It appears that treatment has not worked. Cancer has reappeared and worsened in the lymph nodes, abdomen and possibly now outside the bladder. The doctor discussed two possible treatment options, the first being the chemo drug doxal which has few side effects, which is what the doc leaned toward, and that’s what Karen will be going with for now. If the cancer shrinks or even stays the same we would consider it effective. The next scan will be in 3 months to determine progress. The doctor has had patients on doxal for years. If doxal is not effective, we would try a new immunotherapy. He feels that these are the best options at this time, but we are not out of possibilities for treatment if these don't work.

The fact is, this is a rare form of cancer, and aggressive -- not a good combination. But as we have known from the start, Cleveland Clinic is among the best for this type of thing, we have an outside team of high-level friends in the field who continue to do additional research, and we feel she is getting good care from her medical team.

As always, thank you all for your love and support.