Thursday, August 13, 2009

Treatment holiday

I spoke to my oncologist yesterday. The CT scan after 8 courses shows no improvement on that after 5 courses. What does that mean? It could mean that I have residual disease that is resistant to this chemotherapy, but against this there has been no progression and the only remaining evidence for cancer is a distortion of the ileocecal valve where the presumed primary was. This distortion does not mean cancer - it could just as easily represent scar tissue from where the cancer was. The truth is that a CT scan is not sensitive enough to detect minimal residual disease. I have no systemic marker to detect smaller amounts of disease; my CEA level is in the normal range. I have no symptoms other than chemotherapy-induced ones.

Therefore the decision is that I have a treatment holiday with the presumption that my cancer is in remission. It's rather like watch and wait in CLL. We know that the cancer, while it had spread beyond the bowel into lymph nodes and peritoneal surface, was not extensive. We know that its growth rate was slow. For all we know, all traces of the cancer have gone. I have had at least 4 courses of chemo since the maximal response was achieved. It seems at this point that toxicity is outweighing benefit.

How do I feel? Certainly relieved that I don't have to go through any more chemotherapy for the time being. Anxious about the future. The oncologist is going to take my scans to show the surgeon to discuss the possibility of a second-look laparotomy and possible right hemicolectomy. That will be a difficult decision. If the last operation is a template, the post-operative course is a disincentive to further surgery.

The other option is to forget about the last 6 months and get my life back to normal, doing the things that I normally do. My daughter is getting married on October 3rd and that will provide sufficient distraction to keep me occupied.


Anonymous said...

What a dilemma! I personally feel that your cancer is in good remission. We have been praying for you and you know that helps!

I'm personally such a worrywort that I would opt for the most thorough exam possible, but you know yourself best.

The only good thing (if one can say that) about CLL is it often can be tracked with a simple blood draw.

Prayers continue for you.

Tricia said...

You certainly deserve a break from the toxicity and to get your life back. Weddings bring such joy and hope - and the timing is perfect, it is just the therapy you need. Take care of yourself and thank you for continuimg the blog throughout this long period.

Deb Light said...

Sounds like pretty good news to me.Rest enjoy your daughter's wedding then reaccess everything then.I'm sure you know better than me so do what you and your Drs. decide best!

Thoughts & Prayers,

Burke said...


I have a suggestion.

Pretend you are in your office talking to a patient who is your age and who has exactly the same physical characteristics and problems you do.

Then ask yourself what you would advise him to do.

Almost certainly you will give yourself very good advice.

Anonymous said...

Hi Terry....great that you can take a break from the chemo. I hope that any decision re further treatment or not is easier when you recover your health a little. So how are you actually feeling? Thinking of you. Karen in NZ.

Michelle said...

Good news Dr Terry!

I have you always in my thoughts and prayers!