Needle Biopsy to SABR

Last Monday, May 24, Mark had a needle biopsy of his liver. Since Mark's pain had increased from tumor growth, we picked up a prescription for Oxycodone. The recommended dose from the doctor was 1-2 tablets every 4 hours, as needed for pain. The pharmacist encouraged us not to use the recommended dose, as that was a maximum amount. Initially, Mark took just one tablet and felt like he was floating on a cloud with absolutely no pain, which was heavenly. But that didn't last long, and soon he was taking 2 tablets every four hours. By the middle of that night, he was in incredible pain, with hours to go before he could take more. By morning, he was feeling desperate, so we called the doctor, who had Mark take three pills in addition to his usual dose. Finally, he slept and was out for most of the day, but at least he wasn't in pain. He has returned to the prescribed dose, and although the pain never goes entirely away, it is manageable. He can only sleep on his left side as the tumor in the liver is on his right side, and the tumor next to the pancreas causes back pain. That's right, the cancer is not in his pancreas but in a lymph node close to the pancreas. Nausea and dizziness come and go, and itching has become incessant (a side effect of Oxycodone.) He has prescription creams that help a little. His digestive system is now affected, so he can't eat much and is losing weight rapidly. Sometimes he feels quite chipper, and we're always thankful for those moments. Distractions seem to keep his mind off of the discomfort. 

Thursday, we met with Dr. Crittenden, the radiologist. She explained why Mark is in such pain. Tumors in the liver are typically not painful. My mother died of liver cancer but was rarely in pain. I had wondered why it was so different for Mark. The nerve endings that transmit pain are in the lining of the liver. Mark's tumor is close to the outside edge of his liver, stretching the lining, causing intense pain. Also, he may have had some bleeding from the biopsy that irritated the lining, causing more pain. 

The radiologist would like to use a newer type of radiation therapy on Mark, although it will take about three weeks to start. Can he wait that long with the increase in pain? If not, he can have the traditional radiation, but we're hoping that's not the case. Here's a brief summary of the new therapy:

"Stereotactic ablative radiotherapy (SABR) is a highly focused radiation treatment that gives an intense dose of radiation concentrated on a tumor, while limiting the dose to the surrounding healthy tissue. Like other forms of radiation, SABR works by damaging the DNA of the targeted cells. Then, the affected cells can't reproduce, which causes tumors to shrink. SABR uses the latest image guidance technologies to ablate tumors with millimeter-scale accuracy."

Dr. Crittenden indicated that this therapy has been highly effective in shrinking and eliminating tumors where there are only a few. The combination of Keytruda and SABR has an even better chance for positive outcomes. We didn't know anything about SABR, so we are amazed and grateful for other available options.

Mapping using CT and MRI scans will be done Thursday, the 3rd. It takes about 2 weeks afterward for the actual radiation to be administered. There will be a total of five or six sessions which will be scheduled at our next appointment.

Mark will have his second Keytuda infusion a week from this Wednesday, and that could potentially shrink these two tumors relieving some of the pain. 

For the first time in many years, we have wondered if this could be the beginning of the end for Mark. When Mark was in such intense pain, I knew that I would be willing to let him go rather than have him suffer so. 

We both have relied on the impressions we had earlier. In early December, before we knew of the return of the cancerous tumors, Mark was pondering how to increase his faith. An impression came that he should not fear. "What should I not fear?" he asked. In his mind, he went through a couple things he could have fears about and was told they were not it. But when he asked if he should not fear cancer, the answer was clear. "So, I need to fear less about the cancer?" he asked. "Yes." That seemed odd because, at the time, there was no need to be concerned. Now, we have definite concerns but know we should not fear. Still, what does that mean? What does the future hold? We don't know. 

I recently came across a journal entry I wrote on January 2 after learning about the tumors and decided to use Interleukin-2. 

Last night I awoke several times with a question on my mind. It seemed to be put there. It was simply, “What do I need to know?” After asking this several times, thoughts came in answer. They were something like this, “There will be some difficult times ahead. You may doubt that Mark will survive, but you must not fear. You will not be given more than you can endure, and you will be given strength beyond your own to be a blessing to you and to Mark when he needs you. You have been given knowledge that will sustain you. Continue to seek for increased knowledge and guidance. Your testimony will be a light for others, particularly in your family, to look to in their times of need.”

We both have had feelings that this is not the end but another opportunity to learn, develop empathy, and increase our faith. Of course, our faith is not dependant on whether he lives or dies. Our faith is rooted in our Savior, Jesus Christ. He knows us. He loves us. He will guide us in whatever we have to endure. These things are easier said than done, especially during pain and suffering. It is real, and it is hard, but we know that we can turn to the Lord, and he will sustain us. We also appreciate the kindness and support that we continually receive. Thank you!