April 7th, 2010

Paging Captain Morgan...

I wrote a post here recently in which I stated that I wasn't particularly worried about what was going to come next with my cancer treatment, whether that turned out to be surgery or high-dose chemotherapy (HDC). What a difference a week makes – this evening I'm more apprehensive about (read: frightened by) the whole thing than I've been since before my biopsy results came back, and for the same reason – we're wandering off what I thought was a reasonably clear path, back into the unknown.

Since the last scan, nearly all of my conversations had been with the oncologist – the fellow in charge of my chemotherapy. He'd made it pretty clear that while upping the ante to HDC was an option, in both his opinion and that of other oncos with whom he'd consulted (including *the* expert on testicular cancer, one Dr. Einhorn), it wasn't right for me. It was lengthy, risky, expensive, unpleasant, and not even guaranteed to leave me cancer-free. HCE, I was told authoritatively, would not be the relatively painless chemo experience I've had 'til now. My cancer was tidily all concentrated in one little lump (in, admittedly, a somewhat inconvenient location), and thus clearly the best way to deal with it was surgery. In, out, done. Definitively.

Yesterday, the onco's office called and asked me to come in. I'd thought we'd pretty much covered things on the phone and that my next step was planning preliminary tests with the surgeon.

Turns out the surgeon, looking at the same scans and test results as the oncologist, saw things a bit differently. Surgery to remove that tidy little lump would, in fact, probably be quite messy. It might require “resectioning” and/or outright removal of not just the aorta and vena cava, but potentially other bits of internal plumbing right up to one or both kidneys. It'd be lengthy, risky, expensive, unpleasant, and not even guaranteed to leave me cancer-free. No, clearly the best way to deal with this was chemo. In fact the surgeon, after consultation with *his* peers, declined to attempt the surgery at all (though he was happy to provide several names if I wished to seek a second opinion).

Which leaves me, the average Joe without so much as a CPR certification, trying to figure out which treatment is the one for me. I have two highly-trained medical experts (who had previously been in agreement on my treatment), both telling me that all of their considerable experience and knowledge says I'm now best served undergoing the *other* guy's awful maybe-cure, because *theirs* is worse.

Googling for HDC information is returning articles like “TI-CE High-Dose Chemotherapy for Patients With Previously Treated Germ Cell Tumors: Results and Prognostic Factor Analysis”. I don't have the slightest idea how to phrase a Google search for the surgery option, and I'd probably understand even less of those results than the chemo ones. I've even found one article quoting the aforementioned Dr. Einhorn, on how HDC can succeed as “second-line therapy” for testicular cancer – but apparently not in my specific case. Some articles are encouraging about the possibilities (~70% cure, no fatalities), others not so much (50% survival).

To further complicate matters, since the local surgeon has declined, pursuing the surgical option is likely to involve travel – Texas, New York, and Indiana (home of Dr. Einhorn) are apparently where to look for the necessary specialized surgical skills. Despite the fact that there's almost nothing useful to gain from a physical exam at this point, my onco was less than optomistic about any surgeons being willing to even provisionally commit based solely on my scans/tests. Assuming that a surgeon was willing to talk with me, I'd probably be looking at multiple trips as well as a long-distance hospital stay. So far, my treatment hasn't involved too much in the way of up-front costs, but travel expenses would change that.

Now my onco is polling surgeons in Indiana to see if the surgical option really is still an option. I expect a call from him Monday, if not sooner, at which time a decision will need to be made. It may just end up being HDC by default, at least removing the burden of choice.

For tonight, I'm done with doctors. I'll be consulting with Captain Morgan.