The Emotional Roller Coaster

Today, I went with Judy to Sierra Imaging in Fresno for a follow-up CT scan. On my last study, there was an unexpected new mass in my posterior mediastinum that was treated with a low dose of radiation in the hopes that this would stimulate my immune system to control the disease. I have been looking well and feeling quite well although I have commented in the past about some indigestion.
My CT scan was completed and I went to visit the Radiologist, Glen Hananouchi, a former partner of mine, to review the results, with Judy there as well. I realize this is always a difficult spot to put him in but I have been in this position many times. We reviewed the images and saw the mediastinal mass was smaller. There were no lung or liver metastases. I left the room elated and we sat in the waiting room as I had requested a CD of the images for my records.
Shortly Glen came to get me, appearing crestfallen and I knew the news was bad. There was a totally unexpected new finding. A new lesion had appeared in my small bowel, surrounding the lumen and thickening the wall, measuring about six centimeters in length and about three and a hanf centimeters in diameter. Well, at least the feelings of indigestion were not psychosomatic. There is no doubt that this is a real abnormality and I can't imagine it is anything other than a recurrence of Merkel Cell Carcinoma. This reminds me of the carnival game "Whack-a-Mole" where as soon as you whack it, it reappears elsewhere.
Here are some images from my CT scan. The mass is in the left upper abdomen. The magnigied view shows the bowel lumen (area through which digesting food passes) in white with the wall around it.

Those images are in the coronal plane. Below are axial images.

Again, the small image shows the tumor surrounding the bowel.


So, what next. I await a callback from Dr Nghiem. I have spoken briefly with Dr Flam. I have also spoken with Dr Ed Felix, a good friend, who is well known in the field of laparoscopic surgery and who has trained as an oncologic surgeon. I wii see him on Monday. I think he can remove this tumor using laparoscopic technique, with relatively little morbidity. Hopefully this will happen in the next week or so before I develop a small bowel obstruction. After that, who knows? Chemotherapy? Watch and wait for the next mole to pop up? It may be a while before I get some answers. 
I would not have been surprised to see liver or lung metastases on this examination. In fact, I was almost expecting liver metastases to account for the indigestion. This was a shocker, and speaks to the variability of this disease.
Well, I still will not give up. If the bowel lesion is removed and is confined to the bowel, and the mediastinal lesion is not growing, maybe we can get rid of every trace of this bully for good.