Tests concluding, treatment starting...

Tighe has been through an unbelievable amount of testing in the last week. The result is that the doctors feel they have characterized his tumor and have decided on a plan of treatment.

Those of you reading up on Neuroblastoma will know that it is categorized into stages and risk. Tighe has been categorized as Stage 3 and intermediate risk. The main factors that contribute to this categorization are
1. The size of the tumor
2. It is bilateral, meaning it crosses Tighes midsection
3. Location. It has entered Tighes spinal column.
Some good results we got this week are a) No evidence of the tumor having spread to his lungs or bone marrow b) the biological make-up of the tumor is not considered to be aggressive - in particular it does not have NMIC (or MYCN) amplification. c) Tighe's heart is considered strong enough to undergo the prescribed treatment. A different result on a) or b) above would put Tighe into a Stage 4/High Risk categorization.
Low risk Stage 1 and Stage 2 tumors are generally smaller and in a location that makes them more easily removeable by surgery. Although a Stage 1 or Stage 2 diagnosis would have been much better, the doctors are still very hopeful that Tighe can kick this and have a full recovery with little to no long term affects. I think the key is that it doesn't spread to other parts of his body. If it became a Stage 4 case it would mean much more aggressive treatments and a much worse prognosis. Let's not consider that for now...

So, things have been moving fast today. Since I wrote the above a little earlier this evening, the chemotherapy treatment has started. Tighe is now over an hour into it and is doing very well. The drugs are administered through Tighes IV line and tonights treatment will last about 2 hours. He will be receiving four different drugs over a three day period, then he will rest for three weeks. This will be repeated four times (with variations in the amounts of the four drugs).
For this first cycle (three days) Tighe is an inpatient in the hospital. If he tolerates the drugs well then he will be allowed to receive the next three cycles as an outpatient, just attending the hospital during the day and going home at night.

Possibly after the first two cycles they will do an MRI scan to see if the tumor is regressing. Definitely after the four cycles they will do a scan to see what the status is. The ideal result would be that the tumor has pulled back from the spinal column and that a relatively simple surgery can be done to remove the remainder. The doctors have told us that they have seen shrinkage of up to 90% of the tumor with the course of treatment that Tighe is on. That is a lot to hope for, I am just hoping that it retracts enough from the spinal column that the general surgeons can remove it and the neurosurgeons are not needed.

I'm also thankful that the chemotherapy is under way. I feel that every day we wait was another day that the cancer could spread (or metastisize). BTW, I should mention that the reaon the chemotherapy hasn't started until now is that we needed to wait until we got all the results from the various tests (only two days ago was it confirmed to be neuroblastoma after the biopsy was done) so that the correct amount and type of chemotherapy drugs could be determined. I've been very impressed with the speed at which both our pediatrician and the doctors here at Stanford have operated. I truly get the sense that curing Tighe is extremely important to them and they are moving as fast as possible.
The way chemotherapy works is that it attacks fast growing cells (such as cancer cells). So, now that the chemotherapy has started, the chance of it spreading is greatly reduced. There are other good cells in the body that are fast growing and the chemotherapy drugs also affect them. For example, hair is fast growing, hence many people on chemotherapy lose their hair. A much more serious side effect though is the reductions of white blood cells, red blood cells and platelets (all fast growing and all attacked by the chemotherapy drugs). However, the status of these are monitored closely throughout the treatment and there are ways to replenish or help these if needed.

That is where we are now. Tighe has two nurses looking after him tonight. He's sleeping right now and seems quite content.