When we were growing up there were a whole series of "good news/bad news" jokes going around. One I remember had Sgt Schultz of Hogan's Heroes saying to the prisoners (imagine the thick German accent as you read):

undefined "I haff ze goot news und ze bad news. Ze goot news is zat today vee haff a change of undervear. Ze bad news is zat Hut A must change viz Hut B!"  

Today's visit to the oncologist was a bit of 'good news/bad news'.

The good news is that the PET Scan did not reveal any new areas of cancer activity in Sue's body. Although the cancer is still in her bloodstream and therefore present throughout the body, it is not currently visibly active anywhere other than the liver.

The bad news is that the existing liver lesions, as well as growing in size, have also increased significantly in 'intensity' - by a factor or 4 or 5. There are numbers attached to all of this that relate to the rate of radioactive glucose metabolism, but the basic summary is that the liver lesions are active and worsening. Then again, the good news is that at this point the liver function is not at all compromised and Sue is feeling well.

In exploring the future treatment options, the oncologist is keen for us to consider an all out attack on the liver lesions while Sue is well and before they compromise the function of the liver or nearby organs. The good news is that there are a number of possible options including surgery, Radio Frequency Ablation (RFA), and Selective Internal Radiation Therapy (SIRT). The bad news is that all of these are quite specialised procedures and cannot be done in Darwin. The good news is that there are such specialists around including some in Adelaide based in Flinders Medical Centre. We expect to be heading back to Adelaide within a week or two for a consultation with a liver specialist (this is both good and bad news I guess - maybe they cancel each other out and it is just 'news'?). Whatever the ultimate recommendation as to treatment, any direct action against the liver lesions needs to occur pretty quickly.

There was further bad news. Additional pathological analysis has revealed that Sue's cancer has a BRAF Mutation V600E. I can see you all nodding wisely as if that means something to you, but let me explain anyway!

This particular mutation only occurs in only 5-10% of patients with colorectal cancer. It is much more common in melanomas and the like. It is a particularly aggressive cancer type which also does not typically respond well to currently available chemotherapy strategies in colorectal cancer patients. To quote one journal article, "it is a negative prognostic feature" - translation "if you have this mutation you have a worse likely outcome than someone who doesn't". This all begins to make sense as we look back at the rate and aggression of the the return of Sue's primary tumor in her (now missing) colon.

Any more good news? Of course! Sue is already on the other side of statistical predictions for average survival for BRAF-mutant patients - that is certainly good news. She is also currently experiencing the best level of wellness since before her diagnosis nearly 18 months ago - gotta see that as good news. Want more? OK. We are blessed with family, friends, colleagues, neighbors and blog-readers who apparently love us and care about us - we are neck-deep in supportive community. We continue to enjoy and cherish together the particular sort of intimacy and tenderness that comes as we walk this uncertain path - very good news indeed, and something we would not be quick to give up even if we had the opportunity. And we still maintain a healthy sense of humor and appreciation for the ironic, ridiculous and absurd - how good is that!?

The Bible speaks profoundly of a wife of noble character:

A wife of noble character who can find?
She is worth far more than rubies.
Her husband has full confidence in her
and lacks nothing of value.
She brings him good, not harm,
all the days of her life.

She is clothed with strength and dignity;
she can laugh at the days to come.
She speaks with wisdom,
and faithful instruction is on her tongue.

Her children arise and call her blessed;
her husband also, and he praises her:
“Many women do noble things,
but you surpass them all.”
Charm is deceptive, and beauty is fleeting;
but a woman who fears the Lord is to be praised.

Sue is such a woman, such a wife, such a mother, such a friend. We are blessed indeed.