Yesterday I met with my surgical oncologist. They were uncomfortable with the whole issue of the surgery, given that last fall they took out the wrong half of my liver. We talked about this directly a little. They were apologetic, but admitted that given what we knew at the time, they would make the same decision again. They did regret not going open incision last time, as an inspection of the liver while I was in surgery would possibly have uncovered this tumor. I pointed out that while we were wrong, in my opinion it was the best decision we knew to make in the moment.
They also talked a bit about this tumor and my current situation. Their concern was providing as effective treatment as possible so we don’t have to keep coming back to these issues over and over. They are in full alignment with my medical oncologist’s treatment goals.
Fundamentally, the tumor is addressable. It’s near the surface of ‘segment 6’, so they’re planning to take much of that segment. They do not want to resect the entire lobe, as that will take too much liver tissue, though they might have opted to do so if I still had my left lobe intact. So they’ll be cutting around it, in effect, taking about 15% of my current liver mass.
This go round they are absolutely going open incision. That in turn affects my recovery time, but my surgical oncologist is very much feeling the need to do a close inspection of my entire liver with both instruments and their own hands.
They do believe this tumor predates the last chemo sequence, that what had been diagnosed as a hepangioma was in fact a tumor all along. This may or may not ever be proven, but they will look for evidence of that during pathology.
As I already understood, they view this as good news, the significance being that the presence of this tumor is not evidence that the FOLFOX-Avastin sequence failed. Even so, we still are going to do FOLFIRI because of the possibility that this tumor has in turn shed further groups of ‘seed’ cells.
My surgical oncologist expressed concern about my weight and my fat intake with respect to FOLFIRI, as the irinotecan component of FOLFIRI can cause liver damage, through chemotherapy induced hepatic steatosis. They want me to go on a very low carb diet, cutting out simple sugars, baked goods and so forth. Essentially, Adkins. They do not want me to go all the way to a ketogenic diet.
We are going to follow my medical oncologist’s 4/cut/8 plan of four chemotherapy sessions, the surgery, then eight more chemotherapy sessions. With new appointments made, this now looks as follows:
Tuesday May 10, 2011
Port implant surgery
Thursday May 12, 2011
Pre-chemo party at DiNicola’s restaurant in SE Portland
Friday May 13, 2011
First chemo sequence
Friday May 27, 2011
Second chemo sequence
Saturday June 4, 2011
JayCon at Flying Pie on SE Stark
Friday June 10, 2011
Third chemo sequence
Friday June 24, 2011
Fourth chemo sequence
Tuesday July 19, 2011
Liver resectioning surgery with 4-6 day hospital stay
Chemo will resume again in late August, possibly Friday, August 26.
Additionally I may try to go to ReaderCon right before the surgery, and am definitely going to Renovation August 17 to 21.