As a very active (and still working) "senior", Joan has been accustomed to a lifestyle that would exhaust most people much younger than her. So, when she was single-handedly covering her real estate office activities because Debbie and Tony were away, she expected her fatigue was a normal course of events. Additionally, she thought she was probably a little dehydrated. Nevertheless, on September 18th, 2018, her inner voice told her she ought to consult the advice of her primary care physician. Among other things, he noticed that she was somewhat jaundiced. His concern led to a CT scan on the following day. As a result, a consultation with a gastroenterologist was made for Sept 21st. That led to a visit to Brigham and Women's hospital in Boston for an ERCP on Sept 25th. That test allowed Dr. Jajoo to visibly see that there was an obstruction in her bile duct that was inhibiting the flow of bile (which is produced in the liver) from the liver and the gall bladder (where bile is stored and concentrated). He could see that the obstruction was caused by a mass within and around her bile duct. He was able to insert a 4 inch long plastic (temporary) stent that allowed the bile to flow normally again. At the same time, he was able to do a biopsy of the tissue that was causing the blockage.
On Tues October 2nd, Joan learned that she has cholangiocarcinoma, or bile duct cancer. Debbie immediately informed our dad's oncologist, Dr. James Cleary, who we have always had tremendous respect and care for. He immediately cleared his schedule and we were in his office the following day to discuss a plan going forward. We also met with a surgeon, Dr. Thomas Clancy, with whom we discussed her options. Bile duct cancer is a very rare and aggressive form of cancer. Nevertheless, it appeared that a very complicated and lengthy surgery to remove the tumor, along with a 7 to 8 day hospital stay, was a distinct possibility. However, before getting started the doctors wanted to get a different look at things with another CT scan which they scheduled for Friday, Oct 5th. They were hopeful that by surgically removing the tumor, they'd possibly be able to eradicate the cancer completely and with follow-up chemotherapy for 6 months afterward, she'd be declared cancer-free.
On Wednesday, Oct 10th, we learned the disappointing news that the team of doctors had deemed the tumor too invasive at this point to be able to remove it all with any degree of certainty. It appeared as if the tumor had broken through the bile duct wall and actually surrounded the duct itself in addition to an artery that leads to the liver. Instead, they recommended an immediate regimen of chemotherapy treatment that would involve 6 courses of chemo over 9 weeks. That was not the news we had hoped to hear. At this point, the plan is to attack the cancer with chemotherapy and then afterwards target the tumor specifically with radiation. The hope is that by aggressively attacking this cancer as quickly as possible, they'll be able to shrink it enough that surgery will once again become an option. The surgeon, Dr. Clancy, believes that the possibility of getting to surgery is unlikely so it's our hope that acting sooner rather than later will improve our chances of the tumor shrinking to a size that will allow for the surgery. We have faith in Dr. Cleary's knowledge, experience and concern in guiding us through this challenging process.
On Tuesday, October 16th, Joan started her first round of chemo at Dana Farber Cancer Institute in Boston. The good news is that thus far she is tolerating her first round of chemo very well. She would tell you that she is feeling great. You wouldn't know that she has just endured a strong infusion of poison aimed at attacking the cancer. Her attitude amidst this tragic ordeal is terrific. Her strength and resolve has been amazing and will be a critical part of working through this difficult turn of events. We will remain hopeful of continued good news. We have lots to learn but believe that with a strong support system of medical personnel, family, and friends, we will be able to confront every obstacle head on. Currently, Joan has plans to meet with a nutritionist and will be altering her diet to some extent and we are also considering other homeopathic options in conjunction with the conventional treatment plans in place. Of course, we appreciate any and all prayers you can send Joan's way too. We'll be sure to keep you updated as to her progress. Feel free to reach out to her in any way you'd like. More than likely, she'll be able to take a short break from planning her next trip or working on real estate to visit with you.
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