A New Twist to the Story

Today Steve and I went up to Seattle Cancer Care Alliance (SCCA) to meet with Dr. Farah, an oncologist who specializes in Lymphoma.  He spent a great deal of time discussing Steve's evaluation and treatment.  Dr. Farah did a great job explaining Lymphoma to us the going into details about the course of treatment. 

We also heard of a new twist to the story that could be a real game-changer.  There is still some question about whether Steve has strictly the diffuse Type B large cell, fast growing Lymphoma (Non-Hodgkin's Lymphoma) or whether he FIRST had the slow growing, small cell Follicular Lymphoma that transformed into the fast-growing, large cell diffuse Type B variety.  Apparently there was some indication in his pathology report that this may have been the case.  Seattle Cancer Care Alliance has ordered the slides and samples of Steve's tumors so they can provide us with a second opinion.  If I understood what Dr. Farah was saying, they will look for evidence of follicles in the lymphocytes (white blood cells).  

You might be asking why this is important.  Well, if he first had the slow growing Lymphoma that transformed into the fast growing Lymphoma, that would mean that he would most likely have to live with Lymphoma for the rest of his life -- that kind of Lymphoma is not curable.  It can go into full remission, but it always come back and when it does, it is much more aggressive.  If he simply has the fast-growing non-Hodgkins Lymphoma he has a high rate of cure after treatment.  They are currently performing a cytogenic study of his chromosones to determine if his Lymphoma cells transformed.  In both cases, he would still need to have the full course of Chemotherapy.  We are really hoping and praying that he simply has the diffuse type B large cell lymphoma because then he could go through the treatment and there is a greater than a 60% chance of him being completely cured.

The next two weeks will be filled with testing, scans, surgical procedures and Chemo.  The testing will help the doctors determine what stage of Lymphoma he has (I - IV) and what his prognosis is. 

Here are the 4 Stages of Lymphoma.

If they determine that Steve first had the slow growing Lymphoma, then he will be in Stage 4 because the slow growing Lymphoma affects the stem cells in the bone marrow.  The bone marrow study on Thursday will help us know how his stem cells are doing.

• Stage I: A single tumor which hasn't spread.
• Stage II: More than one tumor, but the tumors are all found in lymph nodes on the same side of the diaphragm (all above or all below). Stage II can also mean that a tumor has spread to another organ, but that it is close to the original lymph node tumor.
• Stage III: More than one tumor with the tumors found on different sides (above and below) of the diaphragm. There may be tumors in the spleen or more than one tumor in nearby organs.
• Stage IV: Many tumors spread throughout an organ such as the liver or stomach, as well as in the lymph nodes. Stage IV can also refer to a single tumor in another organ, plus tumors in distant lymph nodes. (http://www.cancer.org/)

We already know that Steve is at least in Stage II because he had two lymphnodes removed last Monday and both have been confirmed to be cancerous. 

I wanted to provide you with the dates of his tests, surgical procedures and chemo so that you can be abreast of what is going on and can pray specifically for Steve.  

9/26 Steve at  Seattle Cancer Care Alliance with Dr. Farah.	9/27	9/28 Steve having MUGA (Heart functioning test) at 8:30 – Puyallup Nuclear Medicine	9/29 Steve having a Bone Marrow Biopsy at Good Samaritan Hospital at 12:30 pm.	9/30 Steve has a PET Scan at 7:30 am at PET Scan Radiology and then has a CAT Scan at Diagnostic Imaging at 2:00 pm.
10/3	10/4 Steve has an appointment with Dr. Liao to discuss the results of the testing and determine staging and prognosis at 8:30 am.	10/5 Steve has his port surgically put in by Dr. Kim at 8:30 am.  We have a Chemo Teaching class in the afternoon with Dr. Lia0 at 2:30 pm.	10/6	10/7 Steve has his first Chemotherapy with Dr. Liao beginning at 9:00 am.

We are unable to project how things will go after the 7th because we do not know what stage of cancer Steve is in.  The stage and prognosis will affect his treatment.  Right now Dr. Liao has recommended chemo every 3rd Friday for 6 weeks.  We will find out more next week when we meet with Dr. Liao on 10/4/11.

Right now It feels as if we have been sucked into the eye of a hurricane.  Although there is much destruction and chaos going on all around us, inwardly we find great peace in knowing our God is with us in the center of this storm.