Monday, October 26, 2009, part 2

We spoke with the oncologists this evening and finally got some answers as to what course of action they recommend taking with Eve.

The MRI revealed some uncertainty as to what the spots on her kidneys really are. The doctors still believe that the right kidney has a large Wilms tumor in the upper portion, but the lesions in the lower part may be nephroblastomatoses that should, in theory, rapidly respond to chemotherapy. The left kidney may indeed have small Wilms tumors. We will not know for certain what these spots are until they are removed and sent to pathology.

The kidney is in a shell, which means the tumors are contained. The doctors do not want to take a biopsy because there is a chance of spilling contaminated cells into the abdomen, which would raise the stage of the cancer. They recommend we treat with an agressive therapy plan before removing the tumors.

This plan was developed by a Wilms expert in D.C. who runs a clinical trial in which the patient is given 3 (rather than the standard 2) drugs during therapy. Evidence suggests that the extra drug in combination with the standard two may help get rid of the tumor cells while saving the largest amount of normal kidney tissue. He weighed in on Eve's case and recommended we act as if the Wilms is bilateral, which is to treat aggresively. In the trial, 13 out of 14 children showed a favorable response to the treatment.

The treatment would consist of two consecutive 3-week cycles of chemotherapy. Eve will receive Vincristine (weeks 1-6), Dactinomycin (weeks 1 & 4), and Doxorubicin (weeks 1 & 4). There are certainly side effects, some very serious, but the doctors feel that the risks are worth taking. One of the more serious side effects is damage to both the heart and liver. These will be monitored throughout therapy.

After the chemotherapy is complete, Eve will have an MRI to evaluate any changes. If the chemotherapy has the desired effect, she will go on to have surgery to remove the affected parts of the kidneys. After the surgery, the tumors will be sent to pathology to determine what exactly they are, and then the next form of therapy (chemotherapy and/or radiation) will be decided upon then.

As of tonight, the doctors are going to try to get her into the O.R. tomorrow to have the port put in. We hope to have her first treatment this Friday.

Thank you all again for your support and well wishes. We are extremely blessed to have so many wonderful people in our lives. Even though we haven't been able to respond to messages, we have read each one and your thoughtfulness is truly appreciated.