So, I’ve been quiet on the blogging front for the last 6 months because, frankly, life had returned to normal and I didn’t have anything exciting enough to report, aside from work on our little urban farm project.

Now I do have news, and it’s not the greatest…

I did my six monthly PET scan last week and got the results from my oncologist this morning. The scan revealed a 2.6cm tumour (SUVmax of 12.0 for any PET scan aficionados reading this i.e. little doubt it’s cancer) in my liver, close to the margin of my original liver resection. Just a reminder that my primary cancer was in the sigmoid colon, and the liver was a secondary metastatic tumour - hence my stage 4 diagnosis.

This could be interpreted as good news because it might be that some of the cancer cells escaped the initial surgery and have regrown, rather than a completely new tumour that has developed from metastatic disease. Honestly, I think it is a new metastatic growth just because I know how much of my liver they cut out the 1st time around - I’d be surprised if any cancer survived that original hack. The other good news - talking a glass half full approach - is that they didn't find cancer anywhere else - brain, bones, spine - all the common spots for metastatic colon cancer, were clear.

Meeting the liver surgeon tomorrow. Based on prior experience I assume an MRI will follow. They’ll need to decide whether the tumour is operable and if so, whether they use open or laparoscopic surgery.

Assuming surgery is possible (which is not guaranteed) we’ll need to wait for the pathology (incl gene sequencing) of the tumour to know whether I’ll need to go back on chemotherapy. There is a strong case for trying to avoid chemo to “save it up” for if / when I get more desperate. We also discussed the possibility of a clinical trial to try out some new immunotherapy treatments alongside chemo...if we go down that path.

I’ve only told a few people so far and it’s seemed more of a shock to them than it has been to me. I think this is the life of a stage 4 survivor. Unless you’re one of the ultra lucky few who don’t see a recurrence, the reality is that I’m probably going to need to keep getting new recurrences cut out of me. My strategy is just to survive long enough for some of the new potentially curative therapies - mainly immunotherapies so far - to mature.

I'd be lying if I didn't acknowledge this has shaken me. It's been nearly a year since the last surgery in my 1st line treatment. I was just building the confidence to make longer term plans, starting to settle properly back into work. It feels a bit like I've been slowly & painfully picking up a dropped deck of cards, finally getting them back in order, and someone has just grabbed them off me and thrown them up in the air again.

I did consider for a moment keeping this latest development a bit more secret, so I could try and protect the normalcy that has been returning to our lives. I also feel a strange kind of guilt inflicting depressing, 'awkward’ news on others and potentially messing people around at work. But for all sorts of reasons I just don't see secrecy working. So I'll be using this blog to post updates again and save me from constantly having to repeat myself - updating family, friends and colleagues.

The good thing is that I'm now an old hand at this cancer thing, which makes it all a little less scary. However as this is my first recurrence please bear with me while I develop the appropriate etiquette around it. Figuring out how to handle work is going to be particularly tricky. How much can I plan things? Who should I tell ? What kind of commitments can I make ? This is a tricky balance. Things could all go smoothly, in which case I don't want to disrupt my work plans too much because I'll only need a brief absence, or things could not be so smooth, in which case I shouldn't be over committing. Like I said, not sure how to handle this yet.

Here we go again.