Meet the Cancer

Today was a mix of work, research, filling prescriptions and a visit to another doctor. 

Off to a late start, Mario and Sherry both went to work. Mr. FOG was up early and decided not to wake them up.  A late start is not all bad.  They both got some good sleep. 

 Mr. FOG was Mario’s chauffer and after dropping Mario off at work went to Starbucks.  He researched suggested oncologists, developed a list of questions about the cancer and treatment options, and had to track down where we might be able to buy Mario’s Oxycodone.

Oxycodone is almost as scarce as hen’s teeth.  Only some pharmacies carry it.  The prescription cannot be phoned in.  And usually pharmacies require that the patient pick up the medicine him/herself.  Most annoying is that pharmacists often do not want to tell you over the phone if they even have Oxycodone in stock.  Fortunately Jane took over the Oxycodone search and her first guess was correct.  The Walgreens Pharmacy at Piedmont Hospital had the precious Oxycodone. 

Cancer Weapons:  As a primer, there are three ways to fight cancer, well perhaps four or five.  The first is surgery.  You can cut the bad stuff out. Mario’s Atlanta and Miami doctors are neuro surgeons and offer this specialty.  Secondly one can kill the cancer with poison injected into the blood stream.  This is done through chemotherapy provided by oncologists usually having a background in hematology.  Radiation also can be a very good way to kill a cancer and this is done by radiation oncologists.  The fourth way is a holistic approach that uses the body’s own defenses to overcome the cancer. Many would also say prayer is a powerful force and deserve a high place in our arsenal. 

Each approach has pluses and minuses.  Likely Mario will use two or more of these methods to overcome his cancer, and chemotherapy is probably the first weapon he will use since his cancer is probably not localized.

The Cancer:  In the afternoon Mario, Sherry and Mr. FOG met with a radiation oncologist.  This was the doctor that had been referred by Mario’s Atlanta neurosurgeon.  While he is not the specialist we need right now, he had some answers for us and paved the way for tomorrow’s appointment with a hematology oncologist.   We may need a radiation oncologist but probably not just right now.  It was a good meeting and he provided answers to many of our questions. 

The pathology report found that Mario has a Ewing’s Sarcoma, which is a rare cancer, mostly occurring in juveniles, and often of the bones.  Mario’s is the even less common an extraosseous (not of the bone) Ewing’s Sarcoma (EES)  Mario’s radiation oncologist confirmed that he has the rarer ewing's sarcoma that is not in the bone.  We will know more when we talk to the other oncologist tomorrow.  Another uncommon ewing's sarcoma is a perpheral neuro ectodermal tumor (PNET) .  While there are some differences between EES and PNET the treatment is similar.  While probably not its best picture, Ewing's Sarcoma had this publicity picture for our use.

photo courtesy of cancer facebook. com 

With about 4,000 cases a year mostly in juveniles, Ewing’s sarcoma is a rare cancer, and the none bone is a subset, making it even more unusual.   The research on treatment especially for adults is nil to none   The doctor stressed that this is a curable cancer.  Also Mario is young and strong which will help him fight the cancer.

Mario likely has had the cancer from a few months to 18 months, but not much longer.  The tumor grew to a point where it affected a nerve and caused pain.  Doctors do not know what causes this cancer, but it is due to a chromosomal mutation.

Cancer Treatment  We need to move quickly on fighting the cancer.  Waiting will not help Mario. .  For Mario, the treatment that is provided to juveniles will likely be modified for him.  Since Mario has lesions on his liver, the cancer has spread.   This fact means that he should do chemotherapy to hopefully kill the cancer cells in his system.  Chemotherapy should also reduce the size of the tumor in the leg which should in turn alleviate the pain.  Depending on the cancer’s reaction to chemotherapy, next steps would be decided then.   Also with so little data on this cancer and especially in adults, it is almost impossible to give odds on beating the cancer.  But again, it is a curable cancer according tothe doctor.  Location of the tumor, the degree to which it has spread, and how soon it is treated determine the outcome.

Tomorrow afternoon we meet with the oncologist who specializes in chemotherapy.  Also at Emory there are some doctors who have done some research on Ewing’s Sarcoma and we plan to schedule a conference with them soon.  Additional imaging was also requested and will have to done.  We are moving with prudent haste.