The final pathology came back on Mal's tumor, and it is a grade three ependymoma. That means it is a bit more aggressive than we had hoped, and will have to be dealt with through radiation. Dr. Smyth did a good job of reminding us that the long term prognosis for Mal remains the same; this is no death sentence. The most effective way to defeat an ependymoma is to fully remove it from her body, and we believe that has been done. The difference between a grade 2 and a grade 3 is how quickly it grows. Since Mal's cancer moves faster, we must stay ahead of it.
The first step is going to be to wait ten days after her ventriculostomy tube is removed, and then perform another MRI and a lumbar puncture. The doctors saw a portion of the MRI of Mal's spine that caused them some worry, and they want to see it from another angle. They think it is just a cluster of blood vessels, but they have to be sure it is not an early growth of another tumor. Additionally, they will test her cerebral-spinal fluid for cancer cells. The way the doctor put it was "we have to make sure the cow didn't get out of the barn."
Provided that Mal shows no signs of the cancer spreading, we will likely then move forward with localized radiation to Mal's head. That will minimize the negative effects on her development. She will most likely receive thirty treatments of radiation - five days a week for six weeks. This will be very rough on her, but the side effects will be necessary to ensure the tumor is dead. It will not be easy on our family either, but we will continue to draw into the vast reserves of faith, family and friends to help us get through it.
If the cancer has spread, we will have to come up with another game plan. Localized radiation will likely not be an option, and we may also look into chemotherapy. Patients with ependymomas don't necessarily do any better after chemo, but we might as well throw everything we've got at this thing to try to kill it.
Brain cancer is bullying Mal. Getting mad at it won't help. Yelling obscenities about cancer won't help. But everyone is watching. Mal will fight back. It will not be easy, but forcing a bully to leave you alone never is.