impacts). Sam does have some back pain which is likely related to the spot there. These new sites raise questions and there will be a flurry of activity as plans of attack are made.

Next steps

The first question that is being asked is what kind of cancer is this? It is likely that it is the same cancer in a new location but the teams needs to know definitively. The next questions to be answered are related to how to treat the cancer. The medical team is jumping into high gear to start answering these questions. Next up:

• Completed, Feb 16 morning: CT scan of the T3 vertebrae to assess risk and provide imaging that will assist with treatment planning.
• Competed, Feb 16: Discussion with with the Orthopedic surgery team to discuss/plan a biopsy of the cancer in Sam’s shin (the easiest of the new sites to access). This was completed by our medical team and it was determined that this biopsy would not be feasible.
• Feb 22: An alternate option is scheduled to biopsy the new cancer in Sam’s back.
• Completed, Feb 16: Discussion with Radiation Oncologist to discuss new radiation based treatments. Our medical team has been in communication with them and the Radiation team is ready when and if needed.
• Ongoing: reduce medications that have kept Graft versus Host Disease (GVHD) in-check. Increasing GVHD may help in the battle to kill the cancer … though this will need to be monitored closely to ensure Sam’s good tissues are not damaged.

It has not even been 48 hours since we received the PET scan results and I hope you can sense that things are moving quickly – action is being taken.

Although there is a lot going on we were also able to get out and enjoy life.

A great day together

Despite these challenging PET scan results yesterday was a great family day – starting the Family Day holiday weekend off a little early. Yes, we had a big clinic visit in the morning where many of our questions were answered. In the afternoon we had a wonderful time at the Vancouver Aquarium! Watching some very cute creatures and exploring the long history of life on the planet through the various exhibits. Afterwards, we shared dinner together in our room (taco night at the RMH) and took in the Vancouver vs. Detroit hockey game.

Victories and concerns

• The cancer remains and has spread to new areas in Sam’s body. There are many questions that need to be answered and new battle strategies that need to be developed. The medical team has shifted into high gear once again.

• We are thankful that we have access to such incredible tools to show where the disease is in Sam’s body.

• We very thankful for the successful delivery and engraftment of the donated stems cells! To whoever made this donation I cannot thank you enough.

• We are thankful to the medical team who have explained things incredibly well and who have worked professionally and confidently. Your clear communication, compassion, and care give us great confidence.

• Thankful for friends who have chosen to meet regularly to pray for Sam. If you would like to join them talk with Beth H., Krista C., or contact the Westwood Church office.

• There is always concern that the cancer remains. We long for the day when Sam is clear of this disease.