The Possibility

Dr. Leonard Saltz, my medical oncologist, told me quite candidly at our first meeting, on March 12, that my cancer was not curable, but was worth treating, partly because I was a "young 66." He based his diagnosis on a colonoscopy that showed a large tumor in my right colon, an MRI that showed multiple small lesions throughout both lobes of my liver, and manual examination of a hard lymph node in the region of my shoulder and neck. In other words, I had cancer of the colon that had metastasized extensively into both lobes of the liver and appeared to have metastasized further into at least one remote lymph node. 

Ordinarily, MSK would have ordered a PET scan as part of the initial fact gathering.  In light of my rapidly deteriorating condition, Dr. Saltz believed that there was little time to spare (it was his sense that I was "slipping off the table") and  recommended that I commence chemotherapy (specifically, FOLFIRI) immediately. The goal of the chemotherapy was to pull me back from the brink and then give me the possibility of some months, perhaps even a few years, of a relatively good quality of life. 

Because of the extensiveness of the lesions in my liver, it did not appear to be a candidate for resecting. Moreover, if my cancer had indeed spread to a remote lymph node, there would be no point to liver surgery, even if my liver were a good surgical candidate. Colon surgery didn't make sense at that time either, as any surgery would require an hiatus of chemotherapy. 

Over the weeks, as a consequence of the chemotherapy, I have grown steadily stronger, and the tumors have shrunk somewhat. Some three weeks ago, Dr. Saltz consulted with a liver surgeon at MSK, Dr. William Jarnagin, who opined that with a two-operation procedure, it would be possible to resect my liver. Such a procedure would of course make no sense if a PET scan confirmed the presence of cancer in locations remote from the primary tumor in the colon. 

Last Friday morning, I had the PET scan. Because it seemed like such a long shot that the PET scan would not confirm the apparent lymph node involvement, I tried over the last three weeks to deflect any glints of hope. Nevertheless, I had an increasingly hard time sleeping as I waited first for the scan and then for the results. 

This morning, about 8:30 a.m., Susan and I met with Dr. Jarnagin for the first time. He had not yet gotten the results of the scan, but he described the complex liver and colon resecting that he thought plausible in my case. The risks would be what you would expect: very bad things could happen. The goal would be some years of life, with the possibility of cure. According to Dr. Jarnagin, approximately half of those who underwent such a procedure might live for five years, and perhaps 20 percent might live for ten years, after which recurrence of the cancer would be relatively unlikely. (One must speak hypothetically, as five years ago, it is my understanding that livers like mine were not resected.)

Susan and I then proceeded to an appointment with Dr. Saltz. After not too long a wait, we met with him. He had gotten the results of the PET scan and had discussed them with the radiologist. There is no sign of cancer in parts of my body remote from the primary tumor. 

The first operation is scheduled for June 15, which will allow my body time to recover from the chemotherapy prior to surgery. In a future entry on this blog, I will go into more detail about the planned procedure. In the meantime, I thank you, my family and friends, for your steadfast support. If I have had any pretense of courage since the diagnosis of my cancer, it is a reflection of your kindness, your warmth, your prayers, your positive thoughts.