Curveball

Casey scheduled another blood draw for a few days later and followed that shortly with a chest CT. Over the next few days we continued to debate amongst each other about what treatment plan seemed the most logical, and reasonable considering Casey living away from my parents with only myself to really care for him if he did choose the chemo. Should he go home to Colorado to receive treatment, where my Mom could take good care of him? So many things to consider.
Casey got a call last Wednesday from the oncologist regarding the tumor markers in his last blood draw. They are climbing higher. Post surgery his AFP was 58, it is now close to 100. Basically meaning that the cancer is still in him somewhere, and it's growing.
Damn it! I mean....really? I was so not prepared to hear that. I had pretty much prepared myself for the fact that chemotherapy was going to happen but I most certainly did not expect that his tumor markers would rise. Remain the same, maybe even fall a little I thought- but get higher? I just wanted to scream. So- the decision was made. The doctor ordered Casey on not 2, but 3 cycles of chemotherapy, each cycle at 3 weeks. 9 weeks total, which makes his last week of chemo the week of Christmas. Super.
And now I am up to date. Case visited the sperm bank Friday and he will go again tomorrow. The sperm bank will bank his sperm after a down payment and then a yearly payment every year after. At 24 he's not even sure that he wants kids, but, you have to think ahead! The oncologist thinks chemo could start as soon as Tuesday 10/27. My Mom is flying in tomorrow night so she can be here for his first week- which is supposed to be the hardest of each cycle. The first week is the Cisplatin and it's everyday for 2 hours a day. These drugs are administered through an IV drip so Casey will have to go to the hospitals cancer center for treatment.
I have been feeling so helpless so I have been researching how to maintain a healthy diet while taking chemo. It's important to eat well, and provide your immune system with the tools to stay as strong as it can since chemo lowers it's ability to fight off disease.
The coming weeks will be trying, and hard and scary and concerning no doubt. I plan to blog the entire way through though so that anyone who reads this will have an idea of what they might be able to expect. Who knows, maybe all of the anti-nausea drugs they have available these days will keep Casey from getting super sick. Maybe he will just get really tired and some of the worst side effects will pass him by. God I hope so.

Treatment

Treatment options are tricky. Our oncologist gave us a few to "choose" from even though, in the end, he pretty much did the choosing! Since Casey's tumors were considered to be stage 1S (s is equivalent to b, which is one level worse then if he had stage 1a) he could opt for 2 cycles of BEP chemotherapy. BEP is a combination of Bleomycin, Etoposide and Cisplatin, three pretty common chemo drugs used for more then just TC. Or, if the doctor liked the looks of his next blood test he could opt for active surveillance. Surveillance is not just "watching and waiting." They take weekly blood draws to watch your tumor markers, they schedule regular CT scans to monitor any possible re-growth or spread. The oncologist explained that 30% of those who choose active surveillance have a recurrence at sometime in their life. 70% do not- not terrible odds but I don't know that I would want to wake up every day wondering "is today the day they will find out it has come back? Will I officially join the 30% club?" If you were to have a recurrence you would have to have chemo done anyway, so it makes sense to just do the cycles now, get them over with and (hopefully) move on with your life and leave cancer in the past. Easy enough, right? Almost. Chemotherapy has a lot of negative side effects including sterility. Bleomycin is a very potent drug that can wreak havoc on your kidneys and lungs. Vomiting, nausea, hair loss, mouth sores, weight gain, weight loss, dry skin- the list really does go on and on! Plus, for Casey, he had school to consider! He had just started his law school mid-terms. While his school would allow for a medical leave of absence they would not give him credit for the classes he had made it half way through for this semester so he would essentially be starting his 2nd year all over again post chemotherapy! Yuck.
So, we sat at a crossroads. What do you do? What does Casey want to do? We had lots of talking and considering to do and the oncologist wanted Casey to get another blood draw and a chest CT scan (to ensure the cancer did not spread to the lungs). We left his office feeling foggy and even more confused then when we went in. How would we decide which treatment was the best for Casey? Well, we wouldn't have to.