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After seven rounds of chemo (four since the last scans), the chemotherapy is fighting back the lymph node tumors. I have two such tumors. These two guys are the source of all the concern. I also had a very small nodule in the lung, which they were not sure is cancerous, may actually be scar tissue, and would not be too difficult to remove if it were cancerous. That lung nodule is no longer showing up on the scan.
Since chemotherapy cannot eradicate this cancer completely, I have been pushing for more surgery. So I met with both my surgeon, Dr. Hofstetter, and my clinical oncologist, Dr. Eng, recently.
Two weeks ago I had my update CT scan and me with Dr. Hofstetter. He detailed for me what, exactly, I'm asking for with this surgery. Serious stuff it turns out. The hilar lymph nodes are wrapped around the pulmonary artery, so "scraping" it off puts the whole lung at risk. In addition, the two nodes are unfortunately one on each side. This means two complete surgeries, like I had in Jan & Mar of 2007. Painful. Lung surgery is done one lung at a time, so you can breathe with one while the surgeon deflates and works on the other. He would go in through the ribs in the back to get one side. Then I'd have to recover for a couple months and do it again on the other. Another risk is that the lymph nodes are located such that it may be necessary to remove completely the upper lobe of the given lung to get to it. I would have enough capacity to live, but one would rather keep as much lung as possible. Finally, he reminded me, that it is very unlikely this surgery will cure me completely. Given all this, Dr. Hofstetter wanted to make sure we were doing everything else possible first - in other words, keep doing chemo if it is working.
This is certainly scary stuff. Surgery is a risky path. But the way I look at it, having cancer in your body is a risky path, too.
I then met with Dr. Eng two days before thanksgiving. She had been talking with Dr. Hofstetter. Given the sobering difficulties with surgery, I was surprised how they both seemed to be treating the surgery path as viable. Because of several reasons, Dr. Eng thinks that after four more rounds, the window of opportunity for surgery will be better. And it seems like they think it might be a good option, after all. I've been asking them and other doctors about this kind of surgery and I'm finding that no one recalls going in specifically to take these lymph nodes out. The reason is that typically by the time colon cancer shows up in these lymph nodes (which is a common place for it to show up), there is cancer all over the place. In my case, everywhere where they've mopped up using five surgeries and radiation has stayed clean. These two nodes are the only signs now of the cancer. That and my youth, Dr. Eng explained, provide reasons to do the surgery.
The option to continue chemo was strengthened by the result of the CT scan. Yet again we saw dramatic success of the chemo. Four rounds ago, the largest of the two nodes was 4.7cm. Now it is less than half that. What is so remarkable about this is that I have been taking 5-fu based chemotherapy since 2003. Only half of colon cancer cases see significant response from chemotherapy at all. And those that do, it eventually becomes ineffective by a year to two years. Mine is still responsive after four-plus years. Also, the cancer, they say, is growing very slowly relative to what is normal. Is there such a thing as good cancer?
So four more rounds of FOLFIRI plus Avastin. The duration of the rounds will be 14, 21, 14, and 21 days. This gives an extra week for Christmas, and an extra week rest at the end before travel to Houston for the next scans, which are scheduled for the last week of January.
Christine has been doing as badly as we have seen. She is in much pain most of the time. My sisters and their families flew in for Thanksgiving at Mom and Dad's house here in Dallas. The night before Thanksgiving, Christine's migraine got to the dreaded level she sees about twice-a-year where the pain causes her to throw up and be at a 10 level. By morning it was completely unbearable. So while everyone shared turkey, we sat in the ER as they treated her pain with the power drugs.
Still, I give thanks at yet another "this could be my last" Thanksgiving. And I look forward to yet another "this could be my last" Christmas. Isn't that always the case, though?
When I sit and listen to the doctors wrestle with my unique case and I watch them puzzle over how to treat it, I give thanks. No one really expected me to be here at this point and that's pretty cool, I think. Here I am, continually coming back for more appointments, asking "ok, now what?" I don't feel strong - I am pushing along day by day with a just-enough strength. "The Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us with groans that words cannot express."