The Man Who Didn't Give Up Even After Being Diagnosed with Cancer of Unknown Primary at 28, Part 7

June–December 2024 Cancer Center ⑥ Re-hospitalization, but a furious comeback

June
The routine was the same: antibiotics and drainage. However, there was one difference from last time.

The tumor had shrunk on the CT scan.

I hadn't been receiving treatment and the cause was unknown, but I was incredibly happy. I thought, maybe, just maybe, I could make it.

The hospitalization itself lasted two weeks, and I was able to be discharged once my CRP levels stabilized.

Although my progress was good, my attending physician suggested home nursing and house calls in anticipation of the cancer worsening.

"The Cancer Center is a place for patients undergoing cancer treatment; it is not originally a place for someone like you (there for infection treatment)." I was told.

I don't think I was completely abandoned, but it was a little sad. Cancer treatment felt infinitely far away. However, having already overcome several life-or-death situations, my spirits didn't drop, and I remained calm. I just do what I can.

Meanwhile, my physical condition had been stable since my discharge in June. The recurring infections, which I was told would last at least half a year, had stopped. My attending physician was also puzzled.

July–September
Although it was a monthly check-up, my CRP was stable and the recurring infections had stopped. My physical strength also recovered rapidly, allowing me to travel and visit my hometown.

Entering September, my inflammatory markers were within the normal range, and since the tumor was trending toward further shrinkage on CT images, I was finally told, "Let's resume treatment."

I was happy.

And just when I thought we would be restarting chemotherapy next time, I was unexpectedly proposed a tumor resection. However, it was conditional on there being no metastasis.

October
When I underwent a PET-CT to check for metastasis, there was none, even though I hadn't been able to receive treatment since April. I was surprised.

Initially, it was said that the effect of nivolumab was stagnant, but based on this, it was judged to be highly effective.

However, the tumor itself was still lighting up, so I was told it would be better to have it removed.

I was told that along with the tumor resection, there was a high possibility of a total gastrectomy due to adhesions, as well as a 2/3 resection of the pancreas and liver. It was described as a maximum-risk surgery because it involved removing three organs.

I hesitated about the resection. I thought that if I restarted chemotherapy and shrunk the tumor further before surgery, the resection area might be smaller and the aftereffects reduced.

However, there is also a possibility that the chemotherapy might become less effective during treatment, leading to metastasis and making resection impossible.

Now might be the only chance to remove it. When I was agonizing over it on the spot, my wife, who was next to me, said to me,

"Have the surgery." She's a Spartan. But the decision-making power lies with my wife. I immediately bowed my head to the attending physician and said, "Please perform the surgery."

In all seriousness, even if I could resume chemotherapy, I would still be carrying the tumor (the bomb) with me at all times. I cannot rest easy.

On the other hand, the cancer cells within the tumor might already be dead, making the removal of internal organs potentially pointless. Even if I go through the effort of surgery, I might have to live the rest of my life with severe aftereffects.

Even so, I ultimately chose to undergo surgery and accept the aftereffects. I cannot imagine how painful the aftereffects might be, but I figured that as long as I am alive, that is enough. Besides, there are plenty of people in the world who are doing well even after having internal organs removed.

Since others have overcome it, there is no reason I cannot do it too.

November
I successfully made it to the surgery, and although my entire stomach was removed, my pancreas and liver were safe. The second laparotomy was also painful, but I was able to be discharged 8 days after the surgery. I am glad I have a sturdy body.

The aftereffects of having no stomach are tough. Even with liquid food, it would take me two hours to finish a single meal. Still, I never became pessimistic. Even if I cannot eat much, I am happy enough just to be able to taste things normally.

I started meal training while recuperating at home. It happened to be the same time my second child started baby food, so I took it easy, self-deprecatingly thinking that we were doing meal training together.

December
One month after the surgery, the examination showed that no cancer cells were found in the removed tumor, stomach, or the lymph nodes around the stomach.

At this stage, there were no cancer cells in my body, and since I was no different from a healthy person, I was moved to follow-up observation.

Currently, although I am fighting the aftereffects of a total gastrectomy, I am living energetically. At one point, I couldn't even go to the bathroom on my own, and I was bedridden with pleural and abdominal effusion, but now I am living just as I did before the illness.

I am grateful for my healthy body, and I cannot thank my family enough for being my emotional support.

Looking back now, I personally think that what is important in cancer treatment is mentality and luck.

■Mentality
(1) Even if you look up cancer, it is overflowing with negative things and information lacking evidence, so do not look at it more than necessary -> Do not fear it excessively

(2) Doctors always assume the worst when they speak. Even when I was initially told that "peritoneal dissemination is clear on the CT," "life expectancy is 1-2 months," "transitioning to palliative care," or "the effect of nivolumab is plateauing," my mentality did not rot. In the end, they changed their opinion to say that nivolumab had been highly effective.

(3) (It depends on personality, but) shifting your thinking is important. Thinking about the future made me feel dark, so I focused only on that day and that moment. I tried not to think about the future as much as possible.

■Luck
(4) If the hospital I transferred to had been the National Cancer Center, I would have transitioned to palliative care and would not have been able to receive chemotherapy.

(5) Being able to meet an attending physician who decided to proceed with chemotherapy while my condition was poor.

(6) The effect of the medicine matched my constitution.

(7) I am working on treatment in tandem with my attending physician. Every time I had an outpatient visit, I conveyed my enthusiasm to resume treatment and was able to make it happen. It is very important to appeal what you want to do.

In my case, thanks to the high effectiveness of nivolumab, there was no metastasis beyond peritoneal dissemination, and I was lucky. Perhaps some of this luck was the result of approaching things as positively as possible.

I think it is important to control your mentality in a good direction in order to live with the illness for a long time. Due to the nature of the illness, it is difficult to think positively, and it is natural for your mentality to become ill, but I still want you to not forget a positive feeling.

I think it is good for mental health to have many sources of emotional support, whatever they may be.

I was told that my life expectancy was one month if I remained untreated for cancer of unknown primary, but I was able to recover this much. Cancer treatment has no clear end in sight, and there is a possibility that your efforts will not be rewarded. Without a goal like remission in sight, it takes courage to face the symptoms and side effects of cancer, and it is no wonder that people give up.

This illness is just that harsh. However, if this experience can become a driving force for treatment and emotional support, there is no greater joy. I would be happy if writing this had even a little meaning.