I am not a stranger to climbing mountains and now I have to climb two. The mountains are called intravenous (IV) Chemo and HIPEC. I normally enjoy climbing, but I will not enjoy these climbs at all. However I hope that when I have reached the final summit – that I can sit and enjoy the beautiful view and be very proud of my achievement. I am going to prepare well for this.

Since I’ve already been through a de-bulking where most of the cancer has been removed surgically the team at my hospital wants to next treat me with intravenous chemotherapy. I don’t know yet for how long or how often – possibly every two weeks for two to five months. We are meeting with an oncologist this week. This is primarily to treat potential metastasizing cells that might be in my lymph nodes or blood. The last CT-scan showed no visible signs of tumors in the lungs or liver so if there are metastasizing cells it is probably very few. The chemotherapy should knock them down.

The peritoneal membrane works similar to the blood brain barrier and most likely only a small concentration of the IV chemo – if any – will go to the tumors in my peritoneal cavity. That is why intravenous chemotherapy is not very efficient for tumors in that area in the body. About 20 years ago a treatment called HIPEC (hyperthermic intraperitoneal chemotherapy) was introduced and it largely improved survival rate.

The suggested next step after IV chemotherapy will be going back to the operating table. They will open me back up, remove the tumor by the diaphragm, and remove more of the right side of the colon, including the lymph nodes. They will look through every organ and pay extra attention to the rest of the peritoneal membrane to see if there are any more tumors that couldn’t be detected on the CT-scan – and remove them if there are any. This will complete the cytoreductive surgery and I’m ready for the HIPEC.

While I’m still open on the surgery table, they will pour in warm chemotherapy, close me back up, shake and massage me for 90 min so the chemo touches all nooks an crannies. They will then open me up again and remove the chemo before they patch me up. HIPEC is a tough treatment and I will be hospitalized for one to three weeks depending on how well I heal.

We have been uncertain if the order of treatments is the right one. It has been suggested that the HIPEC should be done before a potential IV chemo. We went for a second opinion at Moore’s Cancer Center at UCSD (one of the few centers that specializes in appendiceal cancer). The doctor we talked with there agreed with the doctors at my hospital. One of the reasons, and probably the most important with respect to the order of treatments, is that my peritoneal cavity is inflamed after the first surgery and it will be hard to differentiate between tumor tissue and inflamed tissue. We are meeting with a HIPEC surgeon this week and we are waiting for an evaluation from the cancer hospital in Norway as well.

Luckily I am not climbing alone. Not only do I have several doctors and nurses that want the very best for me – I also have incredible support at home from James and Benjamin – and of course my dog Chess who takes me for walks every day. And not the least, all the love and support I get from my friends and family – from the bottom of my heart: Thank you!