Sandi and I drove to Seattle Thursday to meet with a bunch of doctors from the Seattle Cancer Care Alliance (SCCA) for a thorough second opinion. The trip itself was uneventful, lots of driving, Seattle traffic etc… we stayed at a reasonably nice hotel overlooking Lake Washington, and had dinner from Duke’s Chowder House (yummy).
At the SCCA, we met with an oncologist, a surgeon, a geneticist, and a nutritionist. In general, they were more complete in their description of Sandi’s situation than we have gotten to date. That said, we didn’t hear any significantly different message or analysis from what we already knew from the Oregon Clinic cancer team. There were some important things though.
Sandi’s cancer is classified as “Stage 3 locally advanced”. This means there is no evidence that it has spread beyond the primary tumor, but also means it cannot be surgically removed. Sometimes, the purpose of chemo is to try to shrink the tumor to the point surgery can become viable. We have been hoping is that this would be the case for Sandi.
The surgeon did a very complete job explaining what normal anatomy surrounding the pancreas should look like. Then, he described in quite detail how Sandi’s CAT scan is different from that, and how the blood vessels have been affected. Because of this vascular involvement, and what amounts to the apparent destruction of the normal blood vessels around the pancreas, the probability that chemo can cause Sandi’s tumor to become resectable is very slim. This is hard news, as it puts us on a different footing.
The oncologist was emphatic that Sandi should be feeling better than she has been, even with chemo. He strongly encouraged us to make sure we communicate with Sandi’s care team so they can help. Part of this comes down to the fact that Sandi has been feeling gradually worse over a very long time, so it’s hard for her to figure out what she should expect. The oncologist also thought that presuming the chemo works, Sandi could quite possibly have several quality years of life (albiet coping with chemo as a lifestyle). This is also hard news, but is better than some of the messages we’ve gotten to date. He also spoke of a medical trial that might be relevant, but not until after a couple rounds of chemo though. We’ll keep that one in mind.
The real thing that’s changed is that while the cancer and chemo take a real toll, at least some of Sandi’s feeling sick isn’t from these causes.. Rather, it’s because the cancer has caused her pancreas to stop functioning correctly. We knew this with regard to insulin, and Sandi’s been learning what it means to be a type-1 diabetic.
The conversation with the nutritionist, in conjunction with the other conversations, revealed to me (I think Sandi already had a clue) that her pancreas also is likely failing to produce the digestive enzymes Sandi needs to digest protein, fat, and carbohydrates (AKA food). This means that even though she has been eating (which takes a lot of willpower during chemo), her body has been nominally starving as the food wasn’t being properly digested. Furthermore, undigested food going through the large intestine can cause pretty severe intestinal distress. All this has caused her serious fatigue and illness, slowly building up over a long time. Add chemo to that and it has been a pretty darn hard couple of weeks.
All this actually leads to some good news. Discovery of this digestive issue means Sandi can take pancreatic enzymes when she eats. While it will take some figuring out, we hope it means Sandi can eat more foods and not feel sick from it. I am hopeful that this is a really important discovery that will make her feel a lot better. Time will tell.
Sandi goes back for more chemo Tuesday. Her first round was pretty rough. Hopefully the second round won’t be as bad as they can dial in the chemo a bit, and the pancreatic enzymes may help in general.