The Struggle Has Ended

Greg Hewlett passed away on January 17th after nearly eight years of battling colon cancer. While we grieve his loss, we are comforted to know that he is with his Lord.

If you would like to leave your thoughts on Greg, please see this thread.

If you would like to make a charitable donation in Greg's honor, please see this thread.

Tuesday, December 9, 2003

More remarkable shrinkage of tumor

The appointment with Dr. Hoff yesterday was not routine. Chemo is again postponed. But this time it is because of good news...

The tumor in my liver has again shrunk drastically due to the last two rounds of chemo. So much so that Dr. Hoff believes I am now at a state where surgery is feasible. The actual decision will come from Dr. Nicolas Vauthey, my surgical oncologist, who would perform the liver surgery. I would have met with him yesterday, but he is in Europe for an international meeting and does not return until next Tuesday. I will go back to meet with him Wednesday, Dec 18.
The decision that Dr. Vauthey must consider is:
1. I still need chemo to reduce the tumor more, or
2. I am ready for surgery.
If (2), then there are two options for the surgery:
2a. A one stage approach. In this case, there would be one major surgery to cut a large chunk out of my liver. Even though the tumor shrunk, they like to take out every part of the liver that was ever cancerous to better prevent the cancer from returning. So they are talking about resecting more than half of it. This surgery would likely be on Dec 22 (a visit from St. Nicolas Vauthey?).
2b. A two stage approach. If the portion to be removed is large enough, Dr. Vauthey will do a two stage surgery that he has pioneered at MD Anderson. The first stage is called portal vein embolization (PVE). In this stage, they go in and place artificial clots in the liver vein such that the good remnant is fooled into thinking that it is carrying all the load of the liver, so it starts growing. Thus, we get a head-start on the regeneration process. Then, at the time of the actual resection (about a month later), the percentage of liver removed is actually smaller, decreasing complications and increasing chance of recovery. If we do this option, stage one will probably be next Thursday, Dec 18, and stage two will be in mid January. The first stage is not too traumatic - usually requiring only one night in the hospital. The second stage is major surgery. You can read about PVE here.
I asked Steve Wei, Dr. Vauthey's assistant, what he thought Dr. Vauthey would decide. His reply was that he couldn't say because "we don't see this very often." By that he meant they don't see such initially large tumors shrink so much from the chemo. Steve emailed the CT scan report and the digital images to Dr. Vauthey. If the decision is obvious to him, I should hear this week what to expect. But if it is a tough decision, there will be a doctor's conference on Tuesday where Dr. Vauthey will discuss the case with other oncologists and radiologists involved with my case. I get the feeling from the medical team that this is somewhat unchartered territory. I don't think anyone expected that as advanced as my cancer was in June, we would be at this point today.
Because surgery is likely on the near horizon, Dr. Hoff decided that I would not have chemo now. (yippee) I need to be as healthy as possible for what is coming. So after the meeting, I turned around and drove back to Dallas. Mark Dishman accompanied me. Christine unfortunately missed all the excitement due to the bad cold she has. This was very disappointing to both of us.
So what does all of this mean for my overall prognosis? If this surgery is successful (success is declared if they remove all the cancer in the liver and see no other cancer elsewhere when they go in), then my chances of survival are drastically improved from what they have been. Dr. Hoff told me "most of the time" it is successful. However, statistically there would still be a greater than 50% chance that the cancer would come back. I say this not to be pessimistic, but to let you know the urgency of continued prayer. I am continuing to be hopeful. This is now mixed with much thanksgiving. I thank the Lord for the remarkable shrinkage of the tumor. I am thankful for being at MDACC and for having insurance and finances to get all of this expensive care. And in the short term, I am thankful for getting another week off from chemo!


Nils said...

Maybe being an “interesting” case and perplexing the doctors a bit isn’t always all bad! We praise God for this surprising good news.

Fran said...

ah!! the power of prayer. awesome :-)
love, fran

curtis Frodge said...

hey man that is awesome! praise God! glad to hear you arent having to go through chemo for a good reason this time. i cant wait to see you some time soon, exams are over this week so hopefully ill have a little time at home whenever youre around and we can see eachother or something. well God bless you and Christine i love ya

Terry said...

Greg and Christine
This is wonderful! May the Lord continue to be your cornerman. As always we'll keep the prayes coming.
Love, Terry

Madeleine said...

Praise the Lord, Greg! You've been in my thoughts and prayers quite a lot lately. Thanks for the wonderful update . . . will keep the prayers coming for wisdom and skill for the medical team as well as successful surgery. I hope the Lord has many more years for you amongst us here!! May His Kingdom come and His will be done!

sarah said...

This is fantastic news! We really look forward to seeing you and we will pray for the right decision for the surgery.

David said...

Praise the Lord that nothing for Him is unchartered territory. It's nice to be able to do something for you so far away. I'm flying home for Christmas on Dec 17, so I'll be able to do something close by - if you need anything let me know. You're in good hands - God's hands. We continue to pray for you here in Russia.

Carl said...

We know the the real reason the Colon tumour was 80% non-viable, and the Liver tumour has shrunk. Thank You Lord!

Mike Ernst said...

Praise God from whom all blessings flow!

Jim and Coco said...

I can't help but think of the passage in Job 37:14 "Listen to this, O Job (Greg); Stand still and consider the wondrous works of God."
He is working His miracle in you each and every day.
God bless...........

Cynthia Andrews said...

Congrats!!!! Sounds like an answer to much prayer. As far as the options, I would most definately vote for 2b,. The reason is because you and the doc's can see if the platelets increase and the bilirubin and other liver enzymes decrease as the liver regenerates. A minor procedure done to determine the expected outcome of a very big procedure (2a). Good luck and God bless you both.

Josh Geiger said...

Praise God! We will continue praying, Greg, for you and your wife.

Hale Scott said...

Good people strengthen themselves ceaselessly.