Fill My Head and Search My Heart.

If only I could keep worry away. The past few days have been spent in wondering how all this will play out. Just when I felt like I could finally accept the good news given to me after surgery, I am faced with a tough decision regarding adjuvant chemotherapy. Despair is the absence of hope and a lack of control over the circumstances. So, I must summon all the hope I can find and regain control over the situation. The final decision is mine after all, and I will seek the best medical counsel so that I can at least make an informed one.

Currently, there are two camps. The first advocates an aggressive approach to curing disease by undergoing an additional 4 months of high-dose chemotherapy. The problem is that this treatment regimen is not being recommended to treat known or proven disease, but as "insurance" against possible, residual disease post-surgery. This involves pumping my body full of what amounts to systemic poison since the FOLFOX4 chemo cocktail to be prescribed is full of heavy metals such as platinum. The toxicity of this chemotherapy will again completely wreck my body and suppress my immune system, making me vulnerable during the dangerous winter months and flu season. Further, I may be undergoing the chemo while totally healthy and free of disease-- there's no way to know for sure since we are talking about possible microscopic metastases only. Also, this would require that I keep the ileostomy bag for that much longer since I can't have the operation to reverse it while undergoing chemotherapy. So instead of having it for only 3 months, I would have to wear the bag for what would amount to almost 6 months. This is the aggressive approach to standard cancer care.

The second camp figures that neojuvant chemoradiation (the two months I already had prior to my operation) and the surgical re-section of my colon have completely cured me based on the clinical pathology report. The surgeon found 9 lymph nodes from the 14cm section he removed and none of them appeared to be involved, which is really good news. Following the surgery to reverse the ileostomy in a few months, I should hopefully be restored to normal function and health to enjoy a quality of life very similar to what I had prior to diagnosis of the disease. Of course this is the most desired outcome, but I really want to make an informed decision that I can live with in every sense of the word. It's a very calculated risk, but any additional chemo that I choose now may not necessarily prevent a new, primary cancer from developing in another section of my colon or elsewhere in my pelvis. So that being the case, I would rather skip the chemo and rely on annual screenings for any new signs of disease. That way, I can enjoy my restored health and be vigilant against any new threats to my health without unnecessarily subjecting my body to another round of high-dose chemo.

I have an appointment with two doctors at Seattle Cancer Care Alliance on Tuesday the 28th. SCCA is affiliated with Fred Hutchison Cancer Research Center, UW Medical Center, and Seattle Children's Hospital. They have been sent my complete medical records from Overlake Hospital and will review them in their entirety before discussing my case and my options. If there is a consensus among the doctors that I need the adjuvant chemo, and that the benefits will greatly outweigh the risks, then I will make the tough decision and do what is necessary. However, if the evidence suggests that the additional chemo will provide only marginal benefit while putting me at risk for continued illness or new disease, then I feel strongly enough about it to reject adjuvant chemo and take my chances-- which are actually in my favor.

If the clinical pathology report and staging are correct, then my chances of survival after 5 years is 91%. With the chemo, that number would only improve to 93%. While it's true that such statistics are more significant for someone in their 30s than someone in their 60s, the 2% margin is something I can forgo in order to avoid additional chemo. Unfortunately, cancer is a dark cloud we must all live under. Everyday, I still think of and say a prayer for my friends who have a family member undergoing cancer treatment (Alieke, Steve, Monica, Rebecca, Edith, Joni) and for those who lost a loved one too (Gina, Paul, my cousins). My empathy runs deep and my compassion for their plight is genuine. No one wants to be faced with this decision. There isn't really a "right" choice. So I will continue to do the research, consult with doctors, and discuss it all with my family. The only way I can decide what's right for me is to fill my head and search my heart.