Shades of Gray

I had appointments this past week with two different oncologists -- one was a second chemo oncologist here in Marin (I decided that the first chemo oncologist I met was too depressing and calloused to have as my primary, ongoing doctor -- I have officially named him Dr. Doom-and-Gloom -- and so I "fired" him and asked to see a different doctor) and the second appointment was with a radiation oncologist at UCSF for a second opinion on the radiation portion of the treatment plan. The appointments went great in the sense that both doctors completely agreed with the plan that the other UCSF doctors came up with on Tuesday -- namely, let's start killing the main Bitch ASAP and let time inform us as to what is actually going on with my liver. Both doctors were also very optimistic about my PET scan results. The both agreed that the fact that the spot on my liver did not "light up" on the PET scan is really good news. Apparently, if the primary tumor lights up (as mine did), they expect any satellite tumors to light up as well -- especially ones that are larger than .7cm (the spot on my liver is 1.4cm). So this was definitely very encouraging!! That said, they also agree that since no one knows exactly what this spot is, we cannot rule out cancer and so we will need to monitor it over time. I am beginning to realize how little in medicine is actually black and white -- UGHHH!!

So where does this leave us? Unfortunately, there is also the annoying little detail about the fact that no one has actually been able to prove that I have cancer. All of the doctors agree that they think I have cancer, but we have no proof (remember, the two biopsies were negative so everyone is basing their opinion on the ultrasound and CT scan). I like proof -- it feels very black and white to me. There is no need for gambling; no need for guessing; no need for "wait and see" when things are black and white. So I will likely go back in for another biopsy this week as well as a bone scan to make sure that some shoulder pain that I am having is just muscle aches and not something more serious. If the biopsy comes back positive, our plan is set: I would start chemo and radiation later in the week. But if the biopsy comes back benign again, I am not really sure what we will do next. Do we do another biopsy and waste more time? Do I just take a gamble and follow the doctors' instinct that this is cancer and begin treatment? Or do we do surgery to remove the tumor so that the pathologists can biopsy the entire thing to know for sure? This last options sounds ideal, except for the fact that experience has shown that patients have much better long-term success rates with stage 3 cancer if they undergo radiation and chemo before surgery. And since I am obviously aiming for "better long-term success" this seems like a dangerous option. Again, more shades of gray...

I talked with a friend the other night who recently battled neck cancer and he agreed with me that it's useless to look at statistics for my type of cancer. They are meaningless. By definition, statistics are based on other people. I have said all along that if someone can show me stats on other "38-year-old, healthy, athletic, non-smoking, non-drinking women who have incredible doctors, an amazing family, beautiful children, and a large group of supportive friends praying and supporting them who have the exact same cancer as me", I might be interested in seeing the stats. But I don't have any interest in hearing about some 75-year-old, overweight, lifetime-smoker who had this type of cancer and was treated at a tiny little town in Kansas. And the truth is, the national stats by definition lump everyone together and so I think that they are meaningless. As my friend pointed out, there are only two statistics for any particular cancer patient: either the patient will make it or she won't. So my stats are either 100% or they are 0%, which seems pretty black and white to me.