June 7, evening

Decisions, decisions, decisions...

Heard back via email from Seattle doctor this afternoon. A bit of conflicting info as far as the scan, although his report sounds better or maybe clearer than the scan we had here. Here are his words:

"I have personally reviewed your scans. There are 3 small nodules in the right lung, and 1 small one in the left lung. They are really too small to call metastasis right now. At this point they are "indeterminate", but it is posssible they could represent colorectal mets. The liver mass is a cyst, not a metastasis. There is not that much disease visible in the abdomen. At this point I think you are a reasonable candidate for an aggressive approach to your peritoneal carcinomatosis, ie debulking/ IPHC, since there is no clear evidence of extra-peritoneal metastatic disease. If you are interested in this, then I'd like to see you back to discuss, and have you see our GI med onc to help w/ the intraperitoneal chemo." Dr. Gary Mann

So, good news is that he doesn't really see it anywhere else, at least through the scans, which makes me a 'candidate' for the surgery. "There is not that much disease visible in the abdomen." I'm not exactly sure what that means. The looming question now is, do I do it or not?

I spoke to Dr. Neville this afternoon after he also read the email, and he will be receiving the full report in a few days. Being true to his profession, (and after I pressed him a bit!) he's not leaning too far on the surgery side, though he says this is the 'cutting edge' for now in terms of this type of surgery. He's not had a patient with colorectal cancer that has gone through this surgery yet, since it's a relatively new procedure. He said he's had patients with stage 4 colorectal cancer who have done well with just the chemo.

Since the chemotherapy is systemic (goes through the whole system), it is also reaching the peritoneal cavity. On the other hand, one advantage of surgery is that they can actually see what perhaps could not be evident on the scans. If there is more disease in there, they can cut it out. As he said, this would be an aggresive approach.

I need real clarity right now! I want to make a wise decision, but there are variables on either side. I feel secure with Dr. Neville. He said there have been many advances in this area, ones that they didn't even have two years ago. If this current 'cocktail' of chemo doesn't keep it at bay, there are other ones we can try. And in another two years or more, who's to know what other advances in medicine will have been made...and maybe not such aggressive measures.

Do I just stay on the course I'm on now (6 more cycles of chemo) and hope the odds are in my favor? Or do I do everything that is available to me now while I am still relatively healthy and can handle a surgery like this, thinking that, in the long run, this will significantly increase my chances of survival? Decisions, decisions, decisions...

In any event, I am starting back up on chemo Monday. I feel much better emotionally today than I have the last few days. Thanks for holding me up in prayer!! I can feel the difference.

I welcome your thoughts and insights,

Jane