The Cancer is Spreading . . . and a Decision is Made

Finally, yesterday the radiologist report was in on Monday's CT scan, and I talked with both the surgeon, Dr. M, and the oncologist, Dr. J, about the results. While I'd been waiting for the results, I'd been moving toward some decisions about further chemotherapy. There's a lot of blunt and not-so-easy-to-take information in this posting, so sit down and catch your breath before you start to read.

So, the "okay" news is that the tumor in my abdomen is almost the same size as it was two months ago, which is to say larger than we'd like, and still impinging on my "plumbing" in a number of spots. The "bad" news is that there are signs of metastases to my lungs; they are still small, but they have grown in the last two months, while I've been on this aggressive chemotherapy treatment. That fact, along with the bilirubin and CA 19-9 numbers, suggests that the cancer is doing its thing without being slowed or impacted significantly by the chemotherapy.

The biggest short-term concerns are the areas in my abdomen where the tumor is impacting the function of vital organs. I'm scheduled to have the stent to my bladder replaced next Tuesday (apparently they are good for 3 months, and then need to be replaced). Hopefully, the urologist, Dr. D, can replace the stent with one larger in diameter, to increase the flow from the kidney. The second concern is my bilirubin, which had doubled in a few weeks over the last month. (And Patty reports that I'm glowing a little yellow these days; some days I think I can see it, others I can't.) Dr. J contacted a GI specialist yesterday, who will review my file and see what kind of stent he thinks can be inserted to relieve the back-up of bile. So, I'll have two medical procedures in the next few weeks to take care of my symptoms.

All this week, I have been thinking about my scheduled chemo appointment for Friday, and about being infused again with the two drugs, Gemzar and cisplatin. And my body was revolting. It made me feel sick to imagine putting myself in a situation where I would lose another month of my not-so-long life. Because, that's what I feel about the last month. I haven't been to work in a month, but have had others cover my classes. I have graded papers and made up the final exams, which are being proctored by others on campus. And I will calculate the final grades for students, which are due next Wednesday. But this was not how I wanted the semester to end, nor how I wanted to spend the last month, mostly horizontal and feeling awful. Thinking about all of this, I had decided before talking with the oncologist that I would not do the chemo again.

After encouraging me to try another round, Dr. J suggested that I try to biologic agent, sorafenib. I had looked up the side effects the night before and they looked a lot like the ones I'd already been through; fatigue, hand-foot syndrome, loss of appetite. Dr. J says the side effects have been less intense for patients who have tried this regimen, but I said I need a break. So, we left it there. I'll deal with the medical stuff first.

Dr. M, the surgeon, who has been so forthright and helpful all along in this process, said he understood my decision to forgo further chemotherapy, and that it makes sense to balance quality and quantity of life. He explicitly said that he does not think that receiving additional treatment will extend my life at all, and he also said that, barring some unexpected medical development, he could see me around for another 6 months, give or take 3 either way. I was actually happy to hear a number at this point, since the cancer is on the move, and I wanted an honest assessment of my medical state.

As a result of all of this, Patty has made a call to hospice, to initiate contact with them and see what services they offer and when it might make sense to use them. But don't panic! I feel good today, I'm up and about, and going to have my sparse locks trimmed this afternoon, in the hope that I won't lose much more hair since I'm off the chemo.

Know that I am feeling really good about this decision. Already today, 30 days post the last double infusion, I feel my energy and appetite to be stronger, and my spirits are good because I'm allowing for the possibility that I can have a good quality of life in the time remaining. The chemo simply wasn't allowing for that. If I sound matter of fact about all of this, it's because I'm on the other side of the decision, and not feeling conflicted. I've spent a lot of time and energy processing all of this over the last 10 days, and this feels like the most life-affirming thing I can do right now. For those of you who know me and love me, this may be hard to read, but all I can say is that it feels right. Keep those prayers and good wishes coming! And yes, do balance your knowledge of the new reality with prayers for a miracle. Miracles happen!