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CANCER: An Uncensored Journey

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Bill Sable
Post Posted: Fri Mar 12, 2010 5:30 am

Joined: 14 Feb 2009
Posts: 259
Rogead, many, many thanks to you yourself for taking the initiative to have this procedure...and best of luck with those 3 polyps.
While is doctor is rightly concerned, I will tell you that one of my older (older than me, that is, which is saying something..!!) originally had a dozen or fifteen benign polyps when he had his initial colonoscopy; a year later, he had half a dozen or so; after those were zapped, he remained free and clear for a number of years.

They call anal and rectal cancer "the cancer of shame" for some reason - possibly because it has to do with bowels, bowel movements. Honestly, it escapes me entirely, perhaps because my Mom had colon cancer and lived alot of years with a colostomy, perhaps because I work night crew where we deal with the big, steaming piles the warehouse dumps on us every night. Rolling Eyes Regardless, this form of cancer, like breast cancer, prostate cancer, lung cancer, etc. need to be talked about and, ultimately, prevented.

...and prevented, Brother Rogead, is what you have just done, after enduring the Go-Lytely Express. Prevented or, at worst, gotten an early diagnosis.
I did not, for essentially dumb reasons, and as a consequence I am up to my knees in "Depends" - which is, nevertheless, a vast improvement over 9 months of being up to my knees in "Hollister Premier Drainable Pouch with Clamp, 1-inch Aperture".

So congratulations, honestly and immensely.

The next step is to pass ther word to those close to you.

I'm not pleased to hear about the cardiac situation; that is one thing that I have not had to deal with, thank god.
I will admit, however, that I stopped a smoking about half-hour before my surgery last June and have managed to refrain from said activity since then. This has made walking the hills in SF, and in my neighborhood especially, much, much easier. Got some monumental damn hills around here - great aerobic workout.

Take care, my friend, and keep us posted.
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SharynS
Post Posted: Fri Mar 12, 2010 9:12 pm

Joined: 28 Jan 2006
Posts: 2883
Location: the 'puter 		The first step is always tough but there's so much to be said for early detection. You did good to get it done rogead. I'll be here cheering for you.

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Bill Sable
Post Posted: Sat Mar 13, 2010 4:26 am

Joined: 14 Feb 2009
Posts: 259
All hands!!....especially Rogead, perchance:

Just happened to find this site in a full page ad in "Town and Country" magazine (why I get T&C you would have to ask Shirl Question Embarassed )

The ad reads:

OVER 50,000 MEN AND WOMEN IN THE U.S. WILL DIE FROM COLON CANCER EACH YEAR --- ENOUGH TO FILL THIS STADIUM

GET SCREENED --- IT COULD SAVE YOUR LIFE OR SOMEONE YOU LOVE

Call:410-244-1778 or www.coloncancerfoundation.org

Well worth doing...and well done, Rogead.
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Scott Schroeder
Post Posted: Wed Mar 17, 2010 1:38 pm

Joined: 20 Dec 2007
Posts: 383
Location: Some where on the mountain 		Hey Bill happy Irish Day my Irish brother! Make sure you have a green beer for me today Mr. Green

Hope your feeling and healing well on this fine St. Patti's day?

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I will believe corporations are people when Texas executes one!
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Bill Sable
Post Posted: Thu Mar 18, 2010 3:26 am

Joined: 14 Feb 2009
Posts: 259
and to you, as well, and to the real Ace of Cakes.!!

Fact is, I dyed my Metamucil a fine shade of green just for the occasion...and green Depends...Damn, son!! there just ain't nothing like 'em. Arrow and, what's more...well, we really do NOT need to go there, do we Question Question Just let your imagination do the walking.
Wink
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rogead
Post Posted: Sun Mar 21, 2010 1:44 am

Joined: 11 Feb 2006
Posts: 412
I received a call from the colonoscopist on Tuesday. He said that the largest polyp removed was indeed cancerous. This polyp was in the rectum. He was able to get me in to see the colorectal surgeon on Wednesday. The surgeon did a sigmoidoscopy and gave me an India ink tattoo where few people will ever see it. I have several tests coming up to make sure that the cancer hasn’t spread to other organs—the liver and lungs are the most common places to which rectal cancer metastasizes, but the doctor thinks that to be unlikely. He said that it looks to be a superficial stage I cancer. Because of the location in the lower rectum, standard resection would require a permanent colostomy. This is also a major surgery which would be made riskier by my heart condition. Assuming that it has not spread anywhere else, I will opt for what is known as a transanal excision. In this procedure, the tissue is removed with micro-surgery through the anus. The downside of transanal excision is that the rate of recurrence is about three times higher than resection surgery (15% compared to 5%). Ultimately, it’s a surgical-risk and quality of life issue for me.

