Today we met with Dr. Lin who is an oncologist at the Seattle Cancer Care Alliance (UW and Fred Hutchinson combined). We were referred to him by the oncologists that treated Jon while he was in the UW Hospital. It was an interesting visit and we both liked him. He reviewed all of Jon's scans, histories and notes from SCTWC. He feels strongly that Jon's current condition is a result of liver damage from all of the chemo rather than a complication from the cancer itself. That has been the big question all month and our decision making process has been trying to decide to treat the cancer more aggressively or give Jon some time off to heal. When Dr. Linn looked at his scans he concluded that the cancer has only spread minimally, Jon's liver has shrunk significantly in size, and that he best results obtained from chemo have been with the platinum based therapies like oxaliplatin, 5FU and cisplatin. As a result he feels that Jon should take time off to heal his liver, esophageal varices, and ascites, have a new scan then return to chemotherapy. Y90 is off the table for now as it would cause significant more damage to his liver.

When Jon was first diagnoses and really throughout his whole treatment there has been a question as to whether or not the original source of his cancer was his pancreas or some other GI organ. The original biopsy was inconclusive and Dr. Chue and the other oncologists deduced pancreatic from the pattern of cancer, type of cell, and Jon's history. After Dr. Linn reviewed the 2 1/2 years of records, scans, and results from chemo he is hypothesizing that it may actually be a cholangiocarcinoma (primary in the ducts of the liver) rather than the pancreas. It sounds strange and even upsetting that there would be this type of question, however the treatment for both types are essentially the same and Dr. Chue has also considered this possibility over the course of Jon's treatment. What's somewhat encouraging is that there is a protocol utilizing some platinum based chemotherapies that has produced long term survival in cholangiocarcinoma patients. Also Photo Dynamic Therapy has already been used on primary liver cancers and may be a more viable option should this hypothesis prove correct.

Dr. Lin called and spoke to Dr. Chen while we were still in his office and they concurred that Jon should stop the POLF for now and get scheduled for his next scan. He will be seeing our naturopath, acupuncturist, and nutritionist to focus on healing his liver over the next month. The ascities is somewhat better and he has not had any additional bleeding. Dr. Linn also gave Jon a prescription to reduce the portal hypertension (the back up in the liver that is causing his ascites and varices) and we are hopeful that it will have a positive affect.

Dr. Chue finally called me back last night. He had been in San Fransisco getting a second opinion on his eyes. I am relieved he is still in touch and will get back to him in the next few days to discuss Dr. Lin and Chen's opinions.