Have you noticed that when you first start walking in the forest that you may stumble over branches and trip over rocks but then you begin to find your footing? And as the walk continues the trail becomes easier for you to see, even though there may be less of it visible? 

Today I started to find the trail. The visit to the oncologist helped me understand the treatment regimen. It will be FOLFOX and Avastin for 6 cycles minimum (one cycle every two weeks). FOLFOX is chemotherapy (composed of two compounds, Fluoracil and Oxaliplatin) while Avastin is an immunotherapy. I am happy with this as it means we are hitting the cancer with three separate mechanisms. The chemotherapy disrupts cell replication two ways while Avastin inhibits the growth of new blood vessels- choking off tumors.  

The goal is first to disrupt any cancer cells in the lymphatic system, while the second goal is to reduce the tumor on the diaphragm and possibly diminish or remove cancer cells that have not established.   

Efficacy of the treatments will be measured by two markers, CEA and CA125, along with a CT scan every 8 weeks. I will be getting another CT scan before I start treatment to get a baseline. If the markers or tumor decrease, then we know positively it is working. If there are no increases, it may or may not be working (small cancer cell deposits may be getting hit but the results are not measurable by the markers). However if markers or the tumor begin to increase then we will immediately either switch therapeutics and/or move directly to HIPEC. The only drawback is that it will take six weeks after stopping the Avastin before I could do a HIPEC (Avastin can inhibit recovery). 

The molecular biologist in me was also gratified to hear the appendix tumor will be DNA sequenced across a panel of genes called Strata. This will help us understand potential future therapies, as certain mutations are known to be responsive to different treatments.  

So the new step on the path begins with therapy, starting next week. I have a lot to say about that but will save it for a future post.