Tuesday, December 6, 2011

(posted by Greg)

It has been a couple of busy days. But before writing anything about that (maybe in a follow-up blog), I want to pass along that Monica had an MRI today and a follow-up meeting with the oncologist. The Cancer Agency expedited her MRI which had been scheduled for the 13th and the meeting with the oncologist which had been scheduled for the 20th when I told them that her symptoms were getting worse. (Her limp has quickly gotten worse, her balance is affected and she has some weakness on the right side.).

Unfortunately, the news is not good. What the October MRI detected is in fact the tumour and it has grown since then. The tumour is quite "deep" in the brain. I am have not mastered the technical details but it is near the internal capsule (which, I think, is just above the brain stem and where the motor fibers come together and go from the brain to the nervous system). Monica's right side motor functions are affected because the tumour puts pressure on that area.

According to the oncologist, surgery is not an option because of the location of the tumour. More radiation is likely not an option because this area of the brain had likely been included in the original treatment (this is going to be verified with the radiation oncologist). More chemotherapy is also not an option because of how Monica's bone marrow has reacted to the chemotherapy. Basically, the Dr. indicated that the only good option is a drug called Bevacizumab ("Bev").

The growth of primary tumours to larger than a few millimeters requires the recruitment of blood vessels and vascular cells to support the tumour's  metabolic requirements. A critical element in the growth of primary tumours is the "angiogenic switch": the ability of the tumour to promote the formation of new capillaries from preexisting host vessels.  Bev is a drug which targets angiogenesis. It is administered intravenously as a 30 to 90 minute infusion every two weeks. It has some side effects (high blood pressure) and there is a 5% risk of serious complications (stroke, clots etc).

Prior to this meeting with the oncologist, Monica was not sure whether she wanted to take this drug. However, it quickly became apparent that there are not a lot of treatment options, Monica is "bothered" by the weakness she is already experiencing and the prognosis without treatment is not very good (basically right-side paralysis in 6 to 8 weeks with worse to follow).

I was really proud of how Monica handled the meeting (probably better than me- remember the genetically deficient tear-ducts). She herself asked all of the right questions, quickly analyzed the situation and decided to take the Bev treatment. The Dr. indicated that most patients taking Bev react well to it and feel good (not nauseous as with the chemo). The hope is that it will significantly slow down the growth of the tumour, that it will give some relief from the symptoms and that it will,generally, give some better quality of life while it works.

Monica had the blood work etc done today so that she can start the Bev treatment right away. It may take a few days for the treatments to start as there is quite a demand on the center's facilities for transfusions/infusions and the people needing are triaged for priority.

We have all been worrying about the symptoms. It is funny but there is a sense of relief from getting the actual diagnosis (even though it is bad)- I think it is being reliefed of some of the worrying and having something specific to do. Monica is bearing up well and still has the ability to laugh with us at some of the silly things that happen.