My surgical oncologist and their colleague who'd also been part of my surgery described my omental and thoracic diaphragm tumors as physically discrete, locally advanced metastatic disease. This fits with my medical oncologist's comment that the metastases were probably not systemic, but rather local migration of cancer cells from the liver to adjacent tissue. In other words, things are not as dreadful as they could be. The two surgeons concurred with my medical oncologist's overall assessment that I was likely to continue to see recurrences. They did comment that the diaphragm resecting was a shallow slice out of the tissue and I shouldn't notice any difference in breathing, etc.
We talked about future surgeries. My surgical oncologist was of the opinion I was not likely to have surgery again, as the presentation of my cancer had shifted to small, scattered tumors which aren't normally amenable to surgical intervention. A comment in the surgical report about my liver being "friable" was simply an observation about my tissue quality, not a statement against future surgery. Rather, this will depend on the presentation of future rounds of metastases. They also indicated there might be future, non-surgical treatment options in parallel to systemic chemotherapy, such as TheraSpheres, but again, this would depend on the presentation.
My surgical oncologist was very supportive of me going to a major cancer center elsewhere for a second opinion. To that event, they were willing to give me a release for treatment yesterday, two weeks ahead of the usual schedule, based on the exceptional progress I've made in healing my surgical wound. Apparently, my superpower is surgical recovery.
I wish my superpower was fighting off cancer.
We also spent some time talking about the genomic testing. They did feel it was worth contacting the oncology team I'd seen at Johns Hopkins last summer to see if they were interested. (In point of fact, the Johns Hopkins team has since responded that they don't believe the university has the resources to do the analysis.) My surgical oncologist supported our plan of talking to a pathologist at my home hospital who specializes in oncological genetics, both about possible analysis options, and about the other major cancer center's request for tissue from my original tumor and earlier metastases. We also discussed the letter that needs to go out over their signature requesting the shipment of genomic data from the sequencing vendor to various destinations. Dad and I will be preparing that letter and sending it in shortly for my surgical oncologist's review and signature.
Meanwhile, Dad will be going back to the other major cancer center with my release letter to try to secure an appointment later this month. We'll travel for that, Dad, Lisa Costello and I. I won't see my surgical oncologist again unless something new crops up in future rounds of CT scans which would be relevant to them.