Everyone, please follow Bill’s advice: get a colonoscopy. I had absolutely no symptoms of this. It showed up on a routine colonoscopy I decided to have at the age of 50 (almost 51), which is the standard recommended age for those without a familial history of colorectal cancer/polyps. The colonoscopy is thirty minutes of moderate discomfort…a far better situation than cancer treatment and a lifetime of anxiety and follow-ups.
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Bill Sable
Post Posted: Mon Mar 22, 2010 12:54 am

Joined: 14 Feb 2009
Posts: 259
Rogead, this is not the news I hoped to hear from you, not at all, not in the least. My heart goes out to you, my friend...and know that anything I can do to help, I will do.

Having said that, you might want to get a second opinion on the operation. It is not my understanding that a Stage I tumor/lesion would require a permanent colostomy...we are NOT talking bowling balls, here. Hell, brother, my rectal cancer was a Stage III and I currently have my own asshole back (cranky, not original equipment, but it is mine). I will give you the details of my action and treatment in another post (or PM you, whichever you wish); for that matter, you might want to get ahold of my surgeon and have him take a look. or I could see if he can recommend someone in your part of the world. Think about it and let me know.

Take care, focus in and keep us all informed. Here to help, Brother.
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rogead
Post Posted: Mon Mar 22, 2010 1:56 am

Joined: 11 Feb 2006
Posts: 412
Hi Bill,

The surgeon I’m seeing is one of the best in the field, but I did also get a second opinion. The location of my cancer is less than 5 cm from the anal verge. From what I understand, resection at this location would also require removal of the sphincter muscle itself: thus the colostomy. I’ve also consulted with my cardiologist concerning the strain on my heart that would be caused by an APR. My heart only pumps out about half of the blood it should each time it beats, and since I also have atrial fibrillation, it beats irregularly.

I will, however, continue to research the matter. I have a couple of weeks before deciding. I’ve had lab work for liver function and CEA. I’ll have a CT scan and MRI on Wednesday. I’m scheduled for a rectal ultrasound on the 13th. I’m assuming that they stick a wand up your butt for this one—sounds like fun!! I suspect that I’ll have some surgery shortly after the full staging is completed.
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Bill Sable
Post Posted: Mon Mar 22, 2010 5:22 am

Joined: 14 Feb 2009
Posts: 259
Hey Rogead...I'll double-check and summarize the details and technical stuff re my own surgery; you might want to run them by your guy but it doen't sound as though our situations are radically different except that yours is Stage I and mine was a much more serious Stage III.

Honestly, to judge from my own experience, I do not understand why your surgery for a Stage I lesion/tumor would require - without any other option - that and only that treatment.
I was given the option of a permanent ileostomy/colostomy but chose the rebuilding instead.
You may need yet another opinion and do some online research. What the doc has told you just does not sound right, based on my own experience.

My initial surgery was done robotically and was minimally invasive. Even so, the radiology had shrunk the tumor and surrounding tissue to such an extent that the surgeon had to literally pull down nearly 2-feet of colon with which to fashion the new rectum/anus. Again this was for a Stage III. Did you doc say anything about pre-surgical radiological treament to shrink the lesion? Likewise pre-surgical chemo to preclude metastasis?

I also recently ran across an article which suggested that a new and viable sphincter muscle(s) could be shaped and placed via the use of a piece of thigh muscle. I'll double-check and source on this and pass it along.

BTW, the CT scans and MRI were easily tolerated - the rectal ultrasound was a little daunting - the damned equipment looked (and felt) like a fire hydrant. Less fun.
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rogead
Post Posted: Mon Mar 22, 2010 2:06 pm

Joined: 11 Feb 2006
Posts: 412
Thanks Bill,

The complication in my case seems to be, not the seriousness of the cancer, but its closeness to the anus. I'll run your suggestions by the doctor when I next see him. Did you have a laparoscopy?
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Bill Sable
Post Posted: Mon Mar 22, 2010 7:52 pm

Joined: 14 Feb 2009
Posts: 259
Morning, Rogead

You bet I did..!! Let me run down some of the specifics of my case that way you (and perhaps your surgeon) can compare them with your own case.

But first...(1) are you seeing an oncologist i.e. cancer specialist. If not, you need to. (2) the national Cancer Institute website on rectal cancer and a hundred other subjects, especially the definitions of the "Stages", is well worth the trip, as are other sites.

So, as you know I have have CT scans, PET scans, colonoscopies, ultrasound, diagnostic radiological examine (the famed hypaque enema), radiological therapy, chemo-therapy, blood tests up the wazoo and multiple digital examinations involing what might be termed "the UFCW thrust".

