― Lewis Carroll
Like Alice through the looking glass, nothing is what it seems, and everything is different than it should be.
25 months ago, had somebody told me that I would have surgery in which the entire right lobe of my liver, part of the left lobe and my gallbladder would be removed; the skin of stomach cut stem to stern, and have a hospital stay possibly verging on two weeks, I would have been horrified, frightened and completely disbelieving.
Yet, in my new world behind the mirror, this is the best news I could possibly have heard.
You are cutting out most of my liver? Thank you!
― Lewis Carroll, Alice's Adventures in Wonderland & Through the Looking-Glass
Last Monday, I went for a surgical consult to the UCSF Helen Diller Cancer Center. My metastatic tumors, all three of them, are confined to my liver; such confinement is rare in Metastatic Breast Cancer World since cancer cells like to take up residence everywhere. By the time mets are found, it is usually in several organs and/or bone. When it's in the liver, it's usually all over the liver. In fact, for the statistic lovers among you, near as I can tell, only 5% of women have mets limited the way I have, and that is referred to as Oligometastatic.
Combine my limited disease with my wonderful, smart, and up-to-date oncologist, who is definitely ahead of the cancer curve, and I have been offered the chance to remove this cancer; a chance it appears that very few women get.
Why is that? Among oncologists, metastatic breast cancer is considered a systemic disease and it's always been believed that surgery does no good because the cells are everywhere and will pop up like mushrooms somewhere else. New research is showing that sometimes cells may be limited and not be seeded everywhere, and surgery can help prolong life - or even be curative. Times are beginning to change, and having an oncologist on top of new thought is one of the luckiest things that has happened to me.
Right now, all I have is google and my chemo-damaged brain, but from my searches it appears that very few breast cancer patients have had liver resection surgery. The retrospective study linked above mentions 80, and I found another with 60 and another with less than that, and that seems to be it, at least that I can find online.
Rebel that I am, I will have this rare surgery.
The SF doctor I met with is as high-powered as they come. A CV (that's a fancy word for resume) a mile long, an MD and PhD, a cancer researcher with dozens of published papers to his name. My oncologist described him as aggressive, which is exactly what I want. My oncologist also described me to him - as aggressive. Which is exactly what I am. An appointment was set for last Monday, so I took the day off and headed toward San Francisco.
It was a beautiful sunny day as my husband and I drove the 90 miles to The City. The cancer center had valet parking, thank goodness. Looking for parking in that city would give me a heart attack long before cancer gets me. We found the center easily and with a half an hour to spare before our appointment.
We were called to meet with an intern, who did a basic exam, and then we met with the doctor. I had to bring my scans on CD, and so we waited while the doctors went over it and my paperwork, than did another minor exam. (Of course, they were already familiar with me and my case and had spoken to my oncologist.)
Then I heard the wonderful words, "You are a candidate for the surgery."
He told me that they would do an open surgery and actually do a sonogram directly on my liver to find any hidden cancer. Any surprises they found, they would either cut out or do microwave ablation to kill it. They would take the entire right lobe (which has two mets), and as much of the left lobe (with one) as they can to leave me with liver function. They would also take my gall bladder because it's in the way and, he said, has no useful function. "You'll never miss it."
The liver does regenerate and that happens pretty quickly - in a month or so.
I will be in the hospital for about 7 days if all goes well, which is a bit daunting but in reality is a small price to pay for the potential for long term survival.
However, I definitely intend to buy a TV jammer. Sorry future roommate, but you will not be watching Dr. Phil, the View and the Home Shopping Network all day long. I can't heal with daytime TV on and neither can you. Like my children, I will let you have TV from 8:00 pm to 10:00 pm.
While this surgery is rarely done on breast cancer patients, the ones who have gotten it - those 200 I have found online - have changed their odds from 0% five year survival to 46% five year survival. Some have even gotten ten years, and a few from early studies are still alive.
I intend to be in that group.
I was told I needed to have some scans and that I would need a few weeks off chemo before the surgery, so I was expecting it to happen around the first of November. Shockingly, today I got the phone call that the surgery is scheduled for October 3rd.
By October 13, which is Metastatic Cancer Awareness Day, I should be home and recovered enough to not care that it's Metastatic Cancer Awareness day. It will no longer pertain to me.
By October 27th, my oldest son's 25th birthday, I should be recovered enough to nag him about giving me grandchildren - and mean it.
I feel extremely lucky. It may not work, and cancer may come back. But, I know I will have done everything possible. And, if mental determination counts for anything - this cancer is not returning.
I'm done with it. And, I'm having the miracle surgery to get it out.