September 13, 2008 (Saturday)

OK, Stephanie does not want me to post the first one but I think that it is hilarious. That is Gracie with her crazy face and it was taken right before the second picture above. I am posting that picture so you can see the opaque whitish mass in her right eye. This is not the leukocoria, like the last post, but you can see the actual tumor through her pupil. This is kind of what we saw the first time. We are much better at noticing now and know when to look. The way I got a picture was to have relatively low light and have her look away from the camera when I took the picture so that I got a better angle on the tumor. I think that since the time we first saw it and now, the floating tumor has gotten bigger and thus more visible, but for sure we are more aware so see it more.

Today was a great day for Gracie! She sure did not like her shot but never seemed nauseated or run down because of her treatments. Her blood counts and energy levels should be the lowest on days 7-10 of the 28 day cycle. That puts it next Friday through Sunday next week so we shall see. Also, something that I have forgotten to mention here, Dr. P (her ophthalmologist in Houston) classifies her right eye as class D retinoblastoma and her left as class B retinoblastoma. There are a total of 5 classes (A through E) with E being the eye is unsalvageable and must be removed and class A being that the eye can be treated without chemotherapy. In the past (and in other hospitals) class D eyes have also been removed because treatments have not been very effective in killing the cancers, however Houston has the expertise to treat and possibly save that eye.

Below I am posting the classification table from an article in the Orphanet Journal of Rare Diseases volume 1 of 2006. (Orphanet J Rare Dis. 2006; 1: 31. Published online 2006 August 25. doi: 10.1186/1750-1172-1-31.)  Here is a link to the article (the classification table I have put here is table 2):  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1586012

The ABC classification

Group A: small tumors away from foveola and disc
• Tumors <3>
• Located at least 3 mm from the foveola and 1.5 mm from the optic disc
Group B: all remaining tumors confined to the retina
• All other tumors confined to the retina and not in group A
• Subretinal fluid (without subretinal seeding) <>
Group C: local subretinal fluid or vitreous seeding
• Subretinal fluid alone >3 mm and <>
• Vitreous or subretinal seeding <>
Group D: diffuse subretinal fluid or seeding
• Subretinal fluid > 6 mm from the tumor
• Vitreous or subretinal seeding > 3 mm from the tumor
Group E: presence of any one or more of these poor prognosis features
• More than 2/3 of the globe filled with tumor
• Tumor in the anterior segment or anterior to the vitreous
• Tumor in or on the ciliary body
• Iris neovascularisation
• Neovascular glaucoma
• Opaque media from hemorrhage
• Tumor necrosis with aseptic orbital celullitis
• Phthisis bulbi