Mayo updates and future plans

First off, Mayo is crazy!  I'm sure this holds true for all Mayo campuses, but like 1/2 the town of Rochester is Mayo related.  It's almost like it's own little town.  You go through a security checkpoint, places to eat, grab coffee, lounge/waiting areas, a guy playing the piano, an outdoor courtyard area, etc.  We had appointments in 3 different buildings--but most are connected by a "subway" underground level or they have some skywalks as well.  Then Tom's surgery to check for peritoneal spread was completed at their Saint Mary's campus (like 1.5 miles away from the main downtown campus) 
TLDR at the very bottom for those of you that just need the bullet points!  

Onto the updates, overall mostly what we expected.  His bloodwork has pretty much stayed the same and his CA 19-9 (cancer marker in the blood) has continued to decrease which is positive.  Dr. Truty was very direct about what he looks for before continuing to surgery--3 main things:  

1.  Ability for clean margins (there's no point in doing surgery if you know you have to leave cancer behind)

2.  No metastasis (similar to the first reason)

3.  Overall good health.

So far Tom only has the last one for certain, overall good health besides this damn pancreatic cancer.  *knock on wood* as far as we are aware there hasn't been any metastasis outside the lymph nodes directly surrounding the pancreas, but we will continue to monitor via CT and PET scans to ensure that remains true.  Radiation treatment may be in the future as well depending on how things continue to progress.  

The 1st one actually appears to be the most challenging given the location of Tom's tumor.  As previously mentioned, he has a significant amount of vascular involvement--both arteries and veins.  We knew that going into the meeting and have been doing tons of research about Dr. Truty and his vascular expertise (ie rebuilding arteries and veins due to tumor encasement) The short version is Tom's tumor has entangled itself in almost every major blood vessel it could find in his abdomen or is right next to it.  I've attached a couple pictures Dr. Truty used to explain the issues for us.  The red vessels are arteries and the blue represents veins.  Hopefully you can see the pen drawing/coloring he completed as well.  

       

He classified surgical options as straightforward/easy, hard, and impossible.  Tom's definitely falls into the hard category and only a handful of surgeons/centers would be able to perform such procedures.  While the artery involved is challenging and would need a resection, the vein(s) that is involved is actually more concerning.  His tumor has squished the primary vein reducing blood flow (see colored area above), so will need a stent placed in the next week to open that back up to ensure adequate blood flow to his organs.  It's also wrapped around multiple smaller veins from various organs.  Future surgery will be much more extensive than initially anticipated.  

We expected a procedure called a "whipple" where they remove part of the pancreas or potentially a total removal of the pancreas.  Given the location, Dr. Truty shared that the only curative surgery would involve removal and grafting of the artery/vein, but that would require full removal of the pancreas, spleen, 3 feet of intestine, and potentially part of his stomach. Not because of metastases--but because of how the blood flow goes to those organs.  

 

He had his exploratory look around today and the Dr. couldn't visualize anything suspicious, so no additional biopsies.  They put the saline in his abdominal cavity, swish it around, and suck it back out to check for cancer cells in the lining of the cavity.  We won't have results for at least a week and again--any positives will make it unlikely surgery would move forward.  He is having a bit of pain/discomfort from the abdominal incisions and says his stomach feels really sore/achy, so hopefully that gets better in the next day or 2.    

Next steps--we are coming back next week to get his vein stented and to get a PET scan completed (assuming insurance approves)  The surgeon thought he saw a spot on Tom's liver from the prior PET scan in May he wants to look at and to hopefully see the pancreatic tumor is less active/dying.  

Beyond that--we will continue chemo every other week back home and continue seeing Mayo after every 4 cycles for follow up scans to ensure the tumor is dying, the cancer marker (CA 19-9) is continuing to come down, and there is no sign of metastasis.  There is no specific timeline to plan on surgery--just when those criteria can be met.  It's likely Tom would also need a few weeks of radiation before surgery, but again--that's down the road.  

It's been a hard week just having to discuss all the obstacles we still have to tackle before surgery and how complicated the surgery will be.  We will be enjoying the rest of the week hanging out with the girls and trying to rest and recover to start again next week.  We appreciate all the good thoughts, prayers, and overall support heading our way.  Love ya'll 💖

TLDR:  

No big surprises this week

Nothing immediately disqualifying from surgery, but surgery will be much more extensive than initially thought due to vascular involvement.

Will be returning next week for PET scan to confirm tumor response to chemo and to check suspicious spot on liver from previous scan

Stent will be placed in a narrowed vein from tumor pressure next Friday 8/1

Waiting on abdomen fluid to be checked for cancer cells

Current or future metastasis will disqualify for surgery.