Journal club

Some say your chances of surviving cancer are better when you’re educated about your disease.  You can ask the right questions and make better decisions when the doctors give you options.  I know almost nothing about colon cancer, and my understanding of the biochemistry of cancer in general is rather limited as well.  When I was presented with options by the surgeons or oncologists, I went with what they recommended, and when they weren’t forthcoming, I went with what felt right.  (Calling it “gut feeling” certainly doesn’t feel right.)

To get some background on my case and gain an understanding of where the challenges lie, I started digging into the scientific literature on colon cancer.  I want to know the therapeutic options, understand which ones are preferred under what circumstances, and find out the chances of a cure.  This is no easy task.  PubMed, the archive of biomedical literature, returns 45,400 papers matching the phrase “colon cancer”, nearly 3000 of them published this year.  “Colon cancer” + “peritoneal carcinomatosis”, a rather exclusive pair of terms, returns 160 papers.  This is still a lot, but something I can deal with.

Here’s a good reason not to read too much about your disease.  One of the first publications I picked was a short paper from the American Society of Clinical Oncology’s annual meeting reports from 2015.  It starts, “Metastatic colon cancer is generally considered incurable”.  Which patient might find this information helpful?  I don’t.  I don’t see myself as incurable, and I’m not undergoing therapy for any other reason than being cured.  Despite the blow, I continued reading and, as is often the case, my persistence paid off.  A few pages on, the authors of the article clarify that, “it is conceivable that patients with limited peritoneal disease that can be completely resected may experience a cure”.  This is something I can work with.

I already know what’s bad about my case:

• Late diagnosis.  Early cancer diagnosis goes along with a small primary tumor and lack of metastases.  Colon cancer is often caught before it occurs, when growths in the colon are still benign.  But you have to undergo screening for this.
• Peritoneal metastases.  A cancer that spreads is more difficult to treat than one that’s in one place.  The peritoneum is particularly problematic because it’s difficult for chemotherapeutic agents to reach.

Here’s what’s good about my case:

• Me.  I’m young and in good shape and ready to fight and survive.
• Colon cancer.  This is a type of cancer with generally good prospects of a cure.
• Successful cytoreduction.  The primary tumor and all visible metastases have been completely resected.  This is associated with improved survival.
• No metastases beyond the peritoneum.  All vital organs are clear.  This must be a good thing.  Metastases in lung and liver are much easier to treat than those in the peritoneum, but it must be better not to have to treat them in the first place.
• No tumor markers in the blood.  I interpret this as a limited ability of the tumor to spread.

In spite of the 5:2 score in my favor, I can believe the odds are stacked against me.  Everyone says so, and it makes sense.  But I also believe that I have a fighting chance.  Surgery was an important first step.  The next one is chemotherapy.  How to do this right is not totally clear.  The article cited above ends as vaguely as it starts clearly, by stating that “the optimal approach for patients with peritoneal carcinomatosis will remain controversial”.

One of the controversies is whether to do chemotherapy systemically, as is planned for me, or in a targeted way.  I’ve mentioned HIPEC (hyperthermic intraperitoneal chemotherapy) before.  In this rather harsh and somewhat dangerous procedure, heated anti-cancer drugs are administered directly to the peritoneum – while the patient is cut open.  I missed out on this – whether by accident, by not insisting on it or by design remains unclear.  (According to the surgeon, it didn’t make sense.)  I might yet go for a second opinion on HIPEC, but in the meantime, I’ll get the first full bucket of traditional chemo tomorrow morning.  Wish me luck.