Getting into the actual consultation he did reiterate that two of my three tumors are in a very tricky spots. One being at the base of my superior vena cava blood vessel (the main vein into my heart) and the other one is right by my aorta (the main vein coming out of my heart), these are pretty important veins and if they are compromised during surgery it would bring a whole other slew of issues to deal with, including bleeding out on the table, harsh I know, but that is the reality I am facing. The other tricky part about these two are that they are not in the peritential cavity in the traditional sense that we all know, they are actually just behind which would involve cutting into additional layers of fat and tissue and going into an area that surgeons would prefer to avoid if they can. Not saying that he wouldn't do it if he needed to but just a place to avoid if possible. We have always know that these two were in tricky spots and could be an issue when talking about surgery. Basically, we are at the point of weighing the positives vs. the negatives of this type of surgery. I know that the ultimate goal of this fight is to rid my body of cancer but considering my three tiny tumors are stable and being managed with chemo right now I am in a very good place with this cancer, most people deal with hundreds of tumors right off the bat and can't say they are in a good place. I know that sounds weird to most but in my case it could be a whole lot worse!!
The plan right now is to present my case to the tumor board next Wednesday, which is where a whole group of oncologists (medical, surgical and radiation) along with pathologists get together to discuss cancer patients and their cases to figure out next steps. The possible next step(s) for me are any of the following:
1. Traditional debulking surgery (removal of the lymph nodes with the tumors)
2. Traditional debulking surgery with the HIPEC procedure (removal of the lymph nodes with the tumors then having warm, high concentrated liquid chemo poured into my abdominal cavity for 90 minutes on the operating table, then drained - this is to kill any possible microscopic, rouge cells that are in the abdomen)
3. Traditional debulking then some type of abdominal radiation (either full or targeted to the specific tumor sites)
4. Traditional debulking, the HIPEC procedure, then some type of abdominal radiation (either full or targeted to the specific tumor sites)
5. Just abdominal radiation (either full or targeted to the specific tumor sites)
As you can see there are many different options I am facing. Going up against the tumor board will give the surgical oncologist an entire picture of what could or would happen after possible surgery before making any official decisions.
We also did discuss that surgery could compromise my "good place" status because having surgery would prevent me from possibly being on any type of chemo for a significant amount of time because of the recovery involved, and since I have responded so well to chemo this could be an issue. Also, surgery does put you in an immuno-compromised position to fight off illness and disease and this status could do more harm then good while I am recovering from a surgery in the sense that my cancer could spread or I could contract another everyday illness that would put a wrench in my next step(s). Basically, we are dealing with a situation of "if it ain't broke, don't fix it".
Cancer is a complicated disease and as you can see there is no black and white when it comes to how to fight this. I have put my full trust in my oncology team and I know with their help I will make the best decision possible for my next step(s). I wish it were easier and I could give all of you a definitive answer to what is going to happen but we are working in a situation that requires a crystal ball that we just don't have. I will keep you updated once we heard back from the tumor board next week!!