18th February 2019 - A day of consultations

The first appointment I attended was with a surgeon in one of the hospitals in London. Jane and I brought with us the CD containing the files of the CT scan as well as the results of the biopsy.

The surgeon took a look at the material for a while and then said:

“The primary tumour is quite large, around 9cm squared, but it is in principle resectable, in the sense that it can be physically removed. The real problem is represented by the metastases in the liver: if we attempted surgery now, you would not be able to be on chemotherapy for several weeks, leaving the cancer able to spread further in the body, potentially killing you quite quickly. This means that you need to start from chemo – if the therapy works and it manages to clear the metastases, then I would be happy to operate you.”

Overall the message came across as relatively encouraging, despite the big IF attached to it: chemotherapy would need to cure the liver in order for surgery to be feasible. Jane and I did not know what the probability of that happening was and the surgeon did not want to comment further, noting that this would depend in part on the actual therapy recommended by the oncologist and in part on my individual response to it.

The second appointment of the day was with the oncologist that was recommended by my gastroenterologist. This second appointment was a complete disaster.

He started off by summarising the results of the biopsy and then, speaking in an extremely cold and frank way, told me and Jane:

“The situation is very serious. Your cancer is in Stage IV with more than 20 metastases in the liver. If you do nothing, you will be dead within 2-3 months.”

“Well, interesting to hear but we are going to try to do something about it right?” was my surprised reaction.

The oncologist continued: “You basically have two options: you could opt for a chemotherapy called Gemcitabine, which will give you a median survival of around 7 months but with relatively limited side effects, or for a more aggressive therapy called Folfirinox, which is much more difficult to tolerate but it provides a longer median survival rate of approximately one year. In a nutshell, your decision should depend on whether you place more value on the quality of life or its duration.”

My response to him was quite abrupt:

“To be honest I did not expect to be faced with a choice but a recommendation. In any event, both options sound extremely grim. What about the possibility of surgery?”

The oncologist immediately replied:

“Surgery is only an option when the tumour has not left the pancreas. Unfortunately, that is not the case for you, so I’m afraid you cannot realistically hope to have surgery now or in the future. And regarding the two chemotherapy options, if you really want to know what I would do if I were in your shoes, I would probably go for Folfirinox, because you are relatively young and more likely to tolerate it than an older person would. But it is your choice in the end, of course.”

Jane and I left shortly after, feeling quite upset about the oncologist’s cold and distant attitude and almost certain that we would not go for him in the end.