Valley of the shadow of clinical oncology

If one was intent on finding the sunny side of stage IV melanoma, I may have found it today. My cancer is incurable, but it’s not hopeless. Above all, God is in control of what happens to me and I trust in his plan for my life. Yea, though I walk through the valley of the shadow of clinical oncology, I will fear no evil. Medicine is but one expression of God’s power and might.

My appointment today with the surgeons at OHSU went about as well as such things can. The docs were competent and decisive. They reminded me that I am fortunate to have metastases in only soft tissue and not in my vital organs. As I’ve learned, melanoma is notoriously variable in its pattern of spread, which confounds the ability of doctors to make a prognosis they’ll actually stand by. Late stages of this disease have a vast number of genetic alterations, which confers what pathologists call a “proliferative advantage” to the cancer cells. In other words, melanoma is a disease that does what it damn well pleases. That said, there are strategies that remain open to me.

For anyone who actually cares about this cancer staging business, I am technically stage IVa. I was previously stage IIIc. So my survival odds really haven’t changed much. I am where I was a couple of months ago, give or take a few million cancer cells. Because of having “only” soft tissue mets, my disease remains resectable. As I have learned from my oncologists this week, my body should have an antitumor response from surgery; removing the two nodules is essentially a form of immunotherapy (like the interferon I took in ’08). Resection reduces the tumor burden and thereby eliminates a source of immunosuppression. It levels the playing field, in a manner of speaking, between melanoma and my immune system and at least buys me some time.

My surgery will be performed on an outpatient basis on Feb. 5 at OHSU. My surgical oncologist is the redoubtable Dr. John Vetto, who has done both of my two previous surgeries. Joining him will be Dr. Ken Lee, a plastic surgeon who apparently knows a good candidate for a facelift when he sees it. The nodule in my leg is superficial and its removal shouldn’t be complicated. Cleaning up the fragments of the met removed two weeks ago from my left cheek calls for a little more creativity. Skin and tissue the size of a quarter will be excised, and surrounding skin then stretched over the wound. The side of my face will be swollen and bruised for a while, and a scar may persist. Lee is the director of dermatologic surgery, so it appears I'll be in good hands.

The medical decision-making has been breathtakingly swift since the facial nodule came out two weeks ago. I’m hoping I can slow down now and consider this new world I inhabit. In addition to everything else it does, cancer focuses the mind wonderfully.