Fighting Cancer, part 2 of X: More on surgery

Recently, Mom asked me more about how her surgery had gone. Of course, she wasn't awake during the actual surgery. But also, because of possible brain injury, she has trouble remembering things. Shucks, even I have trouble remembering things. So, I'll go back a bit.

Mom has an autoimmune disease called Wegener's Granulomatosis (WG). Nowadays, it's been renamed to ANCA-Associated Vasculitis. Honestly, you can google for any info I could provide you. I will say that Wegener's is an autoimmune disease, not to be confused with something like AIDS: Acquired ImmunoDeficiency Syndrome. I know they sound similar, but they're almost opposites: In an autoimmune disease like Wegener's, your immune system is almost on auto-pilot and attacks everything in sight, including your own cells. Your immune system is doing *too much.* In an immunodeficient disease like AIDS, your immune system is weak/destroyed. Your immune system is doing *too little.*

Besides Wegener's, another example of an autoimmune disease is systemic lupus erythematosus, AKA lupus.

So, Mom's had Wegener's for many years. And in recent years (2012, 2013), her vision started to deteriorate. That can come with Wegener's, but Mom's Wegener's was apparently stable. So they did an MRI of Mom's head:

That was on 9.28.2012. The left side of the brain is on the right, and vice versa. You can tell by the "R" and "L" notations on the image.

On the left side of the brain, do you see that tumor? I don't, either. Nor did the doctors. If it was there, it wasn't apparent.

Mom's eyesight continued to deteriorate in 2013, and no one had a good explanation nor solution. She even traveled to specialists in Portland and Minnesota. (The latter being the famous Mayo Clinic, which my mom did enjoy.)

All this was also happening while Mom was taking care of Grandma. We all miss Grandma Fong.

Grandma died on Christmas Day, 2013. On February 19, 2014, a Wednesday, my sister took Mom to the ER. They did a CT that evening and another MRI the next evening. They saw this:

It's ~500 days from the earlier MRI. Or 1 year, 5 months.

I've put the earlier MRI below to compare more easily.

I lined up the slices as well as I could.

Of course, now that I look at the slices lined up, I wonder if I do see something? But I know nothing about brain images, so I'll just quote the report summary from 9.28.2012.

IMPRESSION:
1. No evidence of intraorbital or intracranial involvement with
Wegener's granulomatosis.
2. Extensive white matter nodular changes within the corona
radiata and centrum semiovale, nonspecific, but presumably
related to aging. 

The MRI from 2.20.2014 reports the tumor as "5.9 cm x 4.2 cm x 5.3 cm." They also said it was most likely a meningioma. (That would have been a better diagnosis.) 

Anyway, Mom wanted to know about the surgery. My notes say the surgery happened on February 22, a Saturday, starting at 8 AM, lasting several hours. The doctors removed (resected) as much of the tumor as they could, and they also tested the tumor tissue to know exactly what kind of cancer it was. The diagnosis would come back as Primary Central-Nervous-System Lymphoma (PCNSL). Also, they did another CT on February 23 to see how things looked after surgery:

Of course, now Mom had to heal from her surgery. She had some major stitches. I feel like Mom went through every department in the hospital, as she was in op, post-op, acute rehab, rehab, and probably oncology and who knows what else. 

Mom was discharged on March 8, 2014, a Saturday. From the day my sister took Mom to the ER, that's 18 days. If anything, I'd say that Mom's good at rolling with the punches. (Grandma was, too.)

Mom still had a lot of rehabilitation and recovery to do. And, as the tumor was not a meningioma but instead this metastatic lymphoma, Mom needed more treatment. Next up: chemotherapy on March 17, 2014. That was also the start of the Game Developers Conference (GDC), my favorite conference of the year. Should I still go? Would I still go?

One more thing before ending this post. Remember how I said Wegener's is an autoimmune disease, and pretty much the opposite of AIDS, an immunodeficient disease? Well, if you google primary CNS lymphoma, you'll find that PCNSL usually occurs in immunodeficient people. That's right, immunodeficient (aka immunocompromised). So why did Mom get PCNSL, when she should have an overactive immune system? My understanding is that Mom's immune system has been essentially compromised/deficient/suppressed, because she's been on medications, for several years, that suppress her immune system. So, yeah, the drugs my mom was given probably led to her cancer. That said, Mom almost died from Wegener's over 20 years ago. 

We'll just keep rolling with the punches and doing our best.

Fighting Cancer, part 1 of X: Surgery

In February 2014, my mom was diagnosed with a brain tumor:

That blob is a 6 x 4 x 5 cm malignant tumor. Here's a top-down view:

Judging from the images above and other data, the doctors first thought Mom's tumor was benign. They thought it was a "large meningioma"; big but relatively easy to remove.

On February 22, 2014, Mom had brain surgery. The doctors removed as much of the tumor as they could. Below is a picture from the day after surgery.

You can see a bit of the space where the tumor was, and also where they cut into Mom's skull to get to the tumor.

Now that the doctors had cut out the tumor, they could examine it under the microscope to get a better diagnosis. Unfortunately, the doctors discovered that the tumor was not a meningioma, but rather "primary CNS lymphoma." What's that?

• "Primary," as opposed to secondary, means that's where the cancer started. I think that's good; if it were secondary, you'd have to search for the primary tumor, and you'd need to handle two tumors. (No secondary tumors have been discovered in Mom, yet.)
• "CNS" is "central nervous system." That's the spinal cord or brain.
• "Lymphoma" is a cancer of one's white blood cells. White blood cells are part of our immune system and are found throughout our body.

To summarize, some of Mom's white blood cells turned cancerous, and they formed a tumor in her brain. This tumor was malignant, which is bad on a couple levels: 1) It probably grows relatively quickly, and 2) it can spread to other parts of the body. Because of this, the doctors decided we had to do more than just surgery to get rid of Mom's cancer.

Next time: "Fighting Cancer: Chemotherapy. And Fasting."

P.S. Some statistics on primary CNS lymphoma: It's rare: 4 cases per 1,000,000 people. Survival rate: I've seen different quotes. From 10–18 months to > 4 years, for example.