I'm really too busy to even have a job.

Seriously, what's up with all the Garfield pictures?

Honestly, I spend most of my days emailing folks about carcinoid or researching this stuff.  It's getting a bit dizzying, especially since I have some schoolwork to do!

Anyhow, after yesterday's MRI results, I've been really scrambling to figure out what to do next.  Everything is growing, and I need to figure some things out.  I emailed The Grand Poohbah of Carcinoid and he said "spheres, PRRT, Cap/Tem, possible liver directed MIBG, systemic MIBG."

He's a man of few words, but that's because he spends all day every day emailing carcinoid patients around the world.  If I had listened to him in the first place, I might be somewhere else today.  But that's a story for another day.

The liver tumors are the ones that cause a lot of problems.  They produce the hormones that cause the flushing and diarrhea.  Here's how it works:

Carcinoid tumors can produce an excess of hormonelike substances, such as serotonin, bradykinin, histamine, and prostaglandins. Excess levels of these substances can sometimes result in a diverse set of symptoms called carcinoid syndrome.  When carcinoid tumors occur in the digestive tract, the substances they produce are released into a blood vessel that flows directly to the liver (portal vein), where enzymes destroy them. When carcinoid tumors have spread to the liver, the liver is unable to process the substances before they begin circulating throughout the body. Depending on which substances are being released by the tumors, the person will have the various symptoms of carcinoid syndrome.

So it sort of makes sense to work on the liver tumors first.  PRRT works a little bit on liver tumors, but tumors in the liver are generally larger, and the path of the PRRT is too short to effectively reach the entire tumor.  So now we have to investigate Radioembolization as a precursor to PRRT.

Here is Dr. Soulen, talking a bit about spheres/radioembolization.  It sounds super fun.  You can start at the 26:03 mark and end at the 36:08 mark when he starts talking about ablation.