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man on tightrope

Thursday 16th April. D-day at the cancer clinic and hopefully this would be the day the diagnosis would be finished. Arriving at the clinic we were ushered into the corridor between the consulting rooms, populated by seated patients and fearful family members who were, like us, waiting for the guys in white coats to deliver their life shattering verdicts. Fortunately we did not have to wait too long before seeing our familiar gastroenterologist doctor. Bad news was coming….

He told us that the although the biopsy had failed to reach it’s objective of the tumor on the pancreas, the samples taken from the ulcer in the duodenum did contain malignant cancer cells. The pathology report did not confirm whether it was pancreatic or duodenum (bowel) cancer, which remained a mystery. The doc said it didn't really matter as the treatment was the same for both. The good news was that these cells could not be linked to the liver tumor and that meant I had two different types of early stage primary cancer and they could cure it with surgery, he said.

Our hopes crashed against the somber walls of his office, dissapointment reigned once again. I asked what treatment they proposed, to which he answered ‘you need to talk with the surgeon about that’ and then after I had pressed him to be more precise he said no chemotherapy. Already in a slight state of shock, I found this idea hard to swallow, surgery but no chemo?

Anyway, we met with a surgeon who explained that they could cure it with doing a “Whipple” procedure (removing the head of the pancreas, gall bladder and duodenum, then restitching the stomach to the intestines) plus 25% of the liver cut out. He proudly declared that “we are the only hospital in the Netherlands who would attempt such a procedure, and there are only three surgeons here who can perform this 6 hr major surgery”. My thoughts were desperately racing to understand it all.

He outlined the common risks of the surgery itself, the risks of complications and with intricate detail he graphically described the consistency of the pancreas to be like a piece of salmon, soft, slippery and hard to stitch correctly to the stomach walls without getting it wrong. Not very reassuring! My instinctive “NO’ response was a very faint whisper against the roar of fearful thinking and pounding of my heart.

The surgeon continued to illustrate, by pointing out images in the last CT scan, how the tumor next to the pancreas was growing toward the main vein behind the pancreas, which connects the digestion system to the liver. It had already formed an open handgrip shape poised ready to grasp this vein. We needed to act quickly because if that was allowed to happen then he would not be able to cut it out anymore, it would be too late. It was a very dramatic, scary pitch.

I asked if chemo was on the table as part of the proposed treatment, he said yes but the first step was surgery. I remembered the other doc said no, hmmm that was not consistent. The surgeon stressed the urgency so he would put me into the first available slot in his operating schedule.

So that was it, or so I thought, finally we knew I had two types of primary cancer, albeit the tumor next to the pancreas could not be defined. The surgeon had made a very convincing case regarding the tumor approaching the main vein and that I had to do this surgery, and do it fast. Later I would be reflecting on this scenario as being like the blind leading the blind, however at that time his fear driven proposal worked and made me seriously consider this surgery.