Which marathon would drive you to drink first?
6% of you said Dungle Book (Jungle Book).
4% of you said Doe Wipe (Snow White).
89% of you said Dowa the Expluhwa (Dora the Explorer).
But you know what is really going to drive me to drink? This on-again, off-again relationship with radiation-oncology.
So, it's like this:
Left kidney is A-okay.
Right kidney is resected. Almost all of the tumorous areas were necrotic (favorable histology). However, there was one small spot that had viable cancer cells in it. Since it is a small area and not all over the place, this is called focal anaplasia (unfavorable histology). Favorable histology, smaller cells, easier to treat and cure. You can probably guess what unfavorable means.
Technically, with Eve having bilateral Wilms tumor, she is considered Stage V. But, they do stage each kidney individually and both of Eve's were Stage I, meaning the tumors were only in the kidneys and were completely encapsulated.
This all sounds fine and/or dandy. There are pathology reports to read and protocols to follow. But we all know Eve is complicated, no?
Apparently no other kid has been treated like Eve before. I guess that's something she can brag about at sick kids' camp.
According to Dr. WilmsExpert up in D.C., the focal anaplasia adds an "interesting wrinkle" to the case. Nobody wants to be a wrinkle, no matter how interesting it might be.
Normal Stage I treatment is surgery and a two-drug chemo. Eve has already been on a three-drug protocol, which is usually used for higher staged cases. There is no data on kids who have been on a three-drug treatment with Stage I Wilms.
There is a study which shows kids who have been through the Stage I treatment are more likely to have a recurrence than children with more advanced staging who are treated more aggressively (i.e. radiation).
Are you still with me? It's ok. I'm not even sure I'm still with me.
Sooo...now everyone's going to pretend that Eve has unilateral Wilms since her left kidney is so hunky-dory. Just focusing on the right kidney, this anaplastic histology screams, "RADIATE ME!" And that's what we're going to do. I know, I know. You have questions. What exactly are they going to radiate? I thought they removed that kidney?? Good question! They are going to radiate the tumor bed, or where the tumor was. Just in case one itty-bitty cancer cell mysteriously found a way out of the totally encapsulated kidney that was removed. Because, with Eve, it totally could happen and you know it.
There's also no data on kids with Stage I who have been given a three-drug treatment AND who have been radiated.
Protocol? We don't need no stinkin' protocol.
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urban dictionary on protocol:
ReplyDelete1. more lame-ass consultant speak, meaning the process or procedure for performing an activity.
don't worry, we're all with you. feel free to lean over the rails, walk on the grass and do pick the daises.
Gosh seen your post on the list serv today, I am Monika's infamous mommy. Monika would have been stage 1 because the lymph nodes etc were negative for wilms, but the tumor was vascular yada, yada, so they treated her stage 3 due to blood being in the abdomen prior to resection. She did have radiation and actino, vin, and doxo...What a great personality you have! Sure wish you were being treated at UNC as well. Take care and keep on blogging!
ReplyDeleteThey are doing the right thing for her.
ReplyDeleteDavid's original treatment plan was surgery, three-drug protocol, other surgery, finish protocol. Everything about his tumor said favorable histology.
The "wrinkle" was that by the time they finally got around to the second surgery, they had discovered that, as you suggested could happen, the place where the tumor used to be ended up getting its own brand-new tumor.
There isn't a protocol for bilateral because the cases are different. Very different.
But radiation is something that will zap the heck out of anything that could possibly be cancer, as you have seen.
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