Thursday, July 24, 2008

Eight is Enough!

Late Thursday afternoon, I had the pleasure of meeting for the first time with my Medical Oncologist and Sarcoma specialist, Dr. Gina D’Amato. Apparently Dr. D’Amato is quite accomplished in her field, with glowing endorsements from her patients and their families, some of whom have traveled across the country to see her. Prior to her arrival at Emory, she was the recipient of the 2006 Excellence in Care Award. I’m very fortunate to have her as my Oncologist.

In my first meeting, Dr. D’Amato spent more than 1 hour with me, describing in detail the type of cancer I have, the proposed treatment, side effects, contingencies, etc. The level of detail was quite remarkable. She has a good sense of humor, [politely] laughs at my “jokes”, and maintains a positive outlook, all of which I definitely appreciate.

MRI of Right Axilla
I also got the word that she will be ordering an MRI of my right axilla. Apparently the CT scan from last week revealed a possibly abnormality that they need to check out. She thinks it’s probably just a Lipoma (I have several of those), but they need to rule out metastasis.

Cancer Linked to HGH?
As many of you know, I had a Pituitary Tumor nearly 8 years ago, which was surgically removed in October, 2000. Since that time, I have had to take several drugs to keep my endocrine levels in check. One such drug is called Genotropin (a brand of Human Growth Hormone, or HGH). Though there is no established research to “prove” that HGH causes cancer, there are some who would suggest that HGH increases cancer risks. I have been told to discontinue that drug.

Chemotherapy thought to help
Though sarcoma research does not have the wealth of numbers and supporting statistics as more popular forms of cancer (such as breast cancer), there is evidence to suggest that Myxoid Liposarcoma does respond well to chemotherapy. Though this is “good news”, it’s a far more difficult treatment option for the patient than radiation therapy. I should also point out that Dr. D’Amato was one of the 50 doctors present at the sarcoma conference last week where they discussed my case. She apparently took an interest in my case and made an exception in her scheduling to see me the following week.

Thank you sir! May I have another?
And now for the bad news: she has me signed up for numerous cycles of Intensive Chemotherapy. By “intensive”, this is to say that I will be in the hospital for 4 days with each cycle of treatment. This is necessary so that they can closely monitor what’s happening and be able to respond quickly should there be a problem. With each cycle, I will be given Doxorubicin as a continuous infusion for 72 hours and Ifosfamide in 4 separate, daily IV infusions. This cycle repeats every 3 weeks.

Detailed treatment plan and contingencies
Here’s a detailed outline of the proposed treatment:

1. Start with a baseline MRI of left thigh (needed to track progress).
2. Go through two cycles of chemotherapy (#1 and #2).
3. Do another MRI of left thigh.
4. If tumor has grown (unlikely), the chemotherapy is not working. In that case, we punt on further chemotherapy and opt instead for radiation therapy and then surgery.
5. If tumor has stopped growing, we do two more cycles of chemotherapy (#3 and #4).
6. Do another MRI of left thigh.
7. If tumor has not shrunk by now, the chemotherapy is not working as well as expected. In that case, we punt on further chemotherapy and opt instead for possible radiation therapy and then surgery.
8. If tumor has shrunk (expected), we do two more cycles of chemotherapy (#5 and #6).
9. After 6 cycles of chemotherapy (assuming expected behavior), I'm ready for surgery. Surgery is expected to keep me in the hospital for a few days and then put me on crutches for about a month.
10. Based upon the post surgical pathology of my tumor and surrounding tissues, it may be necessary to follow up with 2 additional cycles of chemotherapy (#7 and #8).

Yes indeed, I believe that eight is enough!

Scheduling
Thankfully for me, the good doctor is on vacation all of next week, which means that my first cycle won’t begin until the first week of August (scheduled now to start on Monday, August 4). In the meantime, I'll be getting my right axila MRI, baseline thigh MRI, MUGA scan, port placement, labs, orders, etc. all late next week.

2 comments:

Chuck said...

Yowch! I understand why you're not exactly anxious to get started, but it sounds like a good course of treatment. When you said you wanted to get "effin' huge" you probably should have been more specific ;) Oh, and congrats on the clean liver.

Can I have your liver, then?

Warren Prins said...

Dave,
I was searching for more information on Lipo Sarcoma as I was diagnosed in August with a High Grade Sarcoma. It was surgicaly removed (the size of a foot ball) in late August, and they are now talking about the intense Chemo Therapy you are to under go. Have you started yet? How are you feeling, Is it working