Tuesday Meetings

Pete and I met with three key doctors today at UCSF (Univ. of California San Francisco) -- the chemo oncologist, a liver oncologist, and the surgeon -- and we were incredibly impressed with all three. Unfortunately, the UCSF doctors are no closer to figuring out what the "freckle" is on my liver than the doctors in Marin and so we are still left with the same uncertain diagnosis (either stage 3 or stage 4). As you can imagine, this makes determining the right treatment protocol a complete gamble...which, as you can also imagine, is not really how I ideally want my life/death treatment plan to be determined. This is all so stressful beyond belief!

The UCSF doctors did have a slightly different take on how we should proceed, however, from what our Marin doctors proposed. Basically, their feeling is that (1) the spot on my liver is really small, (2) it's only one spot and it's in a place that would be easy to remove surgically if it were to turn out to be cancerous, (3) we need to get the main Devil Bitch out of my body as fast as possible before it starts kicking off any "spawn bitches". Therefore, they are recommending that I start radiation as quickly as possible (skipping the "systemic chemo" treatment that the doctor in Marin recommended) so that they can kill/shrink the main tumor as much as possible and zap any infected lymph nodes in the area at the same time. For good or bad, the radiation won't affect the liver spot because the radiation will be concentrated on my lower pelvis and the liver is higher up. Simultaneously, I will do a light dose of chemo to help the radiation work better. The chemo may or may not affect the liver spot -- this is the "big test" of all this, and also the part that makes me shake even as I write about it. There are basically four things that could happen in the course of chemo/radiation treatment: (1) The liver spot shrinks. This would indicate that it is for sure cancer, but would also be a good sign that the cancer is responsive to chemo. Ironically, the oncologist pointed out that they actually don't want the spot to completely disappear since it makes it harder to figure out later which part of the liver to remove -- who knew! (2) The liver spot could stay the same size. If this happens, they would feel more confident that it's not cancer, but still not 100% sure until they are able to biopsy it. (3) The spot could grow. Again, this would indicate that it's cancerous and would need to be removed ASAP. (4) More liver spots could show up. This is the most horrible scenario and the one that I need everyone to pray, pray, pray does not happen. I can't even go into detail on what this would mean, since it makes me too sad to think about. But just suffice it to say that this CANNOT HAPPEN!! This WILL NOT HAPPEN!! I absolutely have to keep believing that the spot on my liver is nothing and since it's nothing, there are no other spots that will show up.

We also discussed with the liver oncologist the idea of just lobbing off the part of my liver that has the spot, regardless of what the results show. That way, I don't ever have to worry about whether someone made a mistake and thought it was benign, when in fact it was cancer. The liver oncologist was not opposed to this idea. He said that he will do an ultrasound of my liver during my main surgery -- ultrasound technology is apparently much better than CT scan at determining the true make-up of a liver spot, but it needs to be done internally rather than from the outside to be accurate. And if he decides that the section of my liver needs to come out, I would need a second operation since they have found that doing both surgeries at the same time it just too much for the body to handle.

So assuming we go with this plan, I'd hopefully start chemo/radiation next week and it would last for 6 weeks. I would then have to wait two weeks for my body to heal before I could go in for another PET/CT scan to see what's happened with my liver spot. At that point, the doctors would figure out the next steps. One doctor shared with us that we need to think about my treatment plan in 2-month chunks -- there are just too many unknowns for them to map out the whole plan from Day 1. I can't decide if this makes it less daunting or more overwhelming for me.

The crazy, crazy, crazy thing about this whole experience is that they still have not officially PROVEN that I have cancer. Both biopsy results that they took came back "benign". And, while my lymph nodes looked enlarged in the ultrasound, our oncologist friend Michael shared that they consider lymph nodes to be "positively malignant" if they are >1cm. One of mine was .47cm and the other was .54cm. And the spot on my liver showed up in the CT scan, but not the PET scan, which is suppose to be the true test for cancer. So the only concrete evidence that is leading all the doctors to believe firmly that I have cancer are the ultrasound images of the main tumor, which clearly show that it's broken through the lining walls (benign polyps don't do this).

When I first shared the news of my diagnosis with Michael, he reassured me that it's the oncologists' job to prepare for the worst case, but it's my job to focus on the best case. I love this advice!! I love the fact that all these doctors are going to "throw the kitchen sink at me" and do everything humanly possible to kill this bitch, but at the same time, there is enough uncertainty in my case that I can continue to focus on the best case. I have to focus on the best case...the worst case is just too much to handle.