I wasn't two sentences into writing the blog when the phone rang. It was Dr. Farah from the Seattle Cancer Care Alliance (SCCA). Steve answered the phone and began to tell Dr. Farah the good news from the FISH test. Dr. Farah then interrupted Steve mid-sentence and told him to hang on. Sensing that the doctor had some important news to share, Steve yelled for me to come to the phone. Dr. Farah asked me if I had my notepad handy, because I would inevitably need to take notes on what he was about to share.
He began by reminding us of our visit with him; the day he told us about Diffuse Large B Cell Lymphoma and transformed Follicular Lymphoma. He apologized that the results from the pathology that was done by SCCA had taken so long, but explained that it took a team of pathologists, who specialized in lymphomas, to agree on the findings and sign off on the report.
And then he dropped the bomb. The pathology was suggestive of small cell Follicular Lymphoma. He said that the pathologists had to do many stains and that Steve's lymphoma cells were not diffused large B cells. Dr. Farah said that the cells were definitely small cells without follicles. He told us that the size of the cells is important because this indicates that Steve has an indolent, slow growing small cell lymphoma, for which presently there is no cure.
Dr. Farah had contacted Dr. Liao earlier in the day. The two doctors exchanged findings --Dr. Liao shared the results of the FISH test and Dr. Farah shared the pathology report. I can imagine there was a lot of head scratching and puzzled looks during this conversation. You see, the findings of the FISH test along with all of the PET scan, CT scan and bone marrow biopsy and the pathology from SCCA were completely contradictory. The pathology report was pointing to small cell variety but the lymphoma was the cancer was behaving just like the aggressive, large cell variety. Dr. Farah explained the 90% of all patients with Follicular Lymphomas have translocation in their cells. As I mentioned, Steve's FISH test confirmed that his cells had not translocated (or transformed).
Now, I know you must be completely and utterly confused, because this news left us completely deflated, alarmed, and perplexed. What could all of this mean? What was Dr. Farah implying? He was implying that Steve was in a very small population of patients with lymphoma. Only 10% of all folks diagnosed with Follicular Lymphoma have diffused cells.
Again, the good news here is that Steve was diagnosed in the early stages. Dr. Farah said that 80% of folks with Follicular Lymphomas are in Stage 4 when diagnosed. Because Steve was diagnosed in Stage 1, Dr. Farah said that he has a 60 to 80% cure rate. Although this is not the 90% we were celebrating, it is still some fairly good odds. He said that the best treatment would be to do three rounds of R-CHOP chemotherapy followed by radiation to the groin.
After getting off the phone with Dr. Farah, we called Dr. Liao to get his take on the results. Although Dr. Liao did not refute the pathology report, he had a more positive outlook on Steve's prognosis. Dr. Liao believes, based on looking at all of Steve's test results (not just the subjective results of a pathology report) that, in his mind's eye, there is less than a 2% chance that Steve has a true Follicular Lymphoma. You see, Steve's lymph nodes grew very quickly and presented themselves to be just like a Diffuse Large B Cell Lymphoma. The only difference in his pathology is that his malignant cells are small and not large. He agreed with Dr. Farah about treatment. Steve will have three rounds of R-CHOP chemotherapy followed by radiation to his groin region. Dr. Liao and Dr. Farah both agreed that it would be a good idea to seek a third opinion on the diagnosis. Dr. Liao plans to send Steve's lymph node tissue off to some of the leading lymphoma pathologists to review. Dr. Farah suggested getting a third opinion from the National Institute of Health, the worldwide authorities in lymphoma.
After taking time to pray, grieve, cry, and attempt to wrap our brains around all of this complicated mass of information, Steve is now preparing to face his enemy and is getting ready for the fight of his life. Steve has stepped into the ring with both his gloves and game face on. He is in great shape for this fight. The fact that he has trained a lifetime, both physically and spiritually, makes him favored to win this match.
The bell signaling the start of round one has rung. Steve looks up to see his opponent, wearing a black robe with a hood that conceals his face. Who it is behind that shroud is still a mystery. What we know is that his enemy is aggressive and has shown just how lethal his blows can be. However, Steve is not facing this enemy alone. In Steve's corner is a legion of fierce angelic beings, all clothed in white and armed for battle. Steve is also accompanied by the prayers of a multitude of believers. They will be partners in this fight, duking it out blow after blow until this mortal enemy is slain and Steve stands, his hands raised, and pointing to heaven, giving God all the glory for the victory.
2 Corinthians 12:9
But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me.
For he will command his angels concerning you to guard you in all your ways.
For the LORD your God is the one who goes with you to fight for you against your enemies to give you victory.
- Steve still has a massive collection of fluid (called a seroma) in his leg. The doctor does not want to drain it again for risk of infection. Please pray that the fluid will stop leaking out, it will not become infected, and it will go away on its own. This could pose a problem with chemotherapy and Dr. Liao is hoping it will be resolved before Steve starts chemo this Friday.
- Steve will have his port installed this Friday, October 13th, at 7:00 am at Good Samaritan Hospital. Pray for Dr. Kim, his surgeon, and that the port will be installed without any complications.
- Steve's chemotherapy will begin directly after the port is installed Friday morning. The first round of chemo will take at least 8 hours. This will be a very long day for Steve, as he will have his surgery followed by the chemo. Pray for strength and pray that he does not have ill side effects from the chemo. I will be with Steve the entire day and will try to blog to keep you all updated.
All our love, Steve and Michelle