Today we returned to Doernbecher for a MRI. Everything went well and the new images will be very helpful for the doctors. We now know that the lump is on the upper end of Eila's right kidney, the same area that her second tumor was -- this obviously points to a recurrence of Wilm's tumor. Although the doctors referred to it as small, we were shocked at how big a 2 x 3 cm "lump" is on a 7 cm kidney. From the MRI, it does not appear to be a cyst (it does not appear fluid-filled). Although everyone (including our doctors) acknowledges that the lump is probably cancerous, they are hesitant to officially call it that. This is primarily because the implications of cancer treatment (removing part or all of the kidney, chemotherapy, and radiation) are going to greatly impact the rest of Eila's life.
So what's next for our precious Eila? There's a lot of complicated decisions to make, and they involve balancing our desire to treat the cancer while preserving Eila's kidney function if possible. Her oncologist is working on getting input from doctors near and far -- luckily since Eila isn't sick right now, so we have a little time (a week or so) to look into all these issues more carefully. Eila only has so much kidney remaining after the partial nephrectomy with the second tumor, so balancing the ability to save kidney tissue while eliminating cancer is scary and complicated.
The first decision lies with surgery, do we do it? If no, we assume it's a tumor and we start chemo. Because it's a relapse, this will be a much more aggressive chemo plan than she has done previously. Can we do it? If yes, we have a few choices to make: 1) nephrectomy, 2) biopsy, or 3) resection (partial nephrectomy).
1) A complete nephrectomy (fully removing the kidney) isn't our first choice because it means we've jumped Eila to renal failure (there's no kidney left!), she'll need dialysis and a transplant. A transplant becomes complicated if we learn that it is a tumor because she'll have to undergo chemo and that delays her eligibility for transplant for 2 years.
2) A biopsy (retrieving cells from the lump to test for cancer) is scary because it leads to more extreme choices. If cancer cells are found, it means her cancer treatments need to be expanded to include radiation (something we've always felt lucky to avoid before). If no cancer cells are found, we just watch the lump VERY closely and monitor kidney function MUCH more closely.
3) A resection will also allow cells to be tested for cancer. If cancer cells are found, she starts chemo but we get to avoid radiation. The chemo will have to be selected very carefully to determine the strongest but most kidney-friendly options available. If no cancer cells are found, we increase her kidney monitoring.
I wish I could tell you there was an option 4, none of the above, but I have to accept this horribly scary new reality we're in. Out of the choices here, I think I'm hoping for #3. But it's hard to be hopeful when I feel like my hopes for Eila to have a relatively normal life have been ripped away in one quick flash. Now all we can do is try to find the BEST pediatric surgeon out there and pray that he/she believes that we can save some of Eila's kidney so that we can fix just one problem at a time.
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