Sep 12, 2018 Latest post:
Sep 25, 2018
Dad's Renal Cell Carcinoma is now in Stage IV, and we'd like to make sure everyone stays updated as we make decisions and plans for getting together and for treatment. We are using this Caring Bridge site to keep family and friends updated in one place. We appreciate your support.
Expectations for updates: We get *actual news* about once every week or two, after a few appointments here and there, or when a decision is made. We'll update accordingly, but not exhaustively. Please leave a comment or email Anne Marie if you have a particular question.
Short summary: Dad's cancer status is now Stage IV. A lesion made of cells most likely related to his Renal Cell Carcinoma has been found in his spine after he had a scan to investigate unrelated pain. It's a very early detection of it, and we have a path forward that involves radiation treatments. We have time; no one can tell us exactly how much, but we're not talking about a matter of months.
Longer version: Mid-summer 2018, Dad was experiencing some stomach pain, and his primary care physician ordered a bone scan because of Dad's renal cell carcinoma. We're thankful for him. The bone scan revealed a lesion in his T12 vertebra. Dad isn't experiencing back pain there, which would normally be how a doctor would find this type of metastatic cancer.
In comparison to his annual cancer-screening scan taken back in January, where there was a really soft blip that we can sort of notice now but that didn't stand out then, it looks like there's been moderate growth, speed-wise. (More below about general renal cell carcinoma metastasis.) Dad's oncologist ordered a biopsy and a follow up appointment with the results, which, last week, I attended with him. Given the data from the biopsy, it's most likely that these are renal cells, and not a different type of cancer. We have a Stage IV diagnosis.
Dr Berg, after consulting with Dad's oncologist in Boston and getting his enthusiastic agreement, put everything in motion to see a radiation oncologist to make a plan for a short course of very focused, high-dose radiation treatments. (More on why below.) We'll also be seeing a radiation oncologist in Boston who has done more of this specific type of treatment, and we may see a neurosurgeon for a consult. That's where we're at now. Dr. Castrucci, the Brewer radiation oncologist Dad, Mom, and I visited this past Tuesday, has also ordered a brain scan, as Dad hasn't had an MRI of his brain yet, and it's the one part of his body we should probably check before proceeding full speed with the treatment.
Renal cell carcinoma (RCC) metastasis: Dad had a Stage III RCC diagnosis 5 years back, defined by the fact that he had a tumor in his kidney that had spread to his lymph nodes. The lymph nodes and blood vessels around there, having been in contact with the tumor, were likely to communicate those cells to other areas of the body. Metastasis is when those cells begin to grow somewhere else. Simply put, cancer cells are in one of his vertebra, they came from elsewhere in the body, and that's what defines Stage IV.
The most likely places for RCC to show up again and take root are the brain (which is why we're doing a brain MRI), the lungs, and bone. Dad went for regular scans. They've been clear until now.
Normally bone metastases are found when a patient feels pain. They're also typically scattershot, and therefore require systemic (whole-body treatments with more side affects), rather than focused (clinically more successful), treatment. Dad's got one vertebra with a good-sized, though diffuse and not painful, lesion. There is strength in his bone. The radiation will hopefully halt the cancer if it's responsive, and will give the bone time to heal. RCC thrives on bone cells.
This is, truthfully, a tipping point. Stage IV and the confirmation that cells are showing up elsewhere is not what we've been hoping for all this time with the clean scans, but we have a good path forward, good doctors, and Dad's taking it all in with us at his side. He feels good and he's still working, for now, with a restriction on what he can lift.