It’s been some time since I wrote about my impending CT
scan, and what it might mean for my treatment. Teresa and I got the results of
the scan at the end of July, and now I’m about to take the next step: surgery two
days from now, Friday, August 12.
What the CT scan showed was that my tumors were no longer
shrinking. If they had continued to shrink, as they had done over the first six
months of my chemotherapy, we might have answered the question of what to do
next quite differently. But the fact that the tumors were no longer shrinking was
a sign that the next stage would be that they would begin to grow again. Even
though we don’t know when that next stage might arrive, it might well be soon,
and our oncologist made clear that she felt it would be better to undertake
this clinical trial before the tumors began to grow. That’s probably partly
because I’m stronger now than I would be then, but it’s also because the
surgery itself requires a break from chemotherapy, and it’s better to take that
break while the tumors are still in check.
Meanwhile the CT scan also showed that the cancer still seems to
be confined to my liver. They won’t know for sure if that’s so until they
actually start the surgery and look, but assuming it is so that means I’m still
eligible for this clinical trial, which is designed for cancer that is, like
mine, only in the liver.
The surgery does not remove any tumors; with my cancer that
approach, called “resection,” isn’t feasible. Instead, it makes possible a
targeted assault on the tumors by chemotherapy sent directly to the liver. The surgery
will implant a pump, about 4 inches wide, on the left side of my abdomen,
positioned if possible so as not to bump against my ribs on the top side or
against my belt on the bottom. It turns out there is room in one’s abdomen to
insert an object this big – and once it’s inserted they’ll be able to see where
it is beneath my skin, and insert a needle into it to load the chemotherapy. The pump is cleverly designed: it apparently uses my body heat to
cause freon gas in one compartment to expand, and that in turn pushes the chemo
in a second compartment out into a tube, which is connected to the artery
leading to my liver and so can deliver the chemo directly into the liver.
There's a bit more to it as well. As
part of putting all this in place they also take out my gall bladder; I gather
the gall bladder is almost as useless as the appendix, but the chemotherapy
that’s going to be hitting my liver can destroy the gall bladder inside me, and
that wouldn’t be good. They also have to do some reworking of my abdominal
blood vessels, to make sure that the only artery bringing blood to the liver is
the one that the tube from the pump is connected to; that way they can be sure
that all the blood in the liver is delivering chemotherapy with it.
Doing all this requires about three hours of surgery, and also
involves cutting through the abdominal wall – and so after the surgery itself I’ll
probably be in the hospital for a week. Then I’ll be recovering at home for
about two months, though I’m certainly hoping to be back on the computer long before
that.
Meanwhile, two
weeks after the surgery, we’ll go back to Sloan Kettering and they will load
the pump with a two-week dose of chemotherapy, and the pump will start sending
it to my liver. I gather that the drug they’ll be using, called FUDR, can be
less fun than the two I’ve been on till now, but I’m hoping that I will not
have too much trouble with it. Sloan Kettering, meanwhile, will be carefully
monitoring my liver to make sure it’s not too stressed by all this medicine
coming at it. Once this is all underway, I’ll have two weeks on this chemotherapy
and then two weeks off.
About the same time that my first pump dose is finished, and four
weeks after the surgery, they’ll restart the intravenous chemotherapy I’ve been
having up till now. Probably they’ll modify the drugs I get this way: I was
getting two, gemcitabine and cisplatin, and it looks like they’ll continue the
gemcitabine but drop the cisplatin, which is an irritant and has in fact
irritated a vein in my left arm. What the intravenous chemo does that the pump
chemo doesn’t is to reach the whole body, and therefore to guard against any
spread outside the liver. The net result is that I’ll be getting a two-punch
approach, which is exactly what I like about this trial.
Will it work? There’s no guarantee; this is, after all, a clinical
trial. But the results Sloan Kettering has gotten so far – this technique has
been used in trials for some time – are encouraging. If it works, even
imperfectly, it gets me that much more time to enjoy my life, and meanwhile
improves the odds that I’ll get to take advantage of the wave of research on
other treatments that’s now underway. And if it doesn’t work, there are other
possibilities right now as well. So I’m quite optimistic.
And that's what we'll
be involved with for the next month or two!
