Diagnosed August 1998 after series of MRIs showed numerous small liver
tumors. Biopsy confirmed they were Carcinoid tumors.
Asymptomatic. No syndrome to speak of. Minimal flushing if at all. No diarrhea.
Started chemotherapy regimen at Johns Hopkins in Baltimore September 25, 1998,
alternating DTIC/Adriamycin and 5FU/Streptozocin for a week with three weeks off between
treatments. Had three cycles with all four meds. CT scan after first cycle showed some
shrinkage and disappearance of the more than twenty 2-cm tumors on my liver. No change in
largest 3 cm liver tumor or in a 3 cm mesentery tumor. Scans after 2nd and 3rd cycles~showed
no change -- no shrinkage, no growth.
After the third cycle in March 1999, Hopkins put me on a "wait and watch" schedule with
CT scans every three months. First scan June 14 showed basically no change.
Met with a Carcinoid specialist, Dr. Richard Warner, in New York April 8,1999 for a 2nd
opinion. He ran a series of tests, and all the findings were consistent with a functioning
Carcinoid with elevated levels. He also did a cell proliferation study that showed tumors aren't
all that aggressive. Dr. Warner's recommendation was to start me on Sandostatin with
progressive escalation up to at least 900 mcg a day before switching to LAR 30 mg. He also
recommended liver chemoembolization (CE) and after that a regimen of Sandostatin and
low-dose Interferon.
My Hopkins oncologist OK'd the Sando but said no to the CE. Didn't think it was needed
and it was too risky. Had scheduled meeting with Dr. Larry Kvols, another Carcinoid specialist
in Florida, to get a third opinion on CE, but canceled the meeting to have elective surgery in
September 1999 to remove golf ball-size tumor from ileum that had started causing abdominal
problems. Surgeon said tumor was probably the primary. His report also noted numerous small
liver tumors (so small he could not treat them with RFA), lymph node involvement in the
mesentery, and "seedlings" in the Lining of the stomach.
Since bulk of the tumor load was still in the liver, I continued to pursue CE with Hopkins
oncologist who finally relented Had two liver CEs (right lobe, then left lobe) in early 2000.
Docs said MRIs showed almost 100 percent tumor necrosis. Meanwhile, stayed on Sandostatin
LAR 30 and was on Intron A (Interferon) for a couple of months later in 2000, but stopped due to
excessive fatigue.
Tumor marker tests (5HIAA, CgA) in normal range until late summer 2001 when they
elevated. Meanwhile, late 2001 MRI showed tumors had begun growing back on liver. Dr. Jeff
Geschwind, interventional radiologist at Hopkins who had done first two CEs, recommended a
third.
Saw Dr. Warner November 13, 2001. He recommended staying on LAR 30 and beginning
low dose systemic chemotherapy using DTIC.
Elected to have the third CE (right lobe) which was done January 24, 2002. Again, MRI
showed almost 100 percent tumor necrosis. Left lobe CE scheduled March 21, 2002
canceled.
As of March 20, 2002, awaiting results of recent tumor marker tests to determine
whether to start DTIC. This is the last of the Carcinoid bio written by Bob himself