Chapter Thirteen: Better News

Saturday, January 24

After catching breakfast at Evans', we gathered up Dad's things he might need, valet parked near the front of the hospital, and I wheeled Mom up to his room.

Dr. Sarmiento had already made rounds. Dad asked him how many Whipples he did in a year. Last year he had done 75. Dad told me Johns-Hopkins and Massachusetts General had each done about 150 Whipples per year, but using around six surgeons. Dad, Gary, and John Galloway believe Dr. Sarmiento is in the top three as far as how many of these operations an individual surgeon performs.

In past times the surgeons only took out 4-5 nodes for the pathologist to dissect from the block of tissue extracted. Dad had 29 nodes removed. Only one was positive for cancer cells. Dr. Sarmiento asked how Dad was doing. He admitted to the surgeon he was down, feeling discouraged. Dr. Sarmiento said he shouldn't be discouraged. Virtually all the people he operate on have cancer of the pancreas. The pathologist who works closely with the surgeon is an expert on cancer which originates from IPMN--introductal papillary mucosin neoplasm--which is the type first identified on Dad, in the mucinous cyst seen by MRI and CT, before his scope in South Carolina. He told Dad this was just about the smallest cancer he has seen.

Dad shared with Mom and me the two most encouraging signs from Dr. S.:

1) the very small cancer was a significant prognostic indicator
2) Dr. S. and his pathologist say this cancer is almost certainly not a typical pancreatic cancer.

The IPMN-generated behave differently. For those who don't have IPMN and have pancreatic cancer originating in the ducts, the five-year survival rate is less than 15%. If the cancer started as IPMN, which apparently was the consensus at Emory, Dad has better than a 50% chance of surviving five years. In the broad spectrum of patients, those with "garden-variety" pancreatic cancer have a 10% chance of survival.

Mom, Gary, and I all asked, how can you be sure the tumor was IPMN-originated, just because it was near the other tumor found in the node? Good question, Dad agreed. He plans to follow up on the path report, which didn't give the details on why those involved in the pathology study had drawn the conclusions they did.

Part of their reasoning may have been because the original tumor and the node tumor were smack together--too much to be a coincidence? Was there some kind of transition? It's unlikely two different types of tumors were that close to each other.

Dad explained to us that his tumor was considered a T-3, because it was 2.2 centimeters, but it was elongated, like a flattened, misshapen pancake. In some places it measured 1.5. The outcomes are poorer for a T-3 as opposed to a T-1 or T-2.

N-0 would indicate no nodes with cancerous cells. Dad was barely N-1, which means lower risk. Most of the data is applied to a different type of tumor, so it may not be accurate applied to his case.

The positive node found in Dad's tissue was near the original tumor. Samples were taken of different groups of nodes further from the specimen. Several node groups beyond the positive tumor were clear. When Dad described this to Gary on the phone, he said, "I'm in a class by myself." Mom and I heartily concurred.

John Galloway stopped by and stayed awhile. He said, "As a physician, with the circumstances of your cancer, I might say you didn't really need to take the chemo.

"But as a patient, having experienced near-fatal cancer myself, I would do it. When I heard the chemo and bone marrow transplant would only increase my chances of long-term survival about 10 %, I wondered whether it would be worth it. But I realized I didn't want to look back and regret not doing all I could to live my life to the optimum."

He pointed out that perhaps Dad had a higher likelihood at age 79, nearly 80, of dying from something else other than pancreatic cancer, but he encouraged Dad to take the chemo.

As for Dad's questions about the origin of the cancer, to John it appeared it was contiguous with the IPMN, so it is probably the same type of cancer. John agreed that the moderate nuclear grade (not fast-growing or wild) and the small size were also good signs.

John, a myloleukemia survivor who experienced several close brushes with death, said wryly, "Dr. Hixson , your chances for survival are probably a lot better than mine."

Dad finished his lunch as Mom packed his things. The nurse removed his IV line for the last time. The tech brought his huge plastic chariot/cart, and we loaded him and all his belongings. As we followed him down the hall, me pushing Mom's wheelchair, Elaine the tech and Jean the nurse were there to tell us all goodbye. I got tears in my eyes as I thanked and hugged them. They took such good care of my dad at Emory.

Dad enjoyed resting in the hotel room, Mom as well, while I tracked down his over-the-counter meds and pain medication. The CVS at Emory Village gave me directions to a nearby CVS in Druid Hills where I was able to get his pain prescription filled. After resting, I got us all a carryout from Evans.

We were just finishing dinner when Gary surprised us with a visit. It was a fun family evening.