So today was the first day that we were able to sit down with doctors who were familiar with the type of cancer I’ve been diagnosed with.  Not only familiar… but specialize in dealing with appendiceal cancers.

First we visited Moores Cancer Center at the University of California San Diego.  Our meeting was with Dr. Baumgartner and his team.  First of all… it was just comforting to be in a room with someone who had such a vast knowledge about what was going on inside me.  That being said… there are still so many unknowns and I could tell he wanted to make sure I was aware of all the possibilities of what may occur going forward.  There wasn’t any “sugar coating” and I felt as if we discussed all the “realistic” possibilities.  Both best and worst case scenarios and all possibilities in between.  I’m sure I’ll have some more questions going forward… but we definitely got answers to anything we could think of.  To put it as simply as I’m able to.  

He thinks we go forward with a right side colon removal (a hemicollectomy in surgical terms) so that we can test the lymph nodes in my colon to ensure that the cancer has not entered my lymph system.  The removal of a part of my colon is pretty common in most colorectal cancers and shouldn’t be too life changing. During that process he will be able to get a much better look at the inside of my abdominal cavity.  What he’s looking for is any sign of more tumors inside my peritoneal (abdominal) cavity.  He says it’s likely there could be more, though nothing shows up on the CT Scan…  (CT’s just really aren’t a great resource for detecting small growths that may have started.)  If there IS more tumors… during the surgery they will go forward with a procedure called HIPEC.  You can google it… but essentially it’s where he removes all of the tumors he’s able to see and proceeds to fill my abdominal cavity with heated chemotherapy liquid.  He lets this liquid slosh around in my belly for a while (about an hour and a half)… then sucks it out and closes me up.  It is a pretty intense surgery and I would most likely be in the hospital for 7 to 10 days until my intestinal track gets moving again.  Then we wait for the pathology on my lymph nodes to come back.  (Which could take a week or two).  If my lymph nodes come back negative… then we monitor my scans and blood tests regularly for the foreseeable future.  If  the lymph nodes come back positive… then we proceed with intravenous chemotherapy.  Both of the surgeons we spoke with believe this is the appropriate plan moving forward.  Both Monica and I felt very comfortable with Dr. Baumgartner.  His presence and knowledge really helped set both of us at ease.

One big decision we’ll have to make is if they DO NOT find any further signs of tumors in my abdominal cavity.  After they remove part of my colon, if they DON’T find any more signs of tumors, they could still go forward with the HIPEC portion of the surgery.  The idea being that, though there are no signs of tumors, microscopic little cancer bastards could be floating around in there that could seed and start tumor growth later down the line.  The problem is… because appendix cancer is so rare, there is no real evidence that doing the HIPEC (without any signs of tumors) would actually reduce my chances of having a recurrence.  And while I want to stack the deck in my favor as much as possible… I just hate to go forward with such a serious procedure if there is no evidence that it will actually increase my odds.  It might mean the difference between getting to be home in less than a week with very few complications vs 2 or 3 weeks with a lot more possibilities of complications.  All without ANY evidence that it would reduce the possibility of a recurrence… I just don’t quite know yet.  

Either way… the meeting at UCSD just “felt right”.  Like this was the beginning of knowing where I’m headed.  And as crazy at it sounds… shedding some light on the path we are headed down makes all of this a bit easier.  Even if we know there will be obstacles along the way, it’s just nice to see the road.  We will most likely still consult with others (MD Anderson, OHSU etc)… But we now have a lot more confidence discussing the options.