ALICIA'S STORY

It all started with some pigs in a blanket.

I sat across from my oncologist, Dr. Thierry Jahan, as he spoke. We -- my dad; my surrogate mom, Sally; and I -- had just found out that my cancer had, once again, grown "just a little" in my right glute and both lungs.

No surprise to me. This kind of increase had been showing up on scans for a year and a half, ever since the spring of 2005, when I learned I have alveolar soft part sarcoma, a rare cancer that is slow growing but very difficult to treat.

After meeting with several UCSF doctors -- and even flying to Houston for a second opinion -- I had ended up on interferon, a drug meant to slow or stop the growth. I had stayed on it through gamma knife radiation, when I had two tiny spots on my brain zapped (with no return); through the increased fatigue -- a side effect of interferon -- when we coupled the drug with potent, drowsy-making painkillers; and through each scan that showed the cancer growing a little bit more.

Now Dr. Jahan was saying that the growth was no longer acceptable, no longer something to try to contain with the interferon. All the little growths had added up to one big choice.

So this day, we were talking about options.

First Dr. Jahan mentioned Doxil, which contains Adriamycin.

"Adriamycin?" I said. "The chemo drug?" A drug my mom, who died of non-Hodgkin's lymphoma, had used.

He said Adriamycin itself is different, used for more aggressive cancers.

"So it's not Adriamycin?"

"It is Adriamycin. It's Adriamycin wrapped in fat. That's why it's a pig in a blanket."

Meet my options: Interferon that makes me tired and isn't working, or deadly chemo wrapped in fat.

I couldn't believe I was so calm, even as we were talking about chemo options. We had put chemo at the back of our minds months ago; it doesn't seem to be very effective in ASPS patients. Since it's so toxic and distressing to the body, I wanted to steer clear of it. It seemed a choice with too much cost for the benefit I could receive.

There was another "chemo-ish" option, as Dr. Jahan called it: a pill called Temodar. It's taken daily, and thus slowly builds up in the system. The upshot: When the cancer cells decide to act out and replicate like over-fertile rabbits, a sizable amount of Temodar is there to stop them. That's a comforting thought.

That made Temodar seem like a better choice; steadier, more constant.

Silently I kept saying, "I'm ready, I'm ready" -- even while Dr. Jahan spoke about the nasty side effects -- and I was talking about the Doxil. I was talking about my mother's drug.

Sentimentality, I realize, is no good way to choose a cancer treatment. However, I had asked Dr. Jahan lots of questions about the science of both drugs; we all had. Both have a promising modus operandi: They were both released slowly, resulting in a somewhat steady treatment in my body. (Slow-growing cancers really don't respond well to fast-acting drugs.)

But the bottom line was that neither drug had been used often for alveolar soft part sarcoma, and Dr. Jahan had never used Temodar for ASPS. So basically, as far as decision making went, the science was moot.

"You pick one based on what your lifestyle is like," he said.

I looked at him, dumbfounded. "That's a weird way to pick a cancer treatment, don't you think?" I said. He shrugged.

Besides, what lifestyle? It's not as if I took off on mini-vacations every few weeks and couldn't work in a round of chemo. I went to work, cared for myself and my dog, and went to support activities based on what the side effects of my current treatment would allow. I had no lifestyle outside of cancer.

If I was going to pick a treatment based on lifestyle, then I might as well pick it based on emotional attachment. If I want to bond with my dead mother via toxic drugs, so be it.