Update, 10/19/2007

First, my apologies for taking some time getting this one out. I had fully intended to post an update on Tuesday, after seeing Dr. Grapski, but between needing time to wrap my head around the latest news, meeting with a radiation oncologist yesterday (Thursday, October 18), and getting sick (I got knocked loopy starting Sunday evening...feeling near 100% only today), I'm only now getting around to this. Thanks for your patience.

So, from Tuesday we have good news and bad news. The good news is that we have likely located the sources of my pains in my back and left leg. There is a growing tumor near my tail-bone, roughly 7.5 cm in diameter, as well as another tumor (not sure the size) on my left leg, near the hip-joint. Yesterday's visit with the radiation oncologist was to discuss treatment of these. On Monday I return for a "mock" run of my treatment, when they will confirm that they have defined the proper trajectories for the different radiation beams used to attack my tumors -- coming in from multiple angles allows a greater concentration of radiation on the tumor versus healthy tissue. Then on Tuesday I begin for real, returning Monday through Friday for the next four weeks. After this time, continuation will be determined by (1) whether my pain is improved, (2) whether we see any regression of the tumor in a follow-up scan, and (3) the severity of any side-effects.

In the meantime, we will put aside chemotherapy, and this gets us to the "bad news" portion of our post. We have officially exhausted all chemotherapy options for the liver -- 4 nodules in the liver have seen an increase in size since my last scan, growing by as much as 1/3. Everywhere else (aside from the 2 causing my pain and the 4 in the liver) it appears my cancer is either stable or gone (though we can't say anything with certainly here), so that much is good. Treatment of liver tumors is notoriously difficult, though two techniques have emerged over the last several years that offer some promise. The first uses tiny beads filled with a radioactive element (going alternatively by the names "theraspheres" or "SIMspheres"), which are injected into the blood-stream on its way to the liver. These beads collect in the tumors and there deposit their energy, largely preserving healthy tissue. The second option goes under the name "gamma-knife" or "laser-knife". From what I gather (I have not yet read as much about this), this employs first a surgical procedure to open direct pathways into the liver, allowing laser- or gamma-radiation to then interact directly with the tumors. Both are minimally invasive, with low side-effects and seemingly high success rates, though with the disadvantage -- as with all radiation treatment -- that they interact only with the targeted tumors, and not with any smaller, unseen, tumor in the liver. If simply due to geography (it's offered at Vanderbilt, just 3 hours away and within my HMO region) my best bet will likely be with SIMspheres. I am still gathering information, and must decide when to pursue this. I can say this will wait till after the coming month or so of "standard' radiation treatment. Just how long we'll wait is still to be determined.

And that's about it, sports fans. While the news of Tuesday, that the Xeloda was not working in the liver, was no surprise, it was still a punch in the gut. It is so every time -- no matter how hard I try to prepare myself. Every reminder from the outside -- from a doctor, from a CT scan -- that my cancer is getting beyond the reach of chemo is a jolt. But we respond the same way every time -- we take the hit, and rise again. Life is worth living, at all stages, and so long as I have life within in me, I will fight for it. Thank you all, as always, for your thoughts, prayers, and all other forms of support.