Our family
Curtis and Tav
Friday, April 29, 2011
Infusion Update
Infusion is almost done. He will go home with 5FU for 46 hours now. No side effects so far, he is just tired and excited for Supercross tomorrow!
Folfox +Avastin and Afinitor Infusion
We are at the infusion clinic starting his first round of Folfox with Avastin and Afinitor. The infusion takes about 6 hours total and he will go home with the chemo ball of 5FU for 2 days. A home health nurse will come and disconect him on Sunday. The doctor said she thought he would tolerate this better than the chemotherapy and radiation combonation. I am taking Curtis and Tavner to Supercross tomorrow! We are all very excited! We really appreciate everyone's support and love.. Curtis says this will be him when he is "all healed up"
Tuesday, April 26, 2011
PET Scan Reading
We got an actual copy of the PET scan results today at our appointment. The reading yesterday was visual because the report was not ready yet. There are no tumors or affected lymph nodes in his brain. There is on 7mm lingular nodule, 4mm, 5mm, along with several through out the right lung in both the upper and lower lobe. Subcarinal node measured at 1.2 cm, Cluster of prevascular adenopathy spanning 3.5 cm, Bilateral hilar adenopathy 1cm. See picture. There are 2 hypermetabolic areas in the liver, however no anatomic lesion is seen to coorispond with the activity. (Meaning, there is signs of cancer in the liver, but they are unable to see a lesion or tumor)
The tumor in is rectum has shrunk some and is less metabolically active. There are multiple porta hepatis nodes, largest measuring 1.3cm. (Near his liver)
There is a large cluster of retroperitoneal adenopathy (swelling of lymph nodes surrounding the abdomen)There are multiple retrocrural and retroperitoneal nodes identified (back of abdomen, behind intestines)
Left pelvic lymph node measuring 9mm.
Inguinal nodes are present bilaterally, right measures 1.4cm and left is 1.8cm.
*A dime is 17.8 mm (millimeters), a cm (centemeter) is about the width of a fingertip.
There is extensive growth of the cancer since his last PET scan. Chemo will start Friday. Wish us luck!! Survivor stories are always welcome!!
Monday, April 25, 2011
PET Scan Results
We saw Dr. Sharma today, the oncologist after the 2 1/2 hour PET scan. Although I have not seen the written report yet, this is what was found: Curtis has cancer in lymph nodes in his lungs, more in his abdomen and possibly in his liver. They also did genetic testing to see how well his genes will respond to chemotherapy. His genes look very good and they expect he will respond well. They also provided information about a clinical trial of Everolimus (RAD001, Afinitor) to be used with Folfox (5FU, Oxaliplatin, Leucovorin) and Avastin. We go back tomorrow morning for blood work and to do tests for the clinical trial. The oncologist said that he thinks Curtis has a 60-70% of the cancer responding to this chemo. After 2 months (or 4 cycles) of chemo, they will do another PET scan to see how he is responding. He will go in for 6 hours of infusion of Leucovorin, Oxaliplatin and Avastin. He will go home with the infusion ball of 5FU for 46 hours and will have a home health nurse come and de-access his port. He should start this week. Here is information about how each chemotherapy drug works:
How 5-FU works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
5-FU belongs to the category of chemotherapy called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cell-cycle specific. They attack cells at very specific phases in the cycle. Antimetabolites are classified according to the substances with which they interfere.
How Avastin works:
Monoclonal antibodies are a relatively new type of "targeted" cancer therapy. Antibodies are part of the immune system. Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) entering the body. The antibodies attach to the antigen in order to mark it for destruction by the body's immune system. In the laboratory, scientists analyze specific antigens on the surface of cancer cells (target) to determine a protein to match the antigen. Then, using animal and human proteins, scientists work to create a special antibody that will attach to the target antigen. Antibodies will attach to matching antigens like a key fits a lock. This technology allows treatment to target specific cells, causing less toxicity to healthy cells. Monoclonal antibody therapy can be done only for cancers in which antigens (and the respective antibodies) have been identified.
