Bad News but Mixed Blessings

I attended my impromptu appointment at the Marsden this afternoon and the news was not good, so it is a good job that I am in the relaxed mood that I described earlier today.

I have mentioned that since finishing chemotherapy it has become harder for me to eat again and I discussed this with the oncology team on Monday.

This was fed back to the surgeon (in what seems to have been a slightly exaggerated manner) and, allied with the results of recent blood tests, it seems that the cancer is fighting back now that it has breathing space from the onslaught of chemotherapy. This is an unusual situation and shows the voracity and volatility of my cancer.

I have said in the past that when I was diagnosed I was borderline operable. First there was the worry that there was secondary cancer but also there is a significant amount of regional metastases i.e. bits of tumour outside oesophagus but not in remote parts of the body.  This was highlighted when I had the endoscopic ultrasound report and explains why I was keen to get into theatre.

As a borderline operable case it was a concern to me that chemotherapy did a good job because long term survival is only likely with complete removal of the cancer.

The aim of the chemotherapy was to shrink the tumour, hopefully get rid of some of the regional "flotsam" and generally clear some of the little bits of cancer floating around in the bloodstream.  Prevous discussions about the chemotherapy results were optimistic despite there not being any downward reclassification of the cancer.

My appointment today was with the main man on the Surgical team. Whilst the chemotherapy has been successful, to a degree, he was concerned about the results when taking into account the difficulties eating and also the tumour counts shown by the blood tests.

It will come as no surprise to some that we seem to have a "volatile fella" on our hands.  The tumour counts fell drastically during treatments and now they are rebounding drastically.

So here's the issue; if the surgeon goes ahead with the operation as per the schedule then there is a real risk that cancer could fight back significantly between the operation and the resumption of chemotherapy 10 weeks later (the body needs this time after surgery to build its strength before chemotherapy).  Also, given that the reduction in the cancer is not as much as we might have hoped for the surgeon may find it difficult to remove all of it.  It is the surgeon's job to ensure that all of visible cancer is removed and the microscopic bits are dealt with by the chemotherapy.

So, the suggestion is that we need to go back to the head oncologist and see whether further cycles of chemotherapy are considered a viable path before surgery.  We know that

• The tumour responds to chemotherapy
• The tumour must be contained in order for me to have a fighting chance of successful surgery and a good long term outlook
• I have ridden the initial cycles of chemotherapy well and am of an age where we can be aggressive in the treatment

I have been scheduled to have a meeting with the oncologist at 3pm on Monday and the outcome of this meeting will have a significant bearing upon my future.

If further chemotherapy is considered the way forward then it is likely to start next week and may be another 3 or 4 cycles before surgery.  There will also be another CT Scan to measure the growth of the tumour since the end of chemotherapy.  If we follow that route and the tumour still can't be held in abeyance then there are real problems.  Similarly, if the oncologist does not feel that additional chemotherapy is the right route then there is also trouble ahead.

So what's the good news?  The good news is that the problem has been discovered now rather than after surgery.  It is a combination of factors that have caused the surgeon to question the performance since the end of chemotherapy not least the fact that my oncology appointment was delayed due to our and the oncologist's holidays.  If I had the oncology appointment immediately after the end of chemotherapy then the eating difficulties and the tumour counts would not have been so pronounced and may have passed under the radar.  Discovering a re-ignition of the tumour after surgery would have been a hammer blow and at least that has been avoided.

Kitten was upset and described it as the worst moment since I received news of the diagnosis, which is probably true.  I have worked hard to take charge of my mental and emotional state and that has put me in a good place which, I believe, will help us approach this next phase in a more relaxed and collective way.  That means that I will be less self-absorbed.

Another curry with Sushi and Notoplip was a good instant fix and we will move forward to Monday with an open mind and hopeful that the oncologist can see a clear path forward.