Decisions

So I don't have to worry about the intussecption anymore. That's good news.

I went to see the famous and fabulous Dr. Tempero at UCSF for a second (or third?) opinion about the PET scan and what I should do about it. Dr. Tempero is confident that my cancer has come back. It doesn't suck much worse than that.

She doesn't feel that surgery is a good idea, even if it's possible (which Chang says it is not). Nor is radiation. Her take is that we should consider Gemcitabine, the adjuvant chemo drug I took after my whipple procedure, which in my case, seems to have proven track record having kept the cancer at bay for the last year. Her experience says that if people get a recurrence or metastasis following a whipple, it will normally happen very quickly following the surgery. And in my case it has been over a year since the surgery, most likely due to the Gemcitabine. So treatment moving forward should include it. The surgery is not so good because it is focused on a small targeted area and that's not how my cancer works. Radiation works similarly but additionally might damage stuff and cause future problems while not necessarily giving much benefit.

She, like Kaufman, recognizes that while I probably feel an incredible urgency to do something about this thing growing inside of me as soon as possible, it is ok to wait a while and use the next scan to finalize my decision about treatment. And there's the rub.

Kaufman took my case to the tumor board at Kaiser on Friday morning. A bunch of different specialists sit around and look at pictures of my guts. He called last night to let me know that the board had convinced him that my cancer has returned, reinforcing how badly that sucks. His group recommends radiation therapy. This would not be the very focused cyberknife, but the generally less targeted radiation. They are conflicted about whether to recommend concurrent chemo or not - it makes everything more toxic, apparently. So I am going to see the radiation oncologist in the next little bit for a consultation.

So I don't know what to do and I don't know how to make the decision. I'm not as shocked by all the tumult this time around - I always knew that it was possible that it would come back, unlike the first time around when I thought cancer could never affect me or mine. I, like everyone else on the planet, want the best chance at the best quality life for as long as possible. But where is the balance and the tipping point in the choices of treatment? I feel like I have 6 weeks to make a decision and execute it. That's my timeline and I'm sticking to it - December 1st.