Avastin works by interfering with the process of angiogenesis by targeting and inhibiting human vascular endothelial growth factor (VEGF). VEGF is a cytokine (a small protein released by cells that have specific effects on the behavior of cells) which when it interacts with its receptors in the cell leads to new blood vessel formation or angiogenesis.
How Oxaliplatin Works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
Chemotherapy (anti-neoplastic drugs) is divided into five classes based on how they work to kill cancer. Although these drugs are divided into groups, there is some overlap among some of the specific drugs. The following are the types of chemotherapy:
Oxaliplatin is classified as an alkylating agent. Alkylating agents are most active in the resting phase of the cell. These drugs are cell-cycle non-specific. There are several types of alkylating agents.
How Afinitor Works:
Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.
Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.
There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.
Researchers agree that targeted therapies are not a replacement for traditional therapies. They may best be used in combination with traditional therapies. More research is needed to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.
Afinitor is an inhibitor of mTOR. mTOR inibition blocks the translation of genes that regulate cancer cell proliferation. It also results in reduced levels of certain cell growth factors involved in the development of new blood vessels, such as vascular endothelial growth factor (VEGF).
How 5-FU works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
5-FU belongs to the category of chemotherapy called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cell-cycle specific. They attack cells at very specific phases in the cycle. Antimetabolites are classified according to the substances with which they interfere.
How Avastin works:
Monoclonal antibodies are a relatively new type of "targeted" cancer therapy. Antibodies are part of the immune system. Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) entering the body. The antibodies attach to the antigen in order to mark it for destruction by the body's immune system. In the laboratory, scientists analyze specific antigens on the surface of cancer cells (target) to determine a protein to match the antigen. Then, using animal and human proteins, scientists work to create a special antibody that will attach to the target antigen. Antibodies will attach to matching antigens like a key fits a lock. This technology allows treatment to target specific cells, causing less toxicity to healthy cells. Monoclonal antibody therapy can be done only for cancers in which antigens (and the respective antibodies) have been identified.
Avastin works by interfering with the process of angiogenesis by targeting and inhibiting human vascular endothelial growth factor (VEGF). VEGF is a cytokine (a small protein released by cells that have specific effects on the behavior of cells) which when it interacts with its receptors in the cell leads to new blood vessel formation or angiogenesis.
How Oxaliplatin Works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
Chemotherapy (anti-neoplastic drugs) is divided into five classes based on how they work to kill cancer. Although these drugs are divided into groups, there is some overlap among some of the specific drugs. The following are the types of chemotherapy:
Oxaliplatin is classified as an alkylating agent. Alkylating agents are most active in the resting phase of the cell. These drugs are cell-cycle non-specific. There are several types of alkylating agents.
How Afinitor Works:
Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.
Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.
There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.
Researchers agree that targeted therapies are not a replacement for traditional therapies. They may best be used in combination with traditional therapies. More research is needed to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.
Afinitor is an inhibitor of mTOR. mTOR inibition blocks the translation of genes that regulate cancer cell proliferation. It also results in reduced levels of certain cell growth factors involved in the development of new blood vessels, such as vascular endothelial growth factor (VEGF).
PET Scan
On Thursday during our appointment with Dr. Sklow (the surgeon), cancer was found in Curtis' inguinal nodes. Originally we were told that it looked like the cancer had spread there both during and after his chemo/radiation treatment. The mortality rate with colorectal cancer with spread to these nodes is very high. After speaking to Curtis' radiation oncologist, Dr. Anker, he thinks that the cancer may have just grown there and not necessarily spread. These nodes were not in the original field of radiation because they did not show in the PET scan from January. It is possible that there was a small amount of cancer cells in these nodes and they were not detected during the initial PET scan. If this is the case, there may be an option to do additional radiation on those nodes and do the surgery later. The surgery has been cancelled for now. The PET scan takes about 2.5 hours, so we should have more info by 11am today. I will update as soon as I can. Thanks for everyone's support during this extremly difficult time.
