We are officially go for HIPEC
I had a long, at least for my doctors, phone call with the surgical oncologist at Mt. Sinai this morning. They found more cancer with the laparoscopy than with the CT scan, which was expected and not a cause of concern. We're moving ahead with the HIPEC surgery, tentatively scheduled for mid June.
Which is terrifyingly, excitingly, close.
So, what is HIPEC surgery? It's a two stage procedure. The first involves opening up the abdomen and removing as much cancer as possible. This can be achieved through cutting away tumors, burning them, or removing partial or whole organs (because my cancer is thought to have started in the appendix, I won't be leaving with that organ for sure, as well as part of the large intestine near the appendix). Next, because tumors are more diffuse (or, at least, because they grow different) on the peritoneum, the surgeons will scrape the cancer cells off it. That's stage one. Two is where the HIPEC comes in. HIPEC stands for hyperthermic intraperitoneal chemotherapy, intraperitoneal means within the peritoneum, which encases the abdominal organs. Basically, after the first stage is complete, they fill your abdomen with hot (hyperthermic) chemotherapy to kill off any remaining cancer cells.
To get this far I needed to show a good reaction to chemotherapy, so that the second stage would work, and my cancer needed to be operable. Which brings us to the first potential problem. Just as the laparoscopy found cancer the CT scan wasn't capable of seeing, when they open up my abdomen, they might find a tumor that renders me inoperable. Blood vessels too important to risk cutting or organs you can't live without being affected by tumors, or significantly more cancer than they expect, are the examples given to me. I won't know if I fail out here until after I wake up after the surgery.
The surgery will last 6-10 hours, assuming it goes ahead. For this part, and this part alone, I'll have it much easier than my loved ones. I'll probably be in the hospital for a further eight days, but possibly more, depending on complications. Recovery might take as long as four months.
I have chosen to go ahead with this procedure. Honestly, I've been certain of this since September of last year. It is not a low risk procedure. I know the risks, the potential complications, that I'm going to lose organs and will need to make changes in my life because of that (an easy one is giving up alcohol, between the cancer and the chemo, my liver needs a long break). But this is the only way out. In the best case scenario, the cancer is gone forever. I don't expect that outcome, I've learned my statistics well enough for that, but the most likely case is still years without recurrence, and no recurrence means no chemotherapy.
Because I'll let you all in on a secret, I probably had two more three month rounds of chemotherapy in me before I gave up on it. I've known it since around my birthday in February, when the second of my two rounds completed. Chemotherapy is amazing life saving medication, but it would be heinous torture to administer to someone in any other situation. And my chemotherapy was palliative, not curitive, clearly I'm willing to go through a lot for a long term solution (8 months of chemotherapy and a major operation), but with a palliative treatment, you've got to look at when it isn't worth it anymore. And, if you've struggled with depression your whole life, you've got to be damned sure about it.
After recovery, like all cancer patients in remission, they'll monitor me with CT scans for signs that it's come back. In a small percentage of cases, it comes back right away. In most cases, it comes back eventually. In a small (but not as small as the first case) percentage of cases, it never comes back. If it ever does, all sensible treatment options are on the table, but for me that would probably mean going back on chemotherapy.
But that is much too far off to even consider imagining right now. I've got an apartment to ready.
From the comments
James Petrosky: I don't know where to put this, and I don't know if anyone else is going to get much from it other than a feeling of sadness, but Hank's experience matches my own quite closely, and all the advice given matches what I'd want to say, but have difficulty articulating.