1..the initial colonosopy found three non-maligant polyps in the descending colon and sigmoid colon, ranging in size from 6mm to 20mm (these were removed during the colonoscopy);
...the colonoscopy also found a "frond-like/villous non-obstructing medium-sized mass...in the recto-sigmoid colon... 3mm in length...biopsy sample was taken"

2..lab analysis and ultrasound indicated a Stage III
"rectal mass, adenocarcinoma, moderately differentiated, at least superficially invasive"
located 6 cm up the rectum (i.e. about 1 index finger length, so convenient for some many medical folks..!!), measuring 1.8 X 1.9 cm

3..following several weeks of chemo-therapy and simultaneous radiation therapy, my surgeon did indeed perform surgery ("colectomy/coloproctostomy" is what the billing people call it), specifically laparoscopic low anterior resection with the "da Vinci" robot.
I had a "temporary ileostomy" for about nine months (which was reversed a month ago) and, as mentioned and in layman's terms, my surgeon yanked down about two feet of my colon and sewed the sucker tight to form a new rectum/anus. Not perfect but works better than most cars I have owned.
Post surgical reports indicate "perineural invasion" and four of fourteen lymph nodes positive for carcinoma. (These were removed, soaked in varnish and will form a lovely bracelet.)

Options: give your surgeon this information, if you like, and see why your Stage I requires a solution so different from my own. I'd be interested in hearing what he has to say. Definitely get with an oncologist; if that tumor can be shrunk down prior to surgery (as mine was via radiation therapy) this might affect the outcome

Further: it is possible to transplant the 'gracilis muscle" from your inner thigh to replace/augment existing sphincter muscle.
There is also the possiblity for an "artificial bowel sphincter" which involves an artificial cuff, a pressure regulatied balloon, and a pump to inflate the cuff. Basically, the balloon and cuff are inflated to form a tight. leak-proof sphincter, then, as the need arises, one releases the pressure, releases the fecal material, and then re-inflates. Hate to say it, but it sounds cool

Take care, brother, and keep me posted.
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rogead
Post Posted: Mon Mar 22, 2010 11:46 pm

Joined: 11 Feb 2006
Posts: 412
Thanks for all the info Bill,

I have seen an oncologist in addition to the surgeon. To be clear, a permanent colostomy would be required only if I were to choose the radical surgery. No one I've spoken with has suggested that I do so. In theory, it provides a lower possibility for recurrence since it removes more tissue. Even without the heart complications, I would be very strongly disinclined to having the radical procedure. The potential heart issues just make an easy choice easier.

Since the cancer is extremely small, the doctors (both the surgeon and the oncologist)see no need to shrink it with radiation and/or chemotherapy prior to excision. The trans-anal excision is a robotic micro-surgery in which the surgical instruments are inserted through the anus. In my case, since the cancer is very small and very close (about 4 mm) to the anal verge; entering through the anus is more practical than a laparoscopy. The surgery is essentially the same, it just uses an existing hole rather than making some new ones. I'll keep you posted, and I may have some questions as I go through the various procedures.

Thanks again
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Bill Sable
Post Posted: Tue Mar 23, 2010 3:13 am

Joined: 14 Feb 2009
Posts: 259
back at ya, Brother R

That sounds more reasonable than my initial conclusion that a permanent colostomy would be necessary regardless of the surgery. Don't get me wrong: a colostomy is hardly the "end-of-the-world". My Mom had one for ages - she didn't like it but it worked - and that was back in the '60's and '70's. My guess is that the technology has seen improvements since then.
In my own case a permanent ileostomy was an option. I didn't see any especial reason to run with it but some folks do. The temporary ileostomy was bearable, I worked with it, although I am pleased not to have it (and never quite did figure out how to go surfing with it).

Anything I can do to help you out on this, just give me a holler. BTW I asked my Local to do some outreach to members on this issue, to get members informed re colonoscopies and preventative procedures in general. You might try this via your Local (hopefully with better luck and follow-through Rolling Eyes ).
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Laboryes
Post Posted: Fri Mar 26, 2010 6:03 pm

Joined: 29 Jan 2006
Posts: 1959
Bill, not to be incentive to this thread but I was surfing around on “google image” and stumbled across this shit chart while researching a totally unrelated subject.

When I saw it I totally thought of you and this thread! I know I'm not well! Thought maybe you might be able to use the chart for humorous aspect or serious content? Either way I hope you don't find it offensive? You being night crew and all I figured you'd find something useful to do with it! Mr. Green

One thing is for sure Bill, your thread does stick out in peoples mind and keep them thinking.

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Truman
Post Posted: Sun Mar 28, 2010 1:47 am

Joined: 27 Jan 2008
Posts: 27
Hell, Son...looks like mug shots of UFCW officers.
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