[cancer] Here we go again

I met with my oncologist this morning. I have a 35 mm diameter metastatic tumor in the right lobe of my liver. We are certain this is not a repeat of the false alarm of last year because the medical imaging is corroborated by the elevated CEA levels in my bloodstream, which in turn are highly indicative of liver metastases, among other things.

The proposed course of treatment is a chemo regimen of FOLFIRI interrupted by a liver resectioning. FOLFIRI’s side effects include significant hair loss, elevated fatigue (in comparison to FOLFOX) and more extreme lower GI symptoms.

The current plan is to start chemo on Friday, May 13th, continue for four sessions on a bi-weekly schedule, then interrupt chemo to conduct the surgery, around mid-July. Around late August I will return for eight more bi-weekly chemo sessions. The purpose of the interrupted chemo schedule to ascertain through direct observation of the re-sected tissue whether the chemo course is having an effect on my cancer. If it is not effective, we will resume chemo with a different regimen.

A review of the older CTs suggests this tumor was present prior to my FOLFOX course, but evaluated at the time as a malformation of the blood vessels in the liver. This is ironic for obvious reasons, but also good news, because it means the current metastasis isn’t a post-FOLFOX metastasis. Which is to say, the FOLFOX course may well have been effective.

Also, as this is a readily accessible, single-site metastasis, we continue to view my treatment goal as an eventual full cure. My oncologist has reclassed me back to 30%/5-year survival rate, and suggests that we’re about 50/50 on achieving full cure. I’m not sure I understand how those two statistics are compatible, but that’s how she put it. I would characterize her as neither particularly optimistic nor particularly resigned.

We did discuss the value of continue treatment, and life extension versus quality of life remaining. As we’re still aiming for a full cure, and even in the event of mortality we’re talking about years, not months, we have decided to proceed with the planned treatment. She indicates I’m not a candidate for clinical trials as I have not yet exhausted the core chemotherapy regimens, and my tumor is surgically addressable.

My own emotional picture is deeply mixed in very obvious ways. I recognize that of all the bad things this could be, what we’re facing is about the least-bad. At the same time, I’m about to lose another year of my life to this. My last round of chemo came at an incredibly high cost to me personally, emotionally and professionally. I do not expect this to go any more lightly on me.

Still, I will survive.

PS – Though given this news I do not expect to make any more convention appearances this year after Norwescon, JayCon will still be occurring June 4th. Please come celebrate my life if you can.

28 thoughts on “[cancer] Here we go again

  1. Jake Kerr says:

    “Still, I survive.”

    Cancer may have stuck around to pitch another battle, but you’ll win the war.

    Oh, and fuck cancer.

  2. Alley says:

    You know what, clinical trials are often less health restrictive than what’s currently available. Remember, you always have a choice. I had a tumor on my liver as well (melanoma) and it’s gone. So there is hope 🙂 even though liver tumors are tuff cookies to crack. I did two years of a clinical trial and had no other health problems other than fatigue.

  3. Oh no. I had so wanted you to be in the clear. I will continue to focus on the fact that this one is treatable and that your oncologist thinks that a full cure is still possible.

  4. Elizabeth Stephan says:

    This is not a happy Monday. I will follow Mary Robinette’s good example and focus on the fact that there is positive news here. I hope I have the opportunity to see you at Norwescon. I definitely plan to make JayCon this year.

  5. Yasmine says:

    Just hugs and love. And hope and friendship.

    Yasmine

  6. Damn. Just… damn.

  7. Cora says:

    I’m awfully sorry to hear this. Hang in there and fuck cancer!

    1. Wicketbird says:

      What she said!

  8. Peter Sursi says:

    So sorry. Not sure I can say anything else other than I’ll be sending you good thoughts.

  9. Laurie Mann says:

    I am so sorry to hear this.

  10. Jared Smith says:

    Sorry to hear this. That’s a big fucking bummer. Can only hope for the best.

  11. Kurt says:

    Love, friendship, hope & prayers from Omaha. You WILL defeat this crap. Fact.

  12. Blake HUtchins says:

    Damn it, I’m so sorry. Like Mary Robinette, I’ll focus on the treatable aspect. Hang in there.

  13. Maria Brown says:

    I was diagnosed with stage IV Hodgkin’s when I was 16 and treatment was…well, there’s a reason I don’t watch horror movies. When the cancer came back when I was 20, I honestly wondered if it was worth it to go through another miserable year of treatment and a bone marrow transplant, especially when I was presented with a stack of papers to sign in which I promised no one in my family would sue the hospital if I died from a colorful variety of possible side effects. Well, I had my transplant, survived the miserable year, and will be celebrating 16 years cancer free this year. To be perfectly honest, I still don’t know how I did it. Yes, this is terrifying news for you, and the last thing you wanted to hear, but there is so much hope out there and people who love you and are lined up to support you. In the world of cancer research five years is a lifetime of knowledge and better therapies, and I assure you, as the mother of a beautiful little boy I was told I would never have, it IS worth it. May you be surrounded with joy and love. All my best, Maria.

  14. pelican says:

    I’m so sorry to hear this. I hope you’re surrounded by the people who love you tonight.

  15. Bonnie says:

    Oh, damn. Will keep you in my thoughts.

  16. Treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable treatable! TREATABLE.

    This how I show instead of tell that I’m going MRK’s way, ’cause I’m a writer.

  17. Jan says:

    I know you’ll fight it Jay and win but right now you need a big ((((HUG)))) Cancer sucks BIG TIME!!!

  18. So sorry Jay – Ill be sending lots of supportive vibes throughout. If you need a shoulder you know where to find me chatwise.

  19. Oh no; I’m so sorry. At least this is a “least-bad” option. In MRK’s camp!

  20. Griffin says:

    You will defeat this, just as you did last time.

  21. Well, fuck.

    But it’s certainly good news that this is a leftover met, rather than a new one. Here are my best wishes that this latest mopping-up will complete your cure.

  22. Michael Carychao says:

    You’ve got a lot of heart. I’m rooting for you.

  23. Greg says:

    Jay… Im sorry to hear this news… I had hoped you would have better news this year from your screenings. I wish you well and hope to make it to see you at Jaycon this year….

  24. Sylvia says:

    Oh, well, shit. I’m so sorry. I wish there were something I could say that didn’t sound so hollow.

  25. Jed says:

    Oh, hell. I’m really sorry to hear this. I mean, I’m glad it’s not worse, but still.

    Sympathies and hugs and best wishes for the treatment going well.

  26. Ann Cannon says:

    Jay,

    I plan on calling you later today so we can talk in person. I am not a writer but even if I was I know better than to think that any of our words are enough right now. Sometimes the hardest part of the journey is personal, inside us and most be walked both alone and together. The alone part, I honor and pray for you. The together part, well… you have many you walk it with you and I am one of them. You are loved, period. And, well I am still one of those that believes in the end love conquers all… including cancer. Love you friend. Ann

  27. Sydney says:

    All your friends will be keeping up with you and supporting you from near and far. Sending warm wishes your way.

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