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The dilemma: Several doctors disagree about exactly what kind of tumor has appeared. The disagreement is important; if it's a small-cell tumor, tradition prohibits surgery, for a variety of reasons.
"You really don't have a diagnosis," calls out the pathologist, sparking a fusillade of opinions and suggestions.
"Can he tolerate surgery?" asks a young radiation oncologist.
"He can tolerate it," the patient's doctor declares.
The young doctor proposes a newly developed treatment that could make surgery possible, extending the patient's life significantly. "It probably wasn't being taught when you were in school," he explains impishly to no one in particular. The doctors consider this suggestion and reach a prognosis: Surgery it is. "Whack it out," prescribes the young doctor cheerfully. The team chatters briefly, smiles blooming here and there at their colleague's candor, before moving on to the next patient.
Another old man. Another heavy smoker. He has already undergone several courses of treatment, but suspicious abnormalities have now appeared in both the abdomen and the lung, and a barium enema has revealed a tumor in or near the prostate. "I wasn't sure what to do," his doctor admits.
The team studies images that appear on the computers, which are linked to an overhead screen. Tumors are clearly visible, and a radiologist uses an NFL-style pointer to circle them, à la John Madden.
One of the oncologists: "There is a big lung lesion, and a secondary in the colon. I think it's two separateprimaries."
"You think he's been skunked already?" asks another oncologist. If the man has two separate tumors, he is likely to die no matter what medical resources are brought to bear.
"The management is hard," admits the doctor, adding after a pause, "The big cancer is not going to be cured."
The men and women in the room consider the problem for no more than a minute, all of them staring at the screens. They agree: The man will be treated only to provide comfort. "Another disappointment," says the doctor.
As the meeting breaks up, Abel, Seigel, and Gutierrez gather in a corner. The men are animated, excited. Although none of the patients reviewed today will enter the cancer-vaccine trials and one is beyond help, the Telesynergy Center and the team are ready.
Exactly nine days later, September 28, the trio huddles again following a similar midday meeting. In the intervening days, Temi Linzner got her CAT scan. The Rituxan has worked but not entirely: The battle isn't over. "There is less effusion, still some manifestation," Abel says -- then explains that this means the tumor has shrunk but is still there. "But this [treatment] has definitely helped her. She has a nice prognosis."
Linzner is elated at first but ultimately settles into the more familiar terrain of doubt and fear. She says she's concerned about the many unknowns of her current treatment and worries that she's in for yet another spin on the physical and emotional roller coaster. "In the meantime I'm going on with life normally," she says gamely. "For this I am grateful."
And if the tumor doesn't respond better after another round of the Rituxan, she might yet enter the vaccine trials, Abel says.
For another of Abel's patients, the news on this day has not been so good. The woman learned from a CAT scan that she has cancer. "She has a five-centimeter breast cancer, which is very large," Abel says. "We're going to enroll her immediately in a trial." She will be the first of Abel's patients to enter a cancer vaccine trial, and one of the first at Holy Cross. Maybe, says the doctor, he can save her life.