cancerschmancer - meet the surgeon

october 18 - 8:30am
dr. armstrong - uci surgeon
pavilion 2; 1st floor

that was the appointment on my calendar.

at 6:30am, jamie, matt and i hit the freeway and headed to orange county. we had plenty of time and even stopped for breakfast. the 91 didn't hate us. the day was already looking up.

when we got to the surgeons office, we people watched, we listened and we laughed. we decided to play, "what will the doctor say - loser buys lunch" while we sat in the waiting room.

eventually we made it into the exam room and played "what is that utensil for and where will they use it on matt" to pass the time while we waited. again, we guessed and laughed.

eventually we were met by the resident and matt answered the same 50 or so questions he's been asked by every other doctor and specialist we've met. we once again were told that they are still learning about this rare and aggressive cancer and then they peppered him with more questions. he went the funny route with his answers. she must have left her sense of humor at home that morning. no big deal. it's not like we were there for brain surgery... so i thought.

then dr. armstrong came in. he was very knowledgable. we asked how many of these cases he sees.
1-2 per year. yep, it's rare. remember matt has that only 1 in 100,000 cancer.

i got lost when he said for surgery, he'd "lift the hood" or maybe it was much earlier, which may be why he used that term with me. (see below, it's the first surgery option that the surgeon describes.)

and after the appointment, jamie wrote this summary...


Today we saw the surgeon at UCI. Dr. William Armstrong comes highly recommended by Matt's oncologist, as well as the oncologist at City of Hope. Dr. Armstrong sees 1-2 patients with poorly differentiated neuroendocrine carcinoma per year. His success rate with the very "rare and aggressive" form of cancer has been dependent upon the age of the patient, and also their willingness to allow him to be as aggressive as necessary in order to get them to be surgically cancer-free. If he has to take an eye...he wants to be able to take an eye and the patient needs to be willing. Yes, he was that matter-of-fact. But he said that Matt is otherwise healthy and he is young so the odds are more in his favor that he can withstand an aggressive form of surgery if that's what is called for in his case.

The surgeon reviewed the information we had, scans, reports, documentation etc. but before reviewing everything, he started the conversation by stating that, based on what he read in the initial pathology, the cancer appeared to be moving toward the brain and the eye. BUT upon further review of information, physical examination of Matt, asking a bunch of questions, and looking more closely at the original MRIs of the head, he recognized that the tumor appeared to just be only in the nasal cavity. What he indicated was that it is "localized" (just in the nasal cavity) but what we didn't know about this specific form of tumor is that even though it may look encapsulated (all in a nice little shell) it actually does have "feelers" (little branches that reach out beyond the wall of the tumor) that will try to infiltrate other areas and spread so he said it is crucial to perform surgery in the near future. He wants to wait until Matt has completely finished treatments. Matt has one more chemotherapy session on Monday and then approximately 2-3 weeks remaining of radiation. Matt will need to be finished with treatments for approximately 3 weeks before surgery can happen. So we are looking at the possibility of surgery in the first part of December if all goes according to plan...trusting first and foremost the LORD'S plan above all else.

The surgery was described in a couple ways. The worst of which was that there would be a neurosurgeon involved and he would actually do an incision from ear to ear going up and over the forehead, remove the frontal lobe (forehead bone) and pull down the face and get to the tumor from the top. (sorry for the graphic detail) And then at the same time that the neurosurgeon is doing that, Dr. Armstrong would go in by cutting the inside-upper lip and pull up and go through the nasal cavity that way. Dr. Armstrong said that his objective will be to save Matt's eye by removing the remaining cancer and keeping it away from his optic nerves that are currently being threatened by the tumor. This type of surgery would also require reconstructive surgery at some point for Matt as well. Another surgery described was to just go in endoscopically through the nostril to remove the remaining tumor and obtain clean margins that way. Well, for obvious reasons, we are praying that endoscopically is the way to go. The recovery time for the endoscopic method is a matter of days or a couple of weeks. The more invasive way would have him in the hospital for about a week, with the first few days being in ICU. More time in the hospital is not what a cancer patient wants or needs, and being off work is also concern, so we are praying that the Lord would deliver Matt fully of the cancer and a drastically invasive surgery is not necessary. Please join us in prayer for that.

Matt will begin receiving a very precise form of radiation called "CyberKnife" today. (It really is not as violent and scary as the name sounds.) Cyberknife is a very precise form of pain-free radiation that will pinpoint a specific spot and only radiate that spot without reaching other healthier tissue that doesn't need radiation, or already very radiated tissue that cannot withstand further radiation therapy. Matt's tumor, based on the last MRI, had decreased in size by half! And since then even more of the tumor has exited his body. So it is even smaller still. Praise the Lord! The Cyberknife will help to kill even more of the tumor and prayerfully, by the time he gets his surgery there will be little to no tumor left to be removed! That is our prayer.

So at this point, the next thing happening is Matt has an MRI scheduled for today to measure the tumor size as it is right now. That information will be sent to UCI and then next Friday
there will be a tumor board meeting to specifically introduce Matt's cancer and all of the test results to the team of medical oncologists, radiology oncologists and surgical oncologists, as well as the neurosurgeon and they will discuss the best form of surgery and treatment for Matt's tumor. We will be heading back to UCI next Friday to receive the results of that tumor board meeting and what the recommendation is. If surgery is what the recommendation is, and we believe it will be, then authorization for surgery will be requested and then scheduled from there.



we continue to trust Him.

He doesn't bring us to this point and then abandon us.

matthew 6:26 says, look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. are you not much more valuable then they?

and to that i would say, yes. yes we are.