This blog post will be a little different than the previous format.  Rather than posting as an advocate with the focus on using personal experience to help others, this posting will be an update to my current battle on cancer.  I have made a very short entry in the Medical Journal portion of this page.  However, I will provide much more detail in the treatment options as well as the decisions that have been made.

What a roller coaster ride this has been over the past 3 weeks.  Actually, my anxiety of what could be lurking around the corner began over a month ago when I started experiencing pain again.  This was a pain that was not foreign.  I have dealt with this pain many times before.  I met with my Oncologist and he scheduled follow up tests.  CT Scan, PET/CT Scan and an MRI.  These scans were done in my home town and reviewed by a Radiologist and my Oncologist.  It was determined that there was new development identified and needed to be reviewed by the medical team in Saint Louis at Siteman Cancer Center.  Once they reviewed the scans and confirmed the development, I was contacted immediately so we could further discuss treatment options.  HERE WE GO!

So the exhausting process begins.  

Starting with gathering and organizing of clinical information.  Researching and evaluating current clinical trials as well as existing options both from a surgical and oncology view point.  I have always been very involved in my health process and the medical decisions that are made.  I think my team of Physicians have come to expect my participation and share my thought process.

My CURRENT STATUS is substantially different that one year ago.  Today, I feel like i am in the drivers seat of this crazy ride.  

Last year, we were forced to make decisions that were life saving not necessarily long term.  Although we did make every attempt to balance the needs of now vs. future.  As with so many plans, we had to adjust as the situation changed.  Last year the tumors progressed and became life threatening, we adjusted and met them with equal opposition.  We aborted the chemotherapy plan (1/2 way through it) in order to progress to a multi stage surgical process.  We began with cryoablation to the right lobe of the liver and then followed this 6 weeks later with resection of a portion of the right lobe.  This was then followed up once again with chemotherapy.  

Currently, there is a new tumor development in segment 8 of the liver.  This is the right right lobe of the liver (see above).  At its current state, this tumor  does not present any immediate danger.  My current liver function is also not a threat.  Although we do need to respond to this development soon, we do have a little time to explore and discuss treatment plans moving forward without making urgent care decisions.  The process of deduction to arrive at a current treatment plan usually develops a plan B and beyond.  This time is no different.  Here are just some of the treatment methods we discussed, in no particular order.

• Radiation, exploring the options of Ytrium 90 and proton beam therapy.
• Surgical, discussing location difficulties
• Chemotherapy, discussing targeted therapy treatment options based upon the molecular study results.
• Immunotherapy options that may have an impact based upon the molecular study results.
• Clinical trials, reviewing clinical trials at multiple different phase levels and their applicability for my condition.

Balancing the treatment options can be a difficult task.  Factors considered (from my non clinical perspective) are as follows: 

• Existing health condition.  In my case, taking into consideration the toxicity levels and damage to liver from previous treatments and the effect that new treatments could present.
• Tumor location:  In my case, segment 8 (right lobe) of the liver next to the hepatic vein.  Treatable as the tumor is not endangering the hepatic vein as it has in the past.
• Tumor size:  Current size is treatable with various methods.  Making it a good candidate for Ablation.
• Tumor Load:  Number of tumors involved, amount of cancer cells in the body.  Currently, I have a low tumor load with only 1 tumor identifiable by scans.  This does not mean that more cancer does not exist, just not developed enough to identify by limitations of scans.  Previously, my tumor load was much higher.
• Molecular genomics testing (BioMarker) via tissue samples from biopsy of the metastatic disease.  This is of tremendous value.  Identifies MicroSatelite status as well as mutations of cells.  This information provides a more target decision in choices rather than a machine gun approach.  This becomes critical when choosing therapy options for both Chemotherapy as well as Immunotherapy.  In my case, I am MicroSatelite Stable with KRAS+ mutations.  Unfortunately, this profile has limited efficacy with modern chemo/immunotherapy treatments. 

So what is the best decision to make?  Do we swing for the fences?  

Well, prior to sitting down with the wonderful Physicians at Siteman Cancer Center, I was fully prepared to swing for the fences.  Which would have landed me in a clinical trial.  I had several selected and was looking for direction so we could start the application process to get accepted.  I was well aware of the risks involved.  To me, it made sense.  The risks of standard treatment, toxicity damage and lack of quality of life made my decision relatively easy.  However,  I think we will table that for another day.  Here is the medical line of thinking.  First, whenever resection or ablation is an option, they strongly encourage exercising that option.  The thought is remove the tumor from the body when possible or Kill it to prevent further metastasis from the cells.  I was very apprehensive about this approach.  I have done that before and the cancer has returned.  But the biggest reason for my resistance was the inability to have a measurement method.  I did not want to undergo further treatment without a measurement tool, the tumor is that tool.  I have done this before and did not want to go there again.  At least with the ability to measure the results of the treatment (Chemo and or in combination with immunotherapy) we would have the ability to make changes to the regimen when presented.  This was a BIG obstacle for me to overcome.  In addition, by removing the active tumor, this would exclude me from all the trials I have interest in.  Now where things become a little ambiguous.  Is this new definable tumor residual cancer cells from the previous mCRC that was treated or “New Cancer”.  They (medical professionals) attack and treat these condition’s differently.  This can be a confusing topic.  Simplified, if the cancer is “old”, they will mop up what was left over.  If the cancer is new (recurrence) metastasis then they would treat it with a more global approach with the fear of more development in the effected organ as well as metastasizing to distant organs.  This determination is a best guess.  Working on the basis of time, if the tumor presents within 1 year of last treatment the conservative approach would be to treat it as existing/left over.  In contrast, if the development is presented past 1 year from last treatment it is considered “New”.  The thought of making the wrong assessment is very scary, providing the cancer the environment to expand and become a life threatening condition rapidly.

TREATMENT PLAN

Current Plan:  The first step will be to obtain a current “liquid biopsy” to have a baseline genomic profile to use as a measurement.  This will then be followed my Microwave Ablation”

“Microwave Ablation (MWA) is a form of thermal ablation used in interventional radiology to treat cancer. MWA uses electromagnetic waves in the microwave energy spectrum (300 MHz to 300 GHz) to produce tissue-heating effects.”

to kill the cancer cells in the effected area using heat generated via probes to burn the tissue containing the cancer cells.  This will then be followed by another liquid biopsy to make a comparison.  If the outcome is favorable (low cancer markers) then we will go on surveillance and monitor the condition with scans and blood tests every 90 days.  In the event the cancer markers are still elevated, we will progress to other treatment methods which on the onset will be a new Chemo cocktail.

Backup plan:  This will be more definable when needed based upon tumor load, location and organ or organs involved.  Preliminary, I will proceed with “Swinging for the fences” and apply for acceptance into a clinical trial.  Clinical trials I am currently following involve a multi-disciplinary approach.  Chemotherapy to gain control of the cancer cells combined with Immunotherapy using a PDL1 inhibitor that will hopefully engage my immune system.  I will reserve some of the other tools (Y90 radiation as an example) as a secondary treatment option for life threatening urgency.

More to come, for additional up to date information as this journey progresses please check in on My Medical Journal page.