The surgeon expressed his sympathy for what I'm going through. He is quite clear on believing this lesion to be metastatic colon cancer of the liver, despite the ambiguous PET result. There are several other possibilities, but he finds them all low probability. The proof of course will be in the post-operative pathology report.
We talked about the possibility of a biopsy, but in this case he's strongly in favor of going straight to a resectioning. I agree with this completely. Whatever this thing is, I want it out of me. The plan is to take about 45% of my liver out -- the left half, more or less -- via laparoscopic surgery which will leave entry wounds in various decorative places about my abdomen, including in the existing scar from my colonic resectioning of 2008. I can expect the liver to regenerate to about 95% of its original size within four weeks of the operation. The surgeon says I will feel lousy and tired for about six weeks afterwards, even with the relatively minimal surgical wounds. I pointed out that having just gotten off chemo, I was no stranger to that.
Assuming the pathology report bears out the current opinions, I'll go back on chemo 4-6 weeks after surgery. This will be another six-month course of twelve biweeky infusions, this time FOLFIRI-Avastin. We did discuss the possibility of chemo prior to surgery, but he felt that was not indicated in my case as the lesion is singular and fairly accessible.
The main variable now is the New Zealand-Australia trip. After some discussion, we all agreed that if the lesion is fairly stable in size and presentation, the surgeon is comfortable postponing the surgery until after the trip. Currently it is scheduled for 9/16. However, he did order a CT scan which was done this afternoon, to check on possible growth of the lesion. If it shows evidence of continued development, we will cancel the trip and the currently scheduled surgery and instead have surgery as soon as OR time can be secured. I hope to know on Thursday or Friday which path we're taking.
One of his more revealing remarks was his comment that cancer treatment is a process of controlling the disease over the long term. He called it "eminently manageable", given my apparent tendency to present with one tumor at a time. I remain concerned about the apparent increase in aggressiveness as this journey continues, but we treat what's in front of us.
I'll know more by the end of the week, hopefully, with respect to dates and planning. For now, suffice to say it's falling out about as my medical oncologist said it would, and as I have been expecting.