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Pancreas Cancer

Greg's Crazy Dr Visit! was posted 07/29/2009 09:05 pm by LindaNuc
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WOW, what a day! Had Greg’s appointment with oncologist today to go over CT scan & review blood work. Oncologist continues to be baffled by what is happening. CT (which was done without contrast to spare Greg’s kidneys) showed disease progression in liver –tumors have increased. The odd part is that his CA19-9 dropped from 597 four weeks ago to 143 today. All of Greg’s liver function studies are great. AST & ALT actually have come down from previously (never were out of normal). After staring in silence at the CT scan, for what seemed like an eternity, oncologist said, although he normally trusts the CT completely, he feels it is showing a situation that doesn’t exist. AT THIS POINT IN THE VISIT, His take on the scan was that we were possibly seeing massive scar tissue, where tumors have shrunk. He decides to do an MRI… then we realize Greg’s metal stent will not allow this to be done safely. So next, PET is what oncologist wants but, of course will need to get clearance from insurance company first. As we are discussing the situation, Greg mentions to Dr. that I have sent his pathology slides to Johns Hopkins for a second opinion regarding cancer type. Oncologist asked why I questioned “adenocarcenoma” as Dx. I said because, Greg’s original Dx was neuroendocrine, then after stains were done, tumor was called “primarily” adeno. Would you believe that our oncologist NEVER read the path report. After he looked it over he said that it’s possible that there is a nuuroendocrine component to this tumor even though report says it’s mainly adeno. He has been baffled for months over how the CA19 & tumors NEVER seemed to be in sync. Dr said that if tumors, have a neuroendocrine component, it would explain why they may be advancing so quickly in the liver – not the right chemo! Unfortunately, Dr said, if this is a neuro as opposed to adeno, it would not be the slower growing carcinoid type, it would be the fast growing “small cell lung” type, which is more difficult to treat than adeno. SOOOO… at this point, I’m not sure if we got better news or worse news. We are shooting to have the PET done first, to rule out advancing tumors vs scarred liver tissue. If PET shows the tumors to be active, then Oncologist says he will likely switch Greg to a neuro chemo to see what happens. If it shows the tumors are dying, then Greg continues on Folfox. The only reservations I have regarding jumping into a neuro chemo is, how can we be sure we are using the right stuff. Should the liver tumors be biopsied first? I’m at a bit of a loss as to how this should be approached. Greg is already on his second line of chemo. ANY advice / comments welcome. Thanks*** Linda

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