mixed pathology report

We just got back from seeing our doctors at Beth Israel. The pathology report had both good news and bad news in it. The main good news is that the growth was indeed what they had diagnosed: an epithelioid angiomyolipoma, and not a recurrence of either of Deb's two previous cancers. It was also good news that the other (smaller) lesions that turned up on the ultrasound during surgery seem to be epithelioid angiomyolipomas of a less serious kind; there is reason to hope they might sit there doing nothing into the indefinite future.

The bad news was that the surgery did not produce a clean margin; the tumor goes right up to the edge of the removed lobe and presumably somewhat beyond. Dr. Hanto, the surgeon, says that he cauterized the area, which would kill the tumor cells for another few millimeters. Whether that is enough or not, or whether the surviving cells will be able to reconstitute a viable tumor, we don't know. (Something similar happened when Deb's GIST tumor was removed in 2003. That time the cauterization seems to have been enough, and the GIST has not been seen since.)

Dr. Pandya, the oncologist, emphasized the unchartedness of the territory we're in. Malignant epithelioid angiomyolipomas are extremely rare, to the point that we're talking in terms of case reports, not studies or statistics. (For example, we don't know whether the small nonmalignant epithelioid angiomyolipomas are unusual or not. It's possible lots of people have them and never notice them. Deb may have already had these for many years.)

Both doctors recommended watching to see what happens next rather than jumping into more surgery or some other kind of treatment. We have another ultrasound scheduled for late September, when Deb's liver should have healed and regrown.

Everyone seems happy with the way she is recovering from surgery. We'll go back for another follow-up with the surgeon next Wednesday.

Deb is Home

It took battling through Boston rush hour in the driving rain, but I got Deb home yesterday. She is alert, but achy and without stamina. So if you decide to call her, it's probably best to keep it short.

She's eating normal food, but it will be a while before she returns to her usual diet. The first thing she asked for on getting home was takeout pad thai, not the extra-spicy chicken basil she usually orders.

Still no news from the pathologist. We have appointments next Wednesday with both the surgeon and the oncologist, so I imagine we'll find out more then.

Deb might come home soon

Deb is recovering from surgery as expected. We haven't seen any post-operative complications, so the main thing that is keeping her in the hospital is the need for IV tubes. Today they have her trying to eat semi-normal food and take her medication in pill form. If that all works, she could come home as soon as tomorrow.

My plan had been to go to the hospital every day and hang around reading and using the hospital wireless internet while she dozed. But I've had a cold and they've been keeping her in a ward of transplant patients, where sick visitors are discouraged for obvious reasons. I was feeling particularly chipper yesterday afternoon, so I drove in (about 60-90 minutes each way, depending on traffic) and spent a little over an hour with her before I felt a coughing fit coming on and left. Today I'm a little worse again, and I'm planning to spend what energy I have getting the apartment straightened up.

We still have heard nothing from the pathologists who are studying the lump of liver the surgeon took out. Nobody has made any promises, but I'm expecting to get a report by the end of the week.

Deb is out of surgery

Deb went into surgery first thing this morning, around 7:30, and was in the recovery room by noon. I haven't seen her yet, but I've been getting regular updates from the staff, who say everything went well.

I talked to Dr. Hanto, the surgeon, after the surgery. He said they took out the parts of the liver they had planned to take out, and that the tumor was completely removed.

And then he said something I found confusing, and I have had to remind myself that in both of Deb's previous surgeries (in 1996 and 2003), some impression I got from the surgeon turned out not to be right. (In 1996 the surgeon was too optimistic, in 2003 too pessimistic.) So here it is, for what it's worth: Before cutting into the liver, they did an ultrasound to locate the tumor more precisely. They saw it, but they also saw other small blips in both the part they were taking out and in the remainder of the liver. After removing the selected part of the liver, they sliced into it looking to identify what those other blips had been, and they couldn't find them. Dr. Hanto described this as "nothing to worry about."

I interpret this as: We thought we saw something, and then we looked closer and didn't see it. But the pathologist will look closer yet and will have the last word. I have no idea whether I should be worried or not.

As I write this I am very tired. I have a cold, and we had to get up at 4 to get to the hospital and jump through all the necessary hoops to have a 7:30 surgery. (Route 2 in Cambridge was spookily empty at 5. Sunrise streaming down the Charles is spectacular, though I hope not to see it again anytime soon.) I'll write more when I know more.