Thursday, November 10, 2011

Potential Resection

In an effort to describe our anxiousness yesterday, allow me to tell you about our first encounter with Dr. Chapman. After an hour or so of waiting, the nurse finally called Mom's name. We walked down a long hall and turned a corner. Samantha ran into the phone on the wall, knocking it to the floor. A very nice man walks up smiling, says "It happens to the best of us", and picked up the phone. Turns out, the man was Dr. Chapman.

Dr. Chapman is an incredibly straight-forward, genuine man. He reviewed Mom's history and began discussing her options. Mom has intrahepatic cholangiocarcinoma. There are two other types: extrahepatic and hilar. Intrahepatic is incredibly rare. It starts in the center of the liver, so it involves many of the critical structures (veins and arteries). Intrahepatic cholangiocarcinoma is the only type that is not eligible for a transplant. The recurrence rate is unfortunately high. Mom would have to be on anti-rejection medications, and if the cancer did come back her body would be unable to fight it off. Essentially, they could be wasting a transplant liver.

The next option is a liver resection. A resection would involve removing the tumor. Mom had a volume MRI yesterday afternoon at Barnes-Jewish. This type of MRI will allow Dr. Chapman to ensure Mom has enough healthy liver remaining if he can remove the tumor. Judging by the scans he's seen so far, he said it was 'borderline'. He will also have to make sure that she has an artery that is not too involved in the tumor. He thinks that her right hepatic artery may be spared, but until he see the MRI from yesterday he can't say if resection is possible. The resection surgery is quite risky for intrahepatic cholangiocarcinoma. It isn't uncommon that Dr. Chapman actually clamps off all major arteries/veins, removes the liver completely, takes it to the back table to remove the tumor, and puts it back in. Mom will know by tomorrow afternoon if Dr. Chapman is willing to do the resection. If so, it looks as though the surgery would occur fairly soon. The other complicating factor in a resection is that Mom's inferior vena cava is 100% occluded (clotted). If the resection occurs, he would probably remove the entire occluded portion (about 10 inches) of her vena cava and reconstruct it. Even with a resection, due to the size of her tumor, Dr. Chapman believes Mom has a 50% chance of the cancer recurring. There are many unknowns at this point, but we obviously hope that she is eligible for the resection.

The last option, if she can't have a resection, is a clinical trial that Dr. Chapman recently got approved for. It is specifically for intrahepatic cholangiocarcinoma patients and would involve placing a pump just under Mom's skin that would pump chemo through an artery directly into her tumor. It has less side-effects than the chemo she has been receiving, would affect her blood less, and has a better response. It sounds as if Dr. Chapman can't do the resection, then the chemo pump is what he would recommend Mom doing.

It was an overwhelmingly hopeful appointment. Dr. Chapman is the first doctor Mom has seen that has said "Yes, I think there's a legitimate chance I can take the tumor out". And even a 50% chance of recurrence is a 50% chance of her being cancer-free. I think she would take those odds without hesitation.

Mom continues to feel more like herself. She has been walking every day and walked almost a mile yesterday. Her smart-ass witty banter has returned in full force and is a welcome reminder that she is feeling much better. Please pray that she continues to feel well and has enough healthy liver and uninvolved arteries that Dr. Chapman will feel comfortable doing a resection.

Written/Posted by Jenn.


  1. Thanks for making this blog...Sending love and prayers to your way!

  2. You guys are in my thoughts and prayers.