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[Cancer]

[cancer] A visit with the oncologist

Had another doctor’s appointment Friday, came with. Oncologist this time; a smart, capable doctor just a few years older than me. She walked through the facts of my case, and the ambiguities. Though her emphasis was quite different from my surgeon’s, all the underlying issues were identical. She did show us the CT and PET scans on a monitor, including the relatively prominent liver hotspot.

The oncologist had a fabulous Marcus Welby thing going on — very understated, comforting, comfortable. This contrasts with my surgeon’s rather earnest bluntness, which I think I prefer. But the facts still remain about the irregularities in the lymph, the lung spot, and the liver spots. She doesn’t seem very concerned about the lung, focusing on the alternate explanations for the lung spot.

Unlike my surgeon, the oncologist is not fully confident that we’re going to chemo (and she is the oncologist), but she also didn’t have any alternate theories to cancer for what was going on in my liver. She said, well maybe it’s just a structural feature. I pointed out it wasn’t on last year’s scans, and she acknowledged that.

We also discussed chemo at some length. I would have FOLFOX in two three month courses with a break in the middle for imaging. I’d also be on regular imaging as a long term followup, for some years at a minimum. There’s another drug in the mix, Avastin, that impairs the growth of blood cells in tumors. ETA: advises I have my medication notes mixed up, that the cold side effect is from the oxaliplatin component of the FOLFOX: it has the odd side effect of making the patient radically cold-sensitive. As she said, don’t put your hands in the freezer or drink anything chilled.

The oncologist did say that any appearance of cancer after a surgical resection triggers chemo, that we don’t have to prove it’s in the lymph via tumor detection to do that.

She very strongly prefers to wait and re-image in order to look at growth on the liver and lungs, and re-check the lymph. She felt four months might be better, but two months would be acceptable. I asked what other tests would be appropriate, and this is where the one significant new element emerged. She said an MRI would allow us to evaluate the liver differently, and might reveal new information either confirming cancer or making it less likely.

So I have an MRI the morning of on Thursday, 6/25 before and I light out for Iron Springs. The oncologist will contact me after the MRI to discuss the results, and we’ll either go to a mid-July CT scan from that, or if we’ve confirmed the cancer, we’re go to a consult and map out the treatment plans. If I can humanly manage it, I’m going to take the MRI scans with me to the second opinion on 6/30.

We also discussed the timing and advisability of the liver re-sectioning, but she didn’t shed any new light on that. It all comes down to resolving the ambiguities about what’s going on in my liver, and to a lesser degree, my lung.

So, except for the MRI and some details about chemo, no real news. Like I said, different spin, but we’re still on the watch-and-wait plan for a little while longer.

I’ll try to write a catch up note tomorrow on my emotional journey of late.

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