News from Duke

Well, we had our first visit at Duke today, with Dr. Pappas. He did not really have any surprising news or thoughts, but we do have a clearer picture of the scenario.

First of all, he does not think the lymph node is going to be carcinoid. As he put it, "People either get respiratory carcinoid, or digestive carcinoid, but almost never both." However, that node is significantly larger than normal, so it has to be checked out. As he also said, "This cancer is rare enough that even though I see about as much of it as anyone, I average about one a year." That means you check everything out, no matter how remote the risk.

So, Tuesday we go back to Duke for a lymph node biopsy. This node is directly beside her airway in the left side of her chest, so they are going to do endoscopy with a biopsy probe attached to the scope. When they get to the level of the node, they will punch a hole through the airway wall and gather the biopsy of the node. The airway will self-seal, and that's it. It will take 2-3 days for the result.

If it is not carcinoid, then he wants to proceed with surgery in the next few weeks. If everyone is shocked, and it were to be carcinoid, then we start looking at traditional cancer issues, and chemo/radiation/surgery all come into play.

Bottom line, Pappas believes that these are gastrin-produced carcinoid tumors, and that ultimately the cure is removal of the gastrin. Why does she have so much gastrin? The cells in the stomach that allow someone to absorb B12 through the gut are the same ones that inhibit gastrin. In a patient with pernicious anemia, like Dee Dee, these cells don't work. So the gastrin is produced unchecked. Because the tumors are secondary to the gastrin, if you remove the gastrin the tumors shrivel and go away.

So, the surgery he proposes is to remove the lower third of her stomach, called the antrum. Remember, the tumors are in the upper stomach, so he is saying to simply leave them alone. Gotta tell you, it feels weird to intentionally leave the tumors inside! He also said that because this is so uncommon, there is no single definitive treatment option. He thinks there is a reasonable chance that the folks at Mayo may give different advice, just because there are so few cases of this that there are no real clinical studies for everyone to agree upon.

So please pray for several things:
* Dee Dee as she has this biopsy/endoscopy procedure today
* Healthy lymph node, and that we would learn this quickly
* Continue to pray for the trip to Mayo, and really that the docs there would be in agreement with the docs here
* For our courage and strength. There is something hard about meeting the cancer docs and surgeons that propose to remove part of your stomach. It isn't new revelation, because obviously Dee Dee has known that this was coming. It is just the hard reality of it all coming into plain view.

Thanks to you all, and we'll update later.

Tony