The Struggle Has Ended

Greg Hewlett passed away on January 17th after nearly eight years of battling colon cancer. While we grieve his loss, we are comforted to know that he is with his Lord.

If you would like to leave your thoughts on Greg, please see this thread.

If you would like to make a charitable donation in Greg's honor, please see this thread.

Thursday, November 30, 2006

Surprise - A lung surgery candidate

Looking at my blog, I see that I never wrote about my treatment plan. So what have I been up to? Well, I did another three rounds of chemo, only at a 21-day pace rather than 14-day pace. The 14-day was just too harsh on my body. They kept the dose the same on 5fu and irinotecan, but increased the avastin 50% to cover the 21 days.

This week, I had a CT scan as well as a new test they just started doing - a PET/CT, which is what it sounds like - a combination PET and CT. And then I met with a lung surgeon. I have had the hope for lung surgery all year. I keep being told by my clinical oncologist "maybe next time" on consulting the surgeon. But I have been getting the feeling that the possibility for surgery was slipping away and I may never even get to a position where I could even see the surgeon, much less have the surgeon agree that surgery was a good option.

Cancer treatment in a nutshell (or "why would I want surgery?")
So what fool would actually want lung surgery? Well, this one. Here is my personal simplistic way of looking at cancer treatment. There are three treatments: chemo, radiation, and surgery. Chemo is least traumatic, but typically only slows the cancer down or pushes back the line, and it eventually loses its effectiveness. Radiation can kill tumors, but not always. Also, it messes up the surrounding tissue, and you can only have a certain amount of radiation in your body. Surgery is painful and ugly, but it gets rid of the cancer, at least what was cut out. Simple as that. Many people are surprised to hear that when I woke up from my amputation for bone cancer as a teenager, my feeling was not one of panic or anger, but of relief. Losing a leg was certainly terrible, but the truth was - the cancer was finally gone. It is hard to describe to someone who has not heard the words "it's cancerous" from your doctor, just how much you want to get that stuff out at all costs. This is why the word dreaded by cancer patients is "unresectible".

So I have known all along that I needed the lung surgery. I had also prepared myself to hear the word "unresectible" today.

What I heard
I instead heard a sugeon who told me that I am a good candidate to begin having my lung tumors resected (med-lingo for "cut out"). One key reason he would say that is that it has been over three years since the primary tumor in my large intestine was removed (this is why they wouldn't consider lung surgery years earlier ). Only the primary can spawn new tumors (called metastases, or "mets"). The fact that are still "only" five mets means there is reasonable hope these are all of them or at least the majority of them. And that there may not be hundreds lurking (although that is still a possibility). Another important fact is that I am still clean of any signs of cancer elsewhere in the body. Surgeons are reluctant to put you through lung surgery if there is another tumor somewhere threatening your life. A couple other factors - my CEA is still normal (2.0) and my largest lung met after yet another three months was quite stable. So he thought now was the right time to go in and start cutting them out. He is going to start with those in my left lung (there are two, maybe three). The reason is that the left lung has the largest (1.5 cm). The other lung also has two or three nodules, but they are small enough they would be hard to locate in surgery. The funny thing is that effectively we will end up waiting for those to grow and when/if they do, then we'll get those. Reminds me of this story of Jesus.

My response
I had been preparing for some less positive messages. I had been thinking through whether I would beg and plead for the surgery if he said it was not worth it, or whether I would just trust him that "it is best". And I also thought he might still say "wait, and more chemo". What I did not expect was a cautious optimism, even confidence, on the doctor's part, along with numbers (as high as 30%) that actually show a possibility of getting rid of the disease altogether. I began immediately thinking of you all. And of my Lord who seems to be hearing our cries and answering in a way I could not have imagined. I hear many staff workers at MD Anderson joke me after seeing my history, "you've really come a long way" or "not too many people with as much experience as you". I felt some disappointment that I had not hoped more for good news. I think I have been let down so much, that I am less prone to hope. I still believe this promise in Paul's letter to the Romans, but I have also learned His "good" does not necessarily equal my personal desires. Lately I've been experiencing that it usually does not. I have often been riding on the faith in the Lord of my brothers and sisters around me. Thanks.

The surgery
Is this a difficult surgery? Yes. He says it may be more traumatic than the other major surgeries I have had. (I've had four and they were all pretty bad!) But the bottom line for me is that the doctors believe that this actually gives me the only chance for cure and at least should extend my life enough to make it "definitely" worth pursuing. They will take out enough tissue that my lung capacity will be reduced to about 95% for the rest of my life. What does that mean? That would mean that when I am at the pool, I will only be able to go about 95% of a lap underwater. Seriously though, this is not good, but it is a price I willing to pay.

They were able to schedule the surgery as early as the 14th, but I requested more time off as I am very fatigued, I'm still feeling sick from the chemo and a cold I got over thanksgiving, and I'm just plain worn out right now. So I'm taking a break and we are looking at the first week of January for me to have lung surgery on my left lung.