Cancer 52

I have been talking about my reactions to cancer throughout these blogs, but I have not really said what the problem is. At one level I suppose this does not matter. I have cancer, it is going to kill me, I am not sure when. The health service has not yet established all the facts (sorry, Mr Gradgrind). We are still waiting for the results of further biopsies, and I will have a CT scan later today to determine the extent to which the cancer has spread over the last couple of months. We also do not know how well or badly I will respond to the chemotherapy, and whether the chemotherapy will need to be changed as a result of these awaited tests.

What do we know? After various signs and symptoms followed by tests I underwent an open Hartmann’s procedure. The post-operative histology confirmed a poorly differentiated mucinous carcinoma of the sigmoid colon. The biopsy confirmed the tumour deposits, meaning I have N1 disease (cancer in nearby lymph nodes), and there was also evidence of extra mural venous and lymphatic invasion, but no evidence of perineural invasion. pT4a means my cancer has grown throughout the layers of the colon, but not attached to other organs or structures. pN2b indicates the cancer is in nearby lymph nodes.

While there are overall survival rates for this type of cancer it cannot of course be specific to an individual. The consultant, when asked, gave an estimate of 50% survival rate at 24-30 months. We haven’t started treatment yet so it will help when we see how I respond to that treatment. While I am happy that the people in the NHS will do their best perhaps the most important thing for me is to stay positive and to eat a reasonable diet.

The treatment plan. I have my PICC line fitted tomorrow (in the vein, from my upper arm to above my heart: covered ith a dressing when not in use) and chemotherapy starts on Tuesday. I will be sitting in hospital with a drip for about 4 hours on Tuesday, and then sent home with a bottle attached for a further 48 hours. On Thursday the district nurse detaches the bottles and cleans the PICC line. I am then free for 6 days. On the following Thursday the district nurse takes a blood sample and recleans the PICC line. On the Friday I see the consultant to see how things are going, and then the following Tuesday it starts all over again.

Assuming I respond well and can cope with the side effects (I have decided not to have any) this will be repeated every two weeks for three months, and then a further CT scan will indicate whether it is working. If so, then I will probably have another three months and then take a break from treatment to go and spend a month or two somewhere warm. If things work out well this will be my life between Tuesday and death, however long or short that may be.

I am going to have combination chemotherapy with FOLFIRI +/- Cetuximab depending on my further results. I can look forward to the possibility of a range of side effects, including skin toxicity (stay out of the sun, use moisturiser!), sore mouth and ulcers, cardiac toxicity (due to heart failure), bowel problems, high stoma output, risk of low blood counts, risk of infection, and life threatening neurotropenic sepsis – it is funny how ‘life-threatening’ only comes up at that point. I had the vague idea that the cancer itself is somewhat life threatening (stay positive…).

Right, I am off to fix some skirting boards. Stay tuned for updates on the side effects of chemotherapy.