February 7, 1997

Valerie and I want to thank everyone for being concerned about Darien including all of the cards, gifts, phone calls, thoughts, etc. Please do not stop calling to ask how she is or do not hesitate to come see her; we believe that the more people that care about her, the better she will be.

Darien has liver cancer. Liver cancer in children is rare and is divided into two groups: hepatoblastoma and hepatocellular carcinoma depending on how the cancer cells look under a microscope. Hepatoblastoma is more common and appears to respond to chemotherapy better than hepatocellular carcinoma. Officially, Darien has been diagnosed with hepatocellular carcinoma; however, she has a tumor marker (something in the serum that parallels disease activity) that is elevated, but is more common with hepatoblastoma.

Approximately three-quarters of Darien's liver was removed last Thursday during a six-hour operation. The surgeon believes that he removed all of the tumor that he could visually see; however, prior to surgery, the tumor had began to "rupture". This means that at a minimum, she does have microscopic residual tumor. At this time, they do not have any evidence that the cancer is moving through her body via the blood stream; they removed a few lymph nodes near the liver and they came back negative. Also, all other bone scans and CAT scans came back negative, except for 2 spots visible on a CAT scan of her chest. These 2 spots are important, because if they are cancer, then this is positive evidence the cancer is moving through her body. The 2 spots are very small and if she were a healthy child and they weren't looking for cancer, they would not have suspected anything. The 2 spots did not show up on a normal chest x-ray. They will continue to monitor these spots to see if they get bigger or disappear.

 Darien has just begun her fight with cancer. Prior to surgery, the surgeon cautioned us about how dangerous the surgery itself was and that surviving the surgery would be no small task. Also, once they eyeballed the tumor, it could have been worse than the x-rays were telling them and she could really be in bad shape. Last Tuesday, before surgery, we were feeling pretty low. As it turned out, the tumor was pretty much contained in the liver and had only begun to attach to the diaphragm. In addition, she is recovering from surgery much quicker than they predicted. So, with the exception of the type of cancer she has, we have had lots of good news recently. We feel extremely lucky to have Darien home right now.

Darien is a home. She is able to eat anything she wants, although her appetite is fairly small. She can walk up the stairs on her own and is not on any pain medication. She even went to school this afternoon to see her classmates. On Monday, Darien will go back to the hospital in Temple for more x-rays and blood tests. The surgeon will decide if she has recovered enough to begin chemotherapy. If she has, she will have minor surgery to install a port on her chest for easy IV access. Then, she will begin chemotherapy. Her chemotherapy will consist of giving her drugs over a 2 to 3 day period. They are going to rotate different kinds of drugs, but they will be administered on a 21 to 28 day cycle, depending on how Darien's blood count is doing. As long as it looks like she is responding to chemotherapy positively, they believe she will be doing this for about 1 year. In between treatments, she will be allowed to come home and go to school - depending on how she feels; however, if she gets to feeling too bad or runs a fever, she will have to go back to the hospital.

I've tried to explain everything that I know about Darien and her condition. We are confident that she will do well during the next year, but at this time we cannot predict with any certainty what our schedule will be. Valerie' s parents, who live on Lake Conroe, are available most of the time to help with Vincent and Karis, but we also know that everyone here can help as we need it.

Darien's condition is not a secret, but it is hard for Valerie and I to remember who we have talked to recently or who we have told what to. Valerie and I are glad to share any information with anyone.