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.