Monday Dr. L called me "into his office" to talk about Case's scans. Based on what he sees, he just doesn't think he will be able to avoid a Whipple Procedure. I am not surprised. Although I don't want my baby to go through all of that removal and re-plumbing, I'm okay with it. Would I rather my child have digestive issues over dying of cancer? Um, Yes! So we'll take what we can get!
The doctors here just aren't comfortable leaving large parts of the tumor in Case. The "live" part of the tumor is just completely integrated with the head of the pancreas. There is a chromosomal composition within the cancer cells (like MYC-N) called ploidy. If the cells are "hyper-ploidy," they are less aggressive. If the cells are "diploid," they tend to be more aggressive and grow back. Case, unfortunately, is diploid. It's not as big of a deal as MYC-N, but it just leaves the doctors wanting all of it out; not wanting to sit and watch to see if it would grow back.
Also considering the diploid factor, we will probably follow up with a round or two of a new chemo that Case hasn't had yet. That would take place back home, thank goodness. Although I don't want to do that, and I don't want Case to loose his hair AGAIN, it's an easy enough solution to try to safeguard Case against a relapse.
Dr. L will try to remove the affected lymph nodes, but his main concentration will be this huge (although shrunken) tumor encompassing his intestines and many vessels. So we might have to come back up here for a second surgery if he's not able to remove all the lymph nodes. The incision for the Whipple procedure will be on his front and will go from right under the middle of last ribs and will follow his rib line down his right side. To remove all the lymph nodes Dr L will need to make an incision actually inbetween his ribs under his right arm pit. So again, that might be a second surgery a few months later.
Dr. L said that he would be inpatient from 1-2 weeks. The depressing part to me is that Case needs to hang around here after discharge until he is travel worthy. I thought a day or two, but it's usually one to two weeks!! I feel like I should fill out a change of address form with the Post Office for all the time I'll be here...probably six weeks. X needs to be back in Texas by June 4th because he has a new therapist starting at his clinic. Colin and Graydon will probably go home then too, because our 30-day lease will expire June 7th. At that point my mom will stay with us until we go home. We will probably be at the Ronald McDonald House since our apartment is already leased out after our original term. So complicated.
Anyway, that's the update. Surgery is still on for next week, Thursday May 24th!