The body has between 500-700 lymph nodes. Here is a picture of where they found the new cancer growth.
The body has between 500-700 lymph nodes. Here is a picture of where they found the new cancer growth.
Saturday, April 16, 2011
Urologist
We met with Dr. Dachet, the urologist at Huntsman, on Thursday. They did a scope of the inside of Curtis' bladder and he said the inside looks good. But the tumor is either attached to the prostate or the bladder, and they think it is the bladder because when Dr. Griffen did his ileostomy, he said that it was attached to the bladder. We really won't know anything else until surgery. If they have to remove the bladder, they automatically remove the prostate as well because the prostate is so close to the bladder, if the tumor invaded the bladder, it most likely did the prostate as well.. After looking at the inside of his bladder he says that he is "encouraged" and hopes to not have to remove the entire bladder. If they do have to remove the bladder they will do this procedure:
ILEAL CONDUIT
An ileal conduit is a small urine reservoir that is surgically created from a small segment of bowel. The ureters that drain urine from the kidneys are attached to one end of the bowel segment. The other end is brought out through an opening in the skin (a stoma). The stoma allows the patient to drain the collected urine out of the reservoir.
People who have had an ileal conduit need to wear a urine collection appliance outside their body at all times.
The urologist will save what he can while still "curing" Curtis, but if there is a chance of leaving any cancer behind, they will remove what they need to. Curtis is having an especially difficult time the past few days trying to cope with the new news.. I am surprising him with a night at the Alaskan Inn tonight and we are going to go around downtown Ogden and the train station where we had our engagement pictures done.. So, SSHHHH... DON'T TELL..
ILEAL CONDUIT
An ileal conduit is a small urine reservoir that is surgically created from a small segment of bowel. The ureters that drain urine from the kidneys are attached to one end of the bowel segment. The other end is brought out through an opening in the skin (a stoma). The stoma allows the patient to drain the collected urine out of the reservoir.
People who have had an ileal conduit need to wear a urine collection appliance outside their body at all times.
The urologist will save what he can while still "curing" Curtis, but if there is a chance of leaving any cancer behind, they will remove what they need to. Curtis is having an especially difficult time the past few days trying to cope with the new news.. I am surprising him with a night at the Alaskan Inn tonight and we are going to go around downtown Ogden and the train station where we had our engagement pictures done.. So, SSHHHH... DON'T TELL..
Thursday, April 14, 2011
New Surgery Date
Surgery will now be May 20th. The urologist is unavailable May 6th. We see the urologist today. I will update again after the appointment..
Thursday, April 7, 2011
Surgeon
We met with the surgeon today at Huntsman and did the MRI. The MRI report showed the tumor size was 1.2 cm (previously 15cm). However, when the physician did the exam and looked through the scope the tumor is much bigger than 1.2cm. He stated that it was "enormous" before and now it is "moderate" in size. He also stated that the tumor is still attached to something. The MRI showed that there was no bone involvment, so he believes it is attached to the bladder. The surgeon requested that the MRI be re-read, because the tumor size is very different on the MRI than what he saw. The surgeon does not feel that he has clear margins to reconnect Curtis' bowels without a permanent colostomy. We will see a urologist regarding the bladder involvment on April 14th and follow up with the surgeon on April 21st. We are considering a second opinion on the resection, we will let you know how that goes..
Wednesday, April 6, 2011
MRI and Surgery Date
Curtis goes in for an MRI tomorrow morning at 7:15 at the UofU Hospital. The MRI will be able to tell us if the tumor has shrunk or spread at all. Pray for good news:) We see the long awaited surgeon after that. He will review the MRI with us and discuss which surgery will be best for Curtis. His surgery is scheduled for Friday, May 6th. (Lacey, please tell Zoie to wait to come, Curtis really wants to go to the hospital to see her!!) I will update tomorrow after the appointment. Wish us luck!!
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