Thursday, March 05, 2009

First Oncology Consult

First things first, after receiving the written copy of the pathology report, the urologist we spoke with on Friday reiterated to us that he believes we can take the "watch and wait" approach to Derek's cancer with strict monitoring through various scans and bloodwork. This was/is excellent news and certainly what we've been praying for!

Yesterday, we went to Derek's first oncology consultation. (Once a biopsy confirms cancer, it's SOP to send the patient to an oncologist.) We had some expectation of what we would hear at this appointment. The urologist we spoke with Friday was sure to prepare us, and we would have otherwise been surprised had he not done so. "Keep in mind that an oncologist is accustomed to treating cancer from a chemical perspective while urologists are more apt to take a more wholistic, big-picture approach and thus are not as quick to jump to drugs if there are other options available."

The oncologist confirmed that Derek's cancer was contained to the testicle that was removed and that all other tests showed the cancer has not metasticized. Derek is also fortunate in that his particular type of tumor produced a hormone that can be monitored with regular bloodwork. Unfortunately, non-seminomas are a bit more aggressive and thus have a higher rate of recurrance in the first 18 mos. post-op. Now, that is not to say that his type of cancer is a run-away freight-train. Not by any means. In fact, testicular cancer is one of the least-aggressive cancers. What it does mean is that of all the types of testicular cancer his is in the category most likely to recur (10% chance specifically).

According to this oncologist, we have two options. Neither one is better than the other. He was very careful to emphasize that the line of treatment is a matter of choice not of necessity. Option 1: monitor very closely for the first year at a minimum with monthly bloodwork and quarterly scans; chemo only if a recurrance is found. Option 2: take a round of proactive chemo; this leaves no doubt that any remaining abnormal cells, if any, are dead.

The oncologist's advice was to consider the chemo. But you must remember that he would rather treat the disease chemically - that's what he does. And secondly, because of the general age of the patients he sees with testicular cancer, he does not always see good success with the "watch & wait" regimen because these young men are not vigilant in keeping their follow-up appointments. So as a rule, he advises the chemo b/c he knows that is successful and it leaves no room for apathy/irresponsibility in follow-up.

Before going to yesterday's appointment, we had talked at great length about waiting vs. proactive chemo, knowing that this would be our likely pair of choices. Naturally, we believe that waiting is the better option for us. Why batter the body with chemicals when it may ultimately be completely unnecessary?? Additionally, it does not decrease the chance for successful treatment later on should there ever be a recurrance. Derek is committed to the strict regimen of testing that will encompass the next year or so. And to me, that's the only answer we need.


JanaRae said...

Thanks for keeping us updated. I'm so glad the news is as good as it seems to be. There's still more ahead of your with the follow-ups, of course, but it all still sounds like welcome answers.

And with you in Derek's picture, I don't have a worry that apathy or irresponsibility have any place there with you. (and let there be no misunderdstanding: this IS a compliment. :-) )

The Cockrells said...

Yes, I am always glad to see updates on Derek, thank you! I am thinking about you guys a lot, please know that. It sounds to me like monthly check-ups are pretty pro-active in themselves as long as you/he are vigilant about them. I am so glad things are going well on this front.

Love ya!