Three days after his cancer surgery, James Valentine was faced with a decision

In March I appeared on ABC Radio Sydney and announced that I had a malignant tumour in my oesophagus and would be off the radio for a while.

I wrote an article telling everyone not to worry, a surgeon would remove my entire esophagus and create a new one by connecting the top of my stomach to my throat.

“I'm fine,” I said. “It'll take a while, but I'll be back.”

I don't think anyone who listened to the show or read my article believed that I would be okay.

A quick Google search shows that esophagectomy carries a high risk of post-operative complications and that I may live with significant health problems forever afterward.

For me, it felt like everything had happened very quickly. One day I'm fine, then I get the diagnosis in December 2023, a few weeks later I'm having chemotherapy and radiotherapy, and in April I'll have the full operation.

So when I announce what is going to happen, I am already living in a kind of dissociated state.

I know what's coming is probably going to be terrible. But I only have a few weeks of normality left.

I will spend these last days before I lose a vital organ doing the things I love.

I'm on the air, playing a few saxophone gigs, and spending a lot of time with my wife and kids. I've simultaneously faced and avoided what was coming.

I'm leaving ABC. My family and I are going away for a week.

A timely call

While I'm lounging by the pool in the tropics, I get a call. “You should talk to this guy,” a friend suggests.

And so I meet Professor Michael Bourke, Head of Gastrointestinal Endoscopy at Westmead.

“Come by when you get back,” he invites. “Maybe you’re suitable.”

It refers to a procedure that is far less destructive.

If I qualify and my tumor isn't too advanced or spread, he can remove the cancer cells endoscopically – just go into my throat and cut them out – and then just observe. “We'll keep an eye on you and see if anything pops up.”

What is this supposed to mean??

Five days before the planned complete esophagectomy, I go to the hospital for a pre-admission check.

I fill out the forms and find out what is going to happen to me. Four days before the actual operation, I go to Westmead, get a general anaesthetic and Professor Bourke takes a look at my neck.

I wake up and he says, “Yep, we can do this. Should I put you in for next Tuesday?”

On the same day as the full cut.

I call my surgeon and can hear his concern. “Your disease is too advanced, it's too risky. We need to remove the entire esophagus to make sure we remove all of the cancer.”

I report this back to Professor Bourke, who sends me data and reports from all over the world. He is not the only one who shaves his hair instead of cutting it.

In summary, I may get more cancer in the future with this technique. But their view is: let's treat it when it happens. There's no point in removing an organ until it's really necessary.

I'm a “doctor knows best” kind of guy. I was sent to my surgeon with the recommendation that he was the best.

The oncologist, the radiologist and all the other doctors I came into contact with had assured me that full surgery was the only option and that I was in the safest hands.

My surgeon says that based on everything he has seen and all the data and information he has, I need to have surgery. The endoscopic method works for some people, but not for me.

Now I have two doctors who both know best.

How do I make my choice?

We all face this dilemma, for ourselves, for our parents, for our children. Make a life-changing decision in an area you know nothing about.

Because like everyone says, “Do your research, look online.” I’m not booking an Airbnb here.

I cannot really understand Michael Bourke's research. The surgeon has performed this operation hundreds of times. I can only question him superficially.

And I'm choosing between two people who are both sure they're right.

The surgeon is absolutely right when he says that his procedure follows accepted protocol and is the only way to minimize the risk of future cancer.

Although the professor's approach is new, it has been pursued for decades, it is being developed worldwide, the results are promising and for me it means that I remain intact.

I would rather do something less invasive. I can handle the risk of future cancer. I prefer that risk to the risk of morbidity.

But deep down there was one simple fact that I could understand.

There is only one order in which I can do it. I can do the Westmead operation, and if it fails, I can still do the whole operation. It doesn't work the other way around.

I call my surgeon and tell him I can't come in next Tuesday and instead I'm going to Westmead and have the cancer cells removed from my oesophagus.

This is either the best thing I've ever done or the worst

I won't know for another five or ten years. But of course there's nothing like a life-threatening illness to put everything into perspective. Which of our decisions doesn't involve risk?

How do we make a decision? I have the financial acumen of a koala, but I have a mortgage, a pension and health insurance and I have no idea how it all works.

What I did is my decision. For many sufferers, surgery is the best and only solution.

Ultimately, all we can do is take in what we are told, understand it as best as we can, and then decide for ourselves.

After the procedure, I was exhausted for about six weeks.

The procedure itself, the stressful months before it, the long radiation treatment and the fact that I couldn't eat anything except broth meant that I read a lot of books and watched a lot of television.

I've discovered that I really enjoy boring, slow-paced shows: Masters of the Air – boring and predictable – was perfect.

In the last six weeks or so, I've gotten back to normal. I can eat again and do all the things I love.

Over the next few months, my esophagus will need to be dilated regularly. It is still in the healing phase, so I am currently eating like a reluctant toddler: very slowly, in tiny bites.

I will be examined and tested regularly over the next few years. If the cancer returns, they will detect it early.

But the reality is that I don't live with any more risk of cancer than I did before my diagnosis. Last year, one day I couldn't eat Thai food. The next day I had cancer.

Now I'm going to take a test and wake up and either I have cancer or I don't.

And in the meantime, life will just keep on rushing by, and I'll throw myself into it. And as always, I have no idea what's coming next.

James Valentine will return as host of ABC Radio Sydney Afternoons on 12 August.