Thanks for visiting my CaringBridge website. I appreciate your support and words of hope and encouragement.
Nancy asked me to write this summary of her cancer diagnosis and proposed treatment plan. For those of you who don’t know me, I’m Kathy Schmidt and Nancy and I have been friends since we met at church in 1978. Over the years, we have had many wild and crazy adventures together and we plan to continue those once Nancy wins this new battle with cancer. The journey that Nancy now finds herself on will be a tough challenge for her, but best friends stick together in good times and bad, and I plan to walk every step of this journey with her and support her in whatever ways I can. I know that all of you reading this will do the same.
Earlier this winter Nancy began experiencing severe pain in her stomach and intermittent problems with digestion. She was admitted to the hospital on February 8th where she underwent various tests and procedures, including an exploratory laparoscopic procedure in her abdomen. During the procedure the surgeon noted the presence of several tumors on the peritoneum and inflammation of the small bowel. Several biopsies were sent to Pathology and yesterday Nancy was informed that she has Stage 4 Peritoneal Carcinomatosis. She and I met with the oncologist who will oversee her care, and both of us were very impressed and comfortable with him. He was very clear in his explanation of the diagnosis, was very receptive to us asking whatever questions we had, and took as much time with us as was needed. He also happens to be a specialist in this particular type of cancer. Nancy feels very confident having him in charge of her care and has decided to proceed with the treatment plan he has proposed, which will take place at Mt. Sinai West Hospital in New York City.
This cancer does not stem from her prior breast cancer, but rather is a second primary cancer. Although this is certainly a serious diagnosis as this type of cancer is very rarely curable, with chemotherapy and potential surgery it can become a chronic disease that one can live with. The pathologist was able to determine that the cancer originated in the GI tract, but analysis of the biopsies taken failed to determine the exact location of origin because the cancer is poorly differentiated. That being said, both the endoscopy and colonoscopy she had in January came back clear, so we know the cancer didn’t originate in those areas. There is definitely a blockage in the small bowel, which has inhibited her ability to digest anything. The oncologist suspects this might be the primary tumor site, but can’t say that definitively yet.
The most important thing right now is to shrink that tumor as well as attack whatever other cancer cells exist in the abdomen. The oncologist has recommended that Nancy start a systemic chemotherapy regime immediately. She had a PICC line inserted yesterday and will have her first treatment on Tuesday. The infusions will be every two weeks for at least 3 months, possibly up to 6 months. Each infusion will last 48 hours. She will remain in the hospital until she is able to eat solid food and fully digest it. The oncologist told us that for many patients, tumors causing bowel obstructions respond within a few days after the first infusion and the patient is once again able to digest food. However, sometimes it can take two infusions for the obstruction to clear. Regardless of how long it takes, they will keep Nancy in the hospital until she reaches the point of fully digesting what she eats.
Once she has been discharged, she will continue the chemotherapy treatments at Mt. Sinai’s infusion center, which is only 9 blocks from her apartment. She will spend a few hours each time at the infusion center to make sure she is tolerating the infusion, and then they will send her home with a fanny pack-type device that will continue the infusion until the 48 hours are up. She will also have a PET scan shortly after discharge. This scan will give them a better idea of the location of tumors in the abdominal area.
Her initial chemotherapy regime is called FOLFOX and it consists of Fluorouracill, Oxaliplatin and a reduced folic acid drug called Leucovorin, which enables the Fluorouracil to stay in the cancer cells longer than it could on its own, thus allowing it to be more effective in killing the cancer cells. The oncologist also informed us that molecular testing will be performed on the various biopsies taken which will likely result in additional drugs being added to the FOLFOX regime. This will allow the oncology team to target the treatment to the specific types of cancer cells found, thus giving Nancy’s body a better chance of responding positively to the chemotherapy regime.
Long term the hope is that upon completion of this chemotherapy regime, if it is deemed appropriate, Nancy would be a candidate for the combination of cytoreductive surgery, where the surgeon removes as much cancer that’s still visible from the peritoneum and abdomen, and HIPEC (Hyperthermic Intraperitoneal Chemotherapy), where the entire abdominal cavity and organs are bathed using a heated chemotherapy protocol for 90 minutes. This combo procedure has, to date, been the most effective and promising treatment for this type of cancer, and Mt. Sinai is supposed to be the best hospital in this area for this.
Nancy is confident that she is in very good hands with her oncologist and is relieved to finally have a treatment plan in place. She knows she has a tough fight ahead, but as she’s told many of us, “I beat this once, I can beat it again.” You go, Warrior Woman!!!
On May 4, I had a laparoscopic procedure to see how the chemo was working. The surgeon took 5 samples for biopsies and also scraped the walls of my abdomen for cell samples and fluid. From all of this it was determined that there was no cancer!
So I'm getting a lengthy time off from chemo, followed by a scan now and then . This all does not mean that the cancer won't come bck, hence the scans, but this certainly is manageable. I have follow-up appointments with my oncologist and mu surgeon in upcoming months, in order to monitor me.
But as of now, I'm cancer-free and I'm rejoicing. Thank you all for your constant support and your prayers.
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