7. The Oncology Appointment

February 2014. The scar from my wide local excision heals well and fast. I see the dermatologist again two weeks after the procedure. He is happy with the outcome and the healing. He confirms that the entire skin margin removed which was sent off for biopsy is 'clear', i.e. no cancer cells are present. My case has been discussed by a multi-disciplinary team, involving, besides the dermatologist, a surgeon and an oncologist and the conclusion is that I need no further treatment at this stage. However I am then referred to the oncologist for a consultation.

26 March 2014, 10am. My first ever oncology appointment. 26 March was the first appointment I could get and it works well in many ways so I book it. There is only one slight issue, the 26 is the day after my birthday and even if I have no prior experience of it I am pretty sure that going to an oncology visit with a heavy hangover cannot be a good thing.  What if the oncologist asks me how I feel? I would then have to answer: "I feel terrible with no energy and I have an awful headache; but I would not worry about it as it's definitely got to do with the vast amount of red wine I drank last night"! That would not make a good first impression. So I try to manage this issue as well as I can. I go out for dinner with my friends on March 25, and I do drink red wine but I am sensible (joking apart I always am! Well... almost always). In fact I have a lovely evening with some amazing friends, I also make a little speech about how wonderful life is (ok yes I must have had enough wine!) and I go home content. I am actually quite looking forward to meeting the oncologist the day after.

The visit goes in an excellent way as far as I am concerned. I don't get a huge amount of new information off the doctor to be honest (which I did not already know), but then again I was not expecting to learn any revolutionary information. [I need to add that over the previous weeks I have used a large percentage of my monthly Wi-Fi allowance researching melanoma, but I will talk about my experience of the pros and cos of google-diagnosis in a different post]. Unfortunately I was not taking written notes at the time (like I do now) for my records, however this is pretty much what I was told: 

• Based on the thickness of the mm removed from my back, historical data suggests that I have approximatley 80% probability of 10-year survival. That is to say that, based on historical sample of patients, 8 out of 10 patients who had a skin tumour similar to mine were still alive after 10 years; 2 out of 10 developed metastases and died from the disease. 
• However, these rates don't allow for the very recent and encouraging advances in treatments, so these can be seen as conservative estimates. (At the bottom of the page are the melanoma survival rates for each stage as they are reported on www.cancer.org.)
• I need to be vigilant. Check for any swelling in the areas where most lymph nodes are (neck, armpits, groin), as lymph nodes are where mm usually spreads first. Report to my doctor any symptoms like cough, sore throat or headaches which do not disappear within a couple of weeks. At the same time I don't have to become over paranoid (more easily said than done as I would realise in the future), as I will get headaches and cough occasionally, like people do, and must not always panic that it may be cancer related.
• I need to tell to my first degree relatives that they have a slightly increased risk of developing skin cancer and they should be vigilant too. 
• If all goes well and my melanoma cancer does not progress I don't need to see him again (sadly I would see him several more times over the coming months). 

I tell him that I am optimistic, that I can only go through life like I have always done, with an open heart, with the smile on my face, embracing everything that life throws at me, making the most of everything that I have the luck to enjoy. I have always adopted this approach and I will do it ten times more now. Whilst I will adopt an healthy life-style, I will not constantly worry about the disease coming back as in the end we never know what life has in store for us, so there is no point in worrying in advance about things we cannot control.  He tells me that I am totally right in my approach and that he could not have expressed it himself in a better way than I did.

I leave the oncology clinic and I have mixed feeling; never have I felt so fragile and yet so strong, so mortal and yet so alive.

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Survival rates for melanoma skin cancer by stage

Source: www.cancer.org

It is important to note:

• Improvements in treatment since the statistics were compiled may result in a more favourable outlook for people being diagnosed now.
• Survival rates are based on previous outcomes of large numbers of people who had melanoma, however they cannot predict what will happen in any particular case.

Stage IA: The 5-year survival rate is around 97%. The 10-year survival is around 95%.

Stage IB: The 5-year survival rate is around 92%. The 10-year survival is around 86%.  [this was my prognosis at March 2014]

Stage IIA: The 5-year survival rate is around 81%. The 10-year survival is around 67%. 

Stage IIB: The 5-year survival rate is around 70%. The 10-year survival is around 57%.

Stage IIC: The 5-year survival rate is around 53%. The 10-year survival is around 40%. 

Stage IIIA: The 5-year survival rate is around 78%. The 10-year survival is around 68%.* 

Stage IIIB: The 5-year survival rate is around 59%. The 10-year survival is around 43%. [this was my prognosis at July 2014]

Stage IIIC: The 5-year survival rate is around 40%. The 10-year survival is around 24%.

Stage IV: The 5-year survival rate is about 15% to 20%. The 10-year survival is about 10% to 15%. 
[this is my prognosis after progressing to stage 4 in November 2014]

*The survival rate is higher for stage IIIA cancers than for some stage II cancers. This is likely because the main (primary) tumour is often less advanced for IIIA cancers, although this is not clear.