OK, this is about to get even more confusing...
It APPEARS (key word here) that the lymphoma is gone from Tricia's body! The last few biopsies have shown no lymphoma, and the x-rays from yesterday show the spots in her lungs and the spot in her chest to be shrinking. The last biopsy of her chest DOES SHOW an infection, which Tricia has been receiving antibiotics for since last week.
The doctors believe that the spot in Tricia's chest (outside of the lungs) that showed up for the first time a month ago never was lymphoma. They also believe that the spots in Tricia's lungs (where the lymphoma had been) are now infection spots as well. It is ASSUMED that the chemo did indeed do it's job, and that the infection is presenting itself in some of the same spots as the lymphoma.
Trust me, after having been told over a month ago that the cancer was still present in her lungs, we were also confused...we have spent the last month assuming that was true, when, in fact, that was only what was assumed to be true by the doctors (see This Post).
To better help us understand, we asked the oncologist to draw out the time-line of events...
June 16 - Tricia is diagnosed with PTLD (Lymphoma) when a biopsy comes back positive.
June 18 - Tricia receives the first of four rounds of Rituximab.
July 22 - Via a CT Scan, it is determined that the Rituximab did not do anything to the lymphoma.
July 23 - Tricia receives the first of six planned rounds of R + CHOP, a more aggressive form of chemotherapy.
October 15 - After four rounds of R + CHOP, a scan shows that some of the spots in Tricia's lungs are gone, while others have grown. A new spot around a lymph node in Tricia's chest outside of the lungs has developed. It is assumed that the spots in her lungs are still the lymphoma, and that the spot in her chest is either lymphoma or an infection. The remaining two rounds of chemo are terminated. A successful biopsy of the area in the chest is performed.
November 10 - We finally learn that the results of the chest biopsy shows that this spot is an infection and not lymphoma. We are still told that the spots in her lungs are assumed to be lymphoma.
November 19 - We are told by the oncologist that, in fact, they now believe the lymphoma was gone by October 15. It is now assumed, due to the biopsies showing no cancer and the x-rays showing a reduction in size of the spots that an infection has taken over some of the spots where the cancer was.
The oncologist explained to us that they can't be positive about knowing if Tricia's body is cancer free until either a more invasive, successful biopsy is performed or until the scans and x-rays show no more spots...he explained, at this point, there are three immediate options:
1) Start an even more aggressive regimen of chemo leading up to a bone marrow transplant.
2) Perform an invasive, surgical biopsy (which includes deflating a lung and inserting a chest tube) to get some samples from the remaining spots of the lungs to determine if the lymphoma is still present.
3) Wait until the end of Tricia's current 30 day anti-biotic treatment (for the infection) and rescan to determine if the spots continue to shrink.
Because the first option would be incredibly risky, especially due to the fact that the doctors now assume the cancer is gone, and the second option might also prove worthless, the obvious choice (of the docs and Tricia) is to wait. It's been too long since her last chemo treatment to restart the remaining two treatments (not completing all six of the chemo rounds could prove to be detrimental in the future), so we'll return to Duke in about a month, hoping for some more good news.
Anyway, I hope all of this info helps to make the turn of events more clear for you. The bottom line is that the doctors are very optimistic that Tricia is now cancer free. It was surprising news to us, and I think it might take longer for this good to set in, especially considering that we will continue to be cautiously optimistic until we know for certain that the lymphoma is gone.
Thank you for your encouragement and prayer, and Thank God for providing some good news! We look forward to enjoying Tricia's health as we prepare to move into the new house and spend lots of time with family over the upcoming holidays!
BTW, I now have a cold and fever (and have been quarantined), which is why I haven't had a good chance to collect my thoughts and post until now. Thanks for your patience.