Hello friends and family,

As many of you know, we received sad news over the holidays. Ryan’s cancer has returned. In December, Ryan went in for his standard follow-up bloodwork. The results showed an increase in his CEA level (Carcinoembryonic Antigen), which is a tumor marker for colon cancer. In August, the level was 2.4, which is in the normal range (0-3.8). In December, it rose to 5.4, causing the doctors to order a follow-up CT. This revealed a possible peritoneal implant in the left pelvis as well as some stranding and nodularity in the retroperitoneum at the aortic bifurcation. Unsure if these were cancerous cells or just inflammation, his doctors ordered a PET scan, which confirmed that these areas were metabolically active and probably cancerous.

Ryan had a follow-up appointment at MD Anderson in Houston in January, where they repeated his CEA. This number had now risen to 176.6, a definite sign that cancer cells were reproducing in his body. This along with the CT and PET scan results led them to conclude that he indeed had a recurrence. Normally, the doctors would do a needle biopsy to confirm it is the same type of cancer. However, the tumors are found in difficult locations, making them too hard to reach through a needle biopsy.

So, what are the next steps? Ryan has gone back on chemo. On February 4, Ryan had his port reinserted, and he restarted his chemo regimen on February 7. This spring, Ryan will have 12 rounds of chemo. Each round will begin with an IV infusion of Folfiri. This consists of folinic acid (leucovorin), fluorouracil (5FU) and irinotecan. Additionally, he will be given Avastin (bevacizumab). After the IV infusion, Ryan will be connected to a pump for 46 hours, which will transmit F5U continuously. This process will be repeated every two weeks for 12 cycles, meaning he’ll wrap up chemo on July 10.

Ryan experienced some fatigue, nausea and leg cramps after his first cycle of chemo. His doctors gave him some medicines to help with the nausea and the leg cramps for the second cycle of chemo, leaving just the fatigue as his main side-effect. These chemo drugs are different than the ones he was on last spring, so he shouldn’t suffer from neuropathies in his hands and feet like last time.

On February 25, Ryan met with a colorectal surgeon, Dr. Rebecca Wiatrek, who specializes in surgical oncology at Texas Oncology, to discuss the next steps. After Ryan finishes his chemo in July, she plans on performing abdominal surgery to remove the perineal implant and the retroperitoneal nodes. Then, she’ll use HIPEC (Hyperthermic intraperitoneal chemotherapy) to remove any remaining cancer cells in the peritoneum.

Ryan will have CTs after his fourth and eighth cycles of chemo to ensure the tumors are not growing. If the tumors are stable, then surgery would be considered. If the tumors are worsening, surgery will not be an option.

So how did these tumors get to where they are? Dr. Wiatrek believes these tumors are local extensions of his original tumor that was removed from the colon in December 2018 instead of metastasis, which makes them operable. Assuming the tumors remain stable, she’ll consider surgery once Ryan finishes his chemo. We’ll just have to wait and see how these tumors respond over the next few months. Dr. Wiatrek was very encouraging for Ryan, and he likes her very much.

This news has been difficult to process for all of us, especially Ryan. During his chemo last year, you all were so supportive – sending cards, making phone calls and visiting when possible. This recurrence is scarier, lonelier and more serious. Ryan needs your support again. It means more than you know. We are still hopeful that Ryan has a chance at a long-term cure, but his cancer is very serious. We ask for all of your thoughts and prayers as we start down this long journey again. We love you all very much.