I hate cancer

Now its threatening to kill me and its really pissing me off. Why can't it just piss off already?

I met with my medical oncologist yesterday and found out all about what the results of my latest CT scan mean. It was a long, depressing meeting but at least there is some semblance of a plan now.

So far I've has about 12 CT scans over the past year but only 3 of those have been of my chest. I hand one when I was originally diagnosed in September 08, one before my colon surgery in January 09 and one a couple of weeks ago in August. When I was in the hospital last week or whenever it was, I had a CT scan that showed 2 "suspicious lesions" in my right lung. Well it turns out that there are actually 3 lesions in my right lung and one of them was actually there in the CT scan I had in January 09. The radiologist that looked at my scan in January didn't see or didn't make a note of the lesion that was in my lung at that point. But the radiologist that looked at my most recent scan saw the three lesions and looked back at my January scan and made a note that one of them was actually there in January and had grown in size from then to now. So to summarize there are 3 small (~5mm in size) lesions in my right lung.

One of my first questions about these lesions was are they actually cancerous? The lesions are too small to biopsy and without a biopsy we won't know for sure. However it is highly likely that they are metastases and going forward we will treat them as such.

I know from previous discussions with lots of my doctors that the only real possibility for a cure is the removal via surgery of all macroscopic cancer. Without surgery a cure is not possible, so obviously I was curious to know if I was a surgical candidate. My doctor said that she would talk to a thoracic surgeon, show him my file and try to get a quick first pass opinion as to if I could be a candidate. I heard back from her today that the thoracic surgeon thought I would probably be a surgical candidate. He thought he could probably do 3 wedge resections and remove the tumors without having to remove my entire right lung. Obviously that is great news and Penny and I were tremendously happy to hear that a cure is still not totally out of the question.

As with all of my cancer treatment to date, it's not just a simple case of make an appointment and cut out the nasty bits. There is still the drain in my butt to consider and the likeliness that there is still microscopic cancer floating around in me. My oncologist was keen to get on with chemotherapy in order to make sure that no more tumors form. BUT I can't go on chemo until my drain heals up since chemo affects the body's ability to heal. Also, before the thoracic surgeon will give me a definate yes on my surgical candidacy, I will need to have a PET scan. These are scanners are rare (there are only 3 or 4 in all of Alberta) and hence difficult to get an appointment on.

The ideal scenario according to my oncologist would be something like this: Thursday, get more glue in my drain and pull the drain, then wait for it to heal (maybe a week or two?), then have a PET scan, then start a 3 month cycle of intensive chemo, then have another PET scan and see the Thoracic surgeon, then have surgery. My problem with that scenario is that there are lots of moving parts and lots of potential wait times and one thing I've learned the hard way over the last year is that time is crucial. So Penny and I presented a different potential scenario that may work better, although it will be quite costly: Thursday get more glue and potentially get the drain removed, organize a PET scan immediately in Toronto or Bellingham, a week or two following the scan have my lung surgery somewhere in the US (then my drain and my lung can heal at the same time - don't forget I had my liver surgery with the drain in my butt), about 1 month following surgery when my lung and drain have healed, start chemo for 6 months. We've already looked at the US as a means of speeding things up and have leads on PET scans and hospitals. It takes about a week or 10 days to get either surgery or a PET scan using options in the US. The risk with the option that Penny and I presented is that the microscopic cancer doesn't get treated and more tumors form before I'm done healing from the surgery. I guess there are risks either way.

So, there is lots to digest and lots to think about. I suppose a lot depends on how things go with my drain on Thursday. If it goes well then I could be starting chemo soon but if not then maybe I will need to consider the US options.