Dead man walking

The consultation started with good news that wasn’t exactly news.  Surgery had been a success.  The primary tumor and all visible metastases are gone.  I am R0.  No residual tumor can be detected.  The oncologist further said that my blood was free of tumor markers.  This was not good news, just an observation.  My blood had been clean even when the tumor was proliferating in my colon.  Yet another sign that my case is a bit unusual.

The oncologist was impressed with my progress after surgery and half surprised that we were talking about chemotherapy a mere two and a half weeks after the operation.  I took this as good news, but it wasn’t.  Or maybe it was good news on a small scale while the outlook overall is still bleak.

In ten days, I will start chemotherapy.  It’s the obvious next step and the only way of getting rid of the cancer, but the oncologist was rather negative.  “Your chances of a cure are slim.  Some might say very slim.  Our primary objective should be extending the good life you have left.”  This is not what I came to hear, and it was quite a whammy to start the consultation with.  But I do appreciate honesty and bluntness.  What’s the point of ambiguity in such a situation?

There is some ambiguity because of the option of doing HIPEC (hyperthermic intraperitoneal chemotherapy).  In this procedure, heated cytostatic drugs are sloshed around the ventral cavity while the patient is anesthetized and cut open.  This can improve the therapeutic outcome in patients with cancers that metastasized directly and exclusively into the abdominal cavity, patients whose bloodstream and organs are clean.

I’m a bit confused as to why I shouldn’t benefit from HIPEC.  I seem to tick all the boxes.  Clean organs.  Clean blood.  Messy peritoneum.  But there’s more to it.  The oncologist told me my PCI (peritoneal carcinoma index) was only 10-11.  HIPEC has been shown to be beneficial only in patients with a PCI between 12 and 16.  For all others the risk of another major surgical intervention outweighs the benefits.

I haven’t read up on what the PCI is, how it is calculated and what the error bars on the reported numbers are.  It seems to me that I’m not that far away from the range where HIPEC is indicated.  How can the doctors be so confident in excluding this option?  Maybe I need a second opinion.  On the other hand, do I really want to have my gut slit open again?

Instead, we discussed two options for chemotherapy, one milder, the other one harsher.  The milder version makes it easier to undergo therapy.  The harsher one might prolong good life (but probably not total life).  Which one would you choose?

The decision was easy for me.  Prolonging good life is not interesting to me.  Dying gracefully holds no appeal.  I’m here to survive.  When the doctor said that the harsher therapy would marginally increase my slim chance of survival, I quickly chose pain.  Sign me up for half a year of misery!

Now came the delicate business of squaring chemotherapy with my traveling schedule.  I didn’t want to give the impression of wrong priorities, but I needed to squeeze the next four trips in.  I’m looking forward to every single one and will draw strength from them.  Good thing is that they’re all increments of two weeks apart.  A cycle of chemotherapy takes two weeks, with one day of infusions, two days on a portable pump, a few days of side effects, and the second week relatively painless.

The oncologist was accommodating.  He scheduled the first chemotherapy session two weeks before my next trip, with an extra week of recovery to make sure I respond well to the therapy and don’t suffer from debilitating side effects.  The second session would start right after I’m back from that trip, and so it would continue, neatly enclosing trips to Singapore in December and Thailand in January.

Maybe I do have my priorities wrong.  But if I’m a dead man walking, as they claim, I should at least walk where I enjoy it.  And if, against all odds, I do survive, I’ll have more stories to tell.