The Plan of Attack

Many of you have wondered what exactly we are doing to fight this esophageal cancer and why we have taken the approach we have. As Louise is beginning the radiation and chemo, this week, I thought I would describe in more detail what is going to take place. As you know, we have met several times with the medical oncologist, Dr. Patrick Donovan, the radiation oncologist, Dr. Diane Recine and several members of their staff, including a nutritionist. They have put together a plan that they feel will be the most effective for fighting this type of cancer.

The general plan is that they will administer radiation therapy called intensity modulated radiation from a large machine called a linear accelerator also called Novalis. At least thats what I think they said (our nephew Jaymeson Stroud could probably describe it better). Louise will receive treatment Monday through Friday each week for about 6 weeks depending on how she responds to it. They could give her a one or two week "boost" after that. They mapped out the exact area of the tumor and affected nodes and the specified margins around the affected area with a pet scan and a cat scan. Someway they fused these scans with their computer programs and they know precisely 3-D where to shoot the radiation beam. I watched them from their "control center" the first day and they walked me through each step along the way. They had 5 screens that they were working from, one of which was videoing Louise under the machine. The machine shot the beam from many different angles to the target. Since it was all pre-programmed, they pushed the right buttons and the radiation hit the exact target from many angles. It was interesting how, when the beam might hit some tissue from adjacent organs, it would stop shooting until it rotated to the correct cancer cells. The radiation is very accurate which minimizes the chances of damaging the wrong tissues. The whole process only took about 10 minutes. She will go through the same procedure each day. The cumulative effect of the radiation increases each day. It is like you get a sunburn on top of yesterday's sunburn each day.

Dr. Racine felt like the tumor might shrink within two weeks of radiation to a size that might allow her to even eat solids again. As you know she eats only liquids now and about 80% of her liquid intake is through her food tube directly into her stomach. The radiation might also irritate the esophagus enough that it might hurt too much to eat. We shall see.

During the same 6 weeks of radiation therapy, Louise will have chemotherapy, once a week for those 6 weeks. She will be receiving two types of chemo called Taxol and Carboplatin. One or both of them are supposed to enhance the radiation in the cancer tissues. The effects of the radiation last longer with these chemicals. The radiation also makes it easier for the chemo to attack the cancer cells and kill them. Of course, as most of you know the chemo goes after faster dividing cells in the body which is what cancer cells do. Hair cells also divide quickly and that is why she will probably lose her hair.

After 6 weeks of the radiation and chemotherapy, they will stop giving her all radiation and chemo so her body can heal and her immune system can strenghen and attack the other cancer cells which might be in her system. After the 6 weeks of therapy and 6 weeks off, they will again do the pet and cat scans and see what has happened. Dr. Donovan said, with this type of cancer, about 1/3 of the time they find that the radiation and chemo are completely effective. The tumor is gone and there is no evidence of cancer in the body. With this situation she would not have to have any surgery. (This is our pick for sure). 1/3 of the time the tumor will be much smaller but it will be necessary to operate and remove it. They would take the upper part of the stomach and part of the esophagus. They would either just pull the stomach and reconnect it to the upper part of the esophagus or would use part of the intestine to become part of the esophagus. This alternative might also bring about a cure. The third situation would be that the cancer would have spread and there wouldn't be the necessity to have any surgery.

Sunday Louise and I spoke with a very dear friend of ours, John Shaw, who was my brother Ron's radiation oncologist. I give him credit for helping to extend Ron's life another 4 years. Anyway, he knew our doctors very well and knew the facilities and machinery that we are using. Dr. Racine was a past partner of his. He said that we could not find better doctors or facilities at Mayo, Huntsman in SLC or Anderson in Texas. So, we were very encouraged. Dr. Shaw told us that our plan was exactly right for this type of cancer and was optomistic for the results.

Louise has been a real trooper with all of this. She has a lot of courage and is ready to go through what she must to get better. She has endured a lot already with the inability to swallow food for the last 3 months. Though she has lost 22 pounds at this point she has now stabilized her weight by making sure she eats right and keeps her calorie intake high. She has a positive attitude and has also endured the constant pain in her chest very well. All of your acts of love and prayer has made such a difference to her. She is overwhelmed by all of your friendship and love and encouragement. Thanks so much to all of you. I hope this overview of what she will go through in the next 3 months, will give you a better feel for what is happening.

My best to all of you, Spence