19th February 2019 - Decision time on the oncologist

Jane and I met the other oncologist in the morning. This time we were welcome by a kinder and warmer looking individual, who made us feel immediately more comfortable than the doctor we saw the day before.

He did not present me with options regarding possible therapies, but immediately put forward Folfirinox as the best possible strategy. He also outlined some useful statistics:

“With Folfirinox you have a 30% chance that the tumour and metastases will shrink and a 40% chance that the illness will be stabilised. In case of no response, we would need to switch to the other chemotherapy combination, which includes different drugs, implying that you may well respond to those.”

Importantly, he referred to a number of his patients, who after 2-3 years of treatment under his care were still alive and doing well. This was not at odds with the short median survival rates mentioned by the other oncologist the day before (after all, a median survival of one year does mean that 50% of patients will live longer than that), but it did have the beneficial effect of making me feel that my life would not necessarily end within just a few months.

Regarding the possibility of surgery, he was slightly more positive than the other oncologist, but he still referred to it is a very long shot, with a probability of significantly less than 5% of actually ever becoming a possibility.

Similarly to the surgeon we saw the day before, he explained that the liver would need to be completely clear of any sign of cancer. However, he added that the liver would also have to remain free of cancer for a period of months without any chemotherapy in order for surgery to be safely performed. But given how aggressive pancreatic cancer normally is, he stressed that leaving patients without any treatment for prolonged periods of time would be a highly risky strategy.

In the end, Jane and I decided that we would go with him and, to his credit, he got things moving incredibly quickly. He told us that I would need to have a port installed under the skin in my chest. This would be connected to a large vein in the neck that would deliver the chemo drugs in a fast and efficient way. He organised the relatively minor surgery required for the installation of the port for the following morning and he told me that I would be able to commence the therapy on the afternoon of the same day.

We left him thinking that we had made the right choice. But I was still quite puzzled by what he told us about the surgery option. How could there be such a difference between what we had heard from the surgeon the day before and what we were told by both oncologists?

I thought that this was an issue that I should definitely investigate further in the coming days and weeks, although the top priority now was clearly to get going with the chemo.

Tomorrow would be a big day, my body would begin a transformation with the installation of the port inside my chest and the injection of the chemo drugs, which would likely cause hair loss and other side-effects. I remember taking a photo of me in front of the bathroom mirror just before getting into bed as a way to say goodbye to my old self. Then I let the sleeping tablets do their daily job.