2nd line Cycle 7, MRI, Surgery

On Day 1 of Cycle 7, we got the results of the tumour marker CA 19.9: dropped from 375 to 244. "Good," said the doctor. Yay!

At the next appointment with orthopaedic, we were a little frustrated because they couldn't find my dad's file and so had to ask us background questions all over again. At one point, luckily I highlighted to them that dad was diagnosed with mucinous adernocarcinoma of unknown primary source: they had thought it was cancer of the kidney that had spread to the left femur. However, we were grateful that they tried they best, and that they were friendly and helpful.

Based on the MRI results, the orthopaedic oncologist concluded that the femur could fracture anytime and so they recommended proximal femur replacement surgery (costing RM 13-14k!). We were told that dad would be able to walk after the surgery. Estimated time in ward was a week and it would take another week to fully recover.

There is a much less expensive and less extensive method: 'piling' i.e. a pair of nails and a lock within the bone. However, this means the tumour on the neck of the femur will still be there and so other treatment is needed e.g. radiotherapy, chemotherapy. Usually this method is recommended for patient who's not expected to live much longer.

Incidentally, given that dad had gone past quite significantly the 2-year mark, the orthopaedic oncologist consultant personally thought that it might not be pancreatic cancer and that dad would probably live much longer.

After the surgery, the chance of fracture in that particular bone i.e. left femur will be 'normalised' and that there is low chance that the tumour has/will spread to the lower part of the femur. However, there is no guarantee that cancer hasn't spread to other bones.

To avoid possibly lengthy delay in chemo, they strongly advised that the surgery be done only after the current chemo regimen is done with. Hence, we will meet them in 3 month's time, with X-ray done and reviewed on the same day, to discussing planning of the surgery.

Coinciding with Dr D's suggestion, they referred dad to a surgeon to ask whether the lumps in his abdomen can be surgically removed or not. As blogged previously, we tried to ask oncologist for that option but was refused and subsequently said that an effective FOLFOX chemo regimen would reduce those lumps. If the surgeon agrees to resect the lumps, they hoped to have both surgeries done in the same day to avoid double anaesthesia.

The surgeon, however, appeared to have the similar opinion as the oncologist i.e. no point taking those out when cancer has probably spread to elsewhere in abdomen. He, however, asked for a day or two to discuss with his boss and would call us about the outcome. Even if they consider resection, they would use a camera to examine whether there are (smaller) cancer deposits within the abdomen.

We received a call that day itself, requesting us to see the doctor the next morning. After a longer wait, the doctor came to get us and brought us to meet, evidently, a senior specialist. The senior specialist took time to look through the content of the CDs of the latest PET/CT Scan and of the above MRI, while educating the junior doctor. He also examined the lumps on my dad's abdomen.

We will meet them again in a month's time. In the meantime, they will get (a copy of) the CT Scan (with contrast) results from the Oncology Dept. With all these information, they will discuss with other relevant specialists, especially plastic surgeons. Although they concurred with the orthopaedic oncologists' preference to avoid double anaesthesia, they cautioned that the total time needed for both surgeries may be too long and so may need to be done separately.