Tumor Board Review

Important lesson of the day: If I am worried or concerned about how my treatment plan is going to work out, no need to worry, because it will change again tomorrow...

When I was little, I had this aunt (you know who you are) that would buy me underwear for Christmas each year. The idea that there was a gift of underwear lurking somewhere under the innocent Christmas tree waiting for me was mortifying. Worse yet, we have a large family. I mean really large. Typically at Christmas someone was designated as the Elf (present distributor), and this person would just throw presents to the proper people. We didn't really see everyone open all their presents, yet inevitably when those underwear would turn up, all eyes would be on me. It didn't matter that the underwear were different colored underwear with polka dots, or days of the week underwear, it was mortifying. I will admit that after Christmas the dreaded underwear were often my favorite underwear, but if you had asked me, I would have told I threw the underwear out.

Fast forward a few years. I was a young teenager and my great-grandmother (same side of the family) decided to ask me loudly one day if I "had gotten the monthlies, yet" in front of the family. I wanted to die. What the hell was she thinking? Honestly, she thought it was funny. I've never forgiven her.

These instances scarred me for life, or so I thought.Who would have thought that I would have a blog centered on my cervix? I'm still processing that words like cervix, ovaries, vaginal bleeding are all parts of my everyday conversation now and not in relation to my midwifery education. I guess it's not like I really get a choice. Of course I didn't have to start a blog about all of this, but I figure life as I knew it is over and so I may as well embrace it. There is always the added benefit that the blog allows me to talk about my cervix, ovaries, vaginal bleeding, whatever,  to my computer and not face-to-face (though I've done pretty well with that too).

So today we had an oncology appointment to discuss changes to the treatment plan due to last week's MRI results. Once again I'm going to rave that I have the best NP in the whole world and my oncologist is pretty great too. Today's appointment started with him leveling with me that due to the specific type of cervical cancer I have, they aren't really sure what to do with me. About 80-90 % of cervical cancer is a type called squamous cell carcinoma. This type of cervical cancer is highly researched and has well-established treatment protocols. If I had this type of cancer, the plan post MRI would simply be radiation and chemo.

I'm going to start saving these pics to use as coloring pages...maybe they could have a coloring contest at the oncology office...

 My team is concerned that this plan isn't aggressive enough for the type of cancer I have. Ovarian and uterine cancers are more commonly associated with clear cell carcinomas. So the team considered what the standard treatment protocols for clear cell ovarian and uterine cancers with lymph node involvement would be. According to the literature the protocol would be to remove the lymph nodes and do chemo.

Then they discussed all my options with a radiation oncologist. They discussed continuing with the original plan of radical hysterectomy. The issue with this is that they don't think they would be able to get clean margins. This means they would most likely be able to remove most of the mass but there could still be some cancer cells left in me. In order to get clean margins with the surgery they would have to resect (cut) my ureters (the tubes that transport urine from the kidneys to the bladder) and then re-implant them. Sounds pretty horrible, doesn't it?

The radiation oncologist feels that she can avoid this with radiation. So the next concern is whether or not to "trust" the PET scan. If consensus is they trust it, then plan A. is to do a course of radiation, do another PET, and then (after the second PET) decide about following up with chemo and/or surgery.

In all honestly, my oncologist does not 100% trust the PET scan results. Since I am so young, he would rather be overly cautious. His preference would be to do an exploratory laproscopy (they make a few little incisions in my stomach and put cameras in) to ensure there is no cancer to the upper abdominal cavity. He would also use this as an opportunity to move an ovary away from the radiation field (as long as there is no cancer in the ovary), thereby potentially saving me some ovarian function and fertility options. So this plan, plan B., is essentially an expl. lap, radiation (external beam and brachytherapy) with chemosensitization (Cisplatin), then another PET/MRI combo and follow-up with surgery and/or original chemo plan (Carboplatin & Paclitaxel).

So there you have it. This is where we are now. The tentative date for the surgery is August 24th. It will probably just be an outpatient surgery. Then I will start radiation therapy. All of this is dependent on tumor board review this Thursday morning. Tumor board review is when all of the oncology department gets together to review unique or challenging cases. My 3 seconds of fame are being used up at the meeting this Thursday morning. Everyone will see my MRI and PET scans and all my lab tests. They will know all the specifics of my case and then they will discuss the current plan and brainstorm any other potential options.

They will call us and let us know the results of this meeting when they are done and then Thursday afternoon we will actually meet with the radiation oncologist. The only other decision made today was to make an appointment to get my port placed. A port is a type of IV catheter that is surgically inserted into a vein. This will make everything lab draws, IV fluids, chemo much more convenient for me.