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This site is mostly about racing and the NTT IndyCar Series. I do bring my personal life in here quite often, but some get irritated when I stray too far from motorsports and I get that. Rather than intermingle the two subjects into one post, I decided to split them up for today.

As most know, Susan and I traveled to Rochester, MN last Sunday so that Susan could seek the very best treatment in her battle with pancreatic cancer. My father died of this exact disease in 1994. I recognized that she was experiencing the same symptoms that he had, so we caught it relatively early. Unfortunately, it wasn’t early enough to get to it before the tumor wrapped itself around major blood vessels, making it inoperable by most standards.

This is one of the deadliest cancers and we know it is an uphill fight. Since she was diagnosed on July 7, we went through the emotional gambit early on. But then we moved on to the “what are we going to do about this?” stage. That’s when we learned of a surgeon at the Mayo Clinic that specializes in operating on pancreatic tumors that have encased blood vessels, even though other less-skilled surgeons will not even consider such a procedure.

We sent her scans to him in late July, and he concluded that she met his criteria – Stage 3, meaning it was wrapped around blood vessels and inoperative, but has not spread to any other part to the body. He has been performing this surgery for ten years and has seen outstanding results. Many of his patients have been “cured” meaning they have gone more than five years past surgery and are still showing no evidence of cancer in subsequent scans.

His approach is to remove the entire pancreas and all blood vessels that are encased by the tumor. It is an aggressive approach, where he then reconstructs the blood vessels and actually re-routes the circulatory system in the surrounding area. It is a grueling fourteen-hour surgery that comes with a lot of risks. But it also is the only real option that offers a chance for a much longer life, along with a decent quality of life.

Her entire pancreas would be removed, along with her entire stomach. Removal of the pancreas would make her diabetic, but she would have an insulin pump installed, much like driver Charlie Kimball has. I had thought the lack of a stomach would mean she would have a feeding tube for the rest of her life, but that is not the case. Her digestive system would be re-routed, and she could no longer eat big meals. Instead, she would eat a lot of small portioned meals several times a day. She seems OK with that.

What we anticipated for our trip was one of two possible outcomes. One would be great, the other would be devastating. Either we would learn that the cancer had not spread and we would be scheduling the surgery within the next few weeks, or we would learn that the cancer had spread to other parts of the body and it was too late for the surgery.

What we got was an unexpected curve ball that had a little bit of both, and left more questions than answers.

The good news is that the cancer has not spread. It is still localized to the pancreas. She had a PET scan on Tuesday that showed far less cancer activity than the one she had in late August. Her Monday CT scan showed that the tumor has shrunk significantly since she started chemo in mid-July. The surgeon at Mayo and her local oncologist are both in agreement that she has responded to her chemo very well and it is working about as well as could be hoped for. She has already been through seven rounds and has five more to go.

The bad news is that the blood vessel involvement is so extensive, that the tumor may be borderline inoperable – even by this surgeon’s standards. There is one artery coming from her liver that has so much involvement that it cannot be used in the reconstruction process. That leaves a second artery that is further away, that may be too far away to use. If they try to use it and it cannot be reconstructed, the surgeon described this as a certain “fatal event”.

I learned a lot about tumors this week. I always pictured them as a round ball-like mass that grew inside an organ. What I did not realize is that they are more irregular blobs with tentacles that grow around blood vessels and organs, much like a Wisteria vine wraps around anything it comes in contact with.

This illustration is not Susan’s tumor, but one very similar to hers. The pancreas is in yellow and the tumor is green. The pancreas was removed in the picture to the left to show the tumor fully.

If you see how it has wrapped itself around the veins and arteries – that cannot be pulled away. The vessels have to be removed completely and re-attached; otherwise the cancerous tumor is still there and will grow back. Susan’s involvement with the blood vessels is apparently more extensive than this example.

They did a laparoscopic procedure on her on Wednesday, where they inserted a camera into her abdomen. This will produce a similar model to this one, for her; but we haven’t seen it yet. There is also one final test result we are waiting on, that was performed during this Wednesday procedure. Apparently, PET scans do not pick up cancer activity in the lining of the abdomen (the peritoneum). They did a complicated test to detect cancer cells there. It will be sometime this week before we learn those results. If cancer cells are detected there, then there is no need for the surgery. It’ll be too late.

If that test shows no evidence of cancer cells, then he wants her to complete the final five rounds of chemo and he wants us to return for another evaluation sometime in late January. He will then determine if the risk for the surgery has been reduced, or if the tumor is completely dead from the chemo. Somewhere in there, radiation will most likely be included in her treatment.

Even if his surgery is not an option, there are still others; but they don’t offer potential cures. What they do offer is a higher quality of life, hopefully for a couple of years – but the eventual outcome would be inevitable.

So right now, we wait. We wait for the results of that final test, then we wait for her to complete her chemo in another two and a half months. After that, we wait for the surgeon to decide what the next step is.

Susan and I are both something of control-freaks (me more than her). She said it best the other night, when she said that cancer teaches you early on that you have no control over this. It forces you to learn to go with the flow, even when it isn’t in your nature.

Right now, her spirits are still incredibly high. We were bummed on Tuesday night, after we had left the surgeon’s office without scheduling her surgery. But if we can get over this hurdle of this final test, there is still a lot of reason for hope.

Even though we didn’t hear everything we wanted to hear, we have nothing but wonderful things to say about the Mayo Clinic. I felt as though we had finally reached the major leagues of health care. When Susan had a PET scan in August, it took us ten days to learn the results. The Mayo Clinic has one of the most complex and detailed PET scan machines (proper term?) in the world, but it only took ninety minutes to have the scan read and to have the full results.

As large and complex as the Mayo Clinic is, it runs like a well-oiled machine. They have their system down to an exacting science. And even though they see a lot of patients, they treated us like we were the only people that mattered. That’s quite an accomplishment and a far cry from what we’ve experienced the last few months.

So, that’s where things stand. It wasn’t exactly what we wanted or were even expecting, but I felt like they shot us straight. In this situation, I’d much rather have that, than someone telling us everything will be OK when you know better. I don’t foresee anything changing in Susan’s status for the next couple of months. The chemo has been hard on her. Each three-day session absolutely wipes her out, and she has five more to go. But she says it’s a lot easier to endure them when she knows they are working. That attitude right there is why I married her.

George Phillips

This entry was posted on November 2, 2020 at 4:02 am and is filed under IndyCar. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.