What am I asking for? I need an experienced oncologist’s guidance on two serious and unfortunately irreversible events I am facing. The knowledge I have gleaned over recent weeks does not appear to suffice nor does it allow me to make an INFORMED DECISION on two immediate questions.

1. Radiation therapy - As I understand this treatment it destroys the cells it is focussed on. As Cancer cells are not as robust as our normal body cells we trust that all the Cancer cells in that limited area will be destroyed and that as few as possible normal cells will be affected. In the case of my tumour it is hoped that any melanoma cells missed by the surgery will be destroyed by the radiation. Unfortunately the radiation inevitably causes tissue damage to many surrounding tissue and this in an area that has been seriously compromised by the surgery. The resulting scar tissue will further compound the body's attempts to find a way of dispersing all the fluid in the lymphatic system. Thus lymphedemas are an almost certain complication.
a. The BENEFITS of having radiation is that we may destroy any remaining melanoma cells which it is hoped will contribute to the prevention of regrowth of the lesion and limit further spread.
b. The RISKS as I see them are:
i. It could be futile attempting further spread as it has already occurred and I will be faced with random outbreaks of melanomas anyway!
ii. There is no guarantee that we can be certain of destroying all the melanoma cells particularly if the radiation is applied six weeks later.
c. When WEIGHING the BENEFITS to the RISKS the risk of impeding the normal use of my left arm and carrying a bag for the rest of my life outweighs the uncertain benefit of killing stray cancer cells that could threaten a system which is almost certainly compromised anyway?
2. With this second question I am persuaded that my immune system, which is normally strong, is containing the disease presently and could be poised to attack the cancer. Why do I say this?
a. I have my normal level of energy which is unusual for a person with aggressive cancer
b. I have no pain or discomfort. It is apparently normal for an affected lymph node to become painful.
c. The growth of the lesion under my arm has stopped. In a month (from Late August to 25thSept) it grew from the size of a pea to some 38mm across. Now, almost six weeks later, it is the same size. This has been measured accurately with ultra sound
d. I am positive that, not only has it stabilised, but that in time it will shrink. As my Surgical Consultant commented: “I know all about your type, I have met them before, you are too positive!” I am still not sure if that was intended as a compliment but I will take it as one anyway. Possibly a positive outlook is a factor in recovery! What about this surgery? Does it pass the benefit to risk scrutiny?
e. The BENEFITS I have been appraised of include:
i. Reduction in pain and discomfort.
ii. Obviating the possibility of a burst lesion when it grows further.
f. The RISKS as I understand are:
i. Damage to the nerves controlling the left arm.
ii. While it is hoped that the body will adapt to the interruption of this part of the lymphatic system it may not and then I could face lifelong problems with drainage.
iii. There is a possibility of Lymphedema apparently something not to be wished on anybody?
iiii. All or any of the above will not assist the immune system to solve the basic problem which it appears is the only hope of a reprieve?
3. I would like to know about alternative medical options. For example: “Immunepheresis”?