After weeks that have tested our patience, resilience, anger management skills and humor, we’ve come out on the other side with a plan and are ready to proceed.
As was thought to be the case the last time I wrote, Mary Carol has a Sinonasal Undifferentiated Carcinoma (SNUC) with Neuroendocrine features in her ethmoid sinus. This is the sinus area between your eyes yet about a finger-lengths deep.
From the traditional allopathic angle, MC will start her neoadjuvant chemotherapy this coming Thursday, January 10th at the University of Pennsylvania Hospital. The specific chemotherapy given will be CAV (cyclophosphamide, doxorubicin, and vincristine). The purpose of this chemotherapy is to shrink the tumor enough so that the surgeons can remove the tumor with as little disruption as possible to the surrounding areas.
Due to the rarity of this type of cancer, there is no standard protocol for how to handle it. Penn advocates using neoadjuvant CVA chemotherapy before surgery while other universities favor a neoadjuvant treatment of chemo-radiation therapy prior to surgery. The radiation oncologist at Penn recommended that proton radiation be utilized due to the location of the tumor and its proximity to her brain, optic nerves, etc. Penn does not currently have proton radiation so we sought other options and opinions. We will be going to Gainesville, Florida for a second opinion.
Gainesville is one of four centers in the US that have proton radiation and they have been a hub of research in SNUCs of late. Although MC will remain with the brilliant surgical team at Penn (Dr. Bert O’Malley and Dr. Sean Grady) it is a possibility that she use Gainesville for her neoadjuvant treatment as she and Tom have a house in the area.
As of today the plan is as follows; MC will have her first course of CVA chemotherapy at Penn on Thursday, January 10th. On Monday, she and Tom will drive to their house in Florida. On Thursday, January 17th we are scheduled to see a Radiation Oncologist with whom she will discuss his/her advice on neoadjuvant therapy. They may agree with Penn’s plan of CVA chemotherapy or they may recommend chemo-radiation with proton radiation. At that point, Meme can either remain in Florida and follow Penn’s plan or Gainesville’s plan. She may also chose to come back to Philadelphia although I believe if she’s going to be feeling cruddy she’d prefer to be in sunny, warm weather.
The goal is to shrink the tumor so that surgery can be performed. Penn’s course of action would be one round of chemo every three weeks. Mom will have an MRI after the first three week time period has elapsed. If the tumor has not shrunk enough, round two of chemo will start. This will go on at most for three chemo treatments. The window for surgery will be between the 2n until after the 3r round of chemo. The surgery is another email all together and we’re taking this day by day.
On the complementary front, MC has plowed through literature and has started herself on a supplement regime. Luckily, mom has a friend and trusted advisor who has been treating cancer alternatively for over twenty years. In addition, Meme is a now a vegan and shared her gallon-sized snack bag of raw vegetables with me today. She continues to work out, laugh and meditate - as well all should!
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