• Rich

Ambulatory Goal Posts

When I last wrote, you might recall, we had a definite plan: wait for an operation date, get everything done in one sitting, go home, recover, and that would be that. We have, however, come to learn through bitter experience that all goal posts within this particular journey are seemingly infinitely movable. Now that’s not to say anything entirely disastrous has cropped up, but not looking beyond the next confirmed appointment (or even the Next Corner...) is definitely the way to approach this particular journey in order to avoid any potential disappointments.

So let’s start with the good news: we now have a date for surgery – next Monday 14th November. The frustrating news is that they’re not going to do everything in one fell swoop, as we had hoped. But more of that later.

The journey since we last spoke has unfolded as follows... In early October I went as planned for various scans over the course of two days in London – MRI Pelvis and Liver and a full body CT scan. These were punctuated by an excellent and surprisingly convenient overnight stay with my brother and his family in Oxford which made the whole ordeal something of a pleasure.

About a week later I received an email from my oncologist in Brighton asking if they (the London lot) had told me the scan results. I emailed back to say that I hadn’t heard from anyone, and that I would chase the results. She emailed straight back, saying simply “I have it. Just wondering whether they were arranging to tell you the results?”.

Forgive us for being lily-livered, but that threw my wife and I into a bit of a spin. I wrote straight back. “Oh. That doesn’t sound very promising. Anything I should be aware of?”.

No reply.

Bekky and I spent the next 24 hours in a state of mild panic, not knowing what her email was implying. Being ludicrously British as ever, I didn’t bother her again as I didn’t wish to be a burden, knowing how busy she is. After 24 hours, however, we could wait no longer so I telephoned her number, expecting to have to go through various different preventative barriers before I could speak to her. I was therefore pleasantly surprised when she picked up the phone straight away.

She apologised profusely for not having responded sooner and when I asked if there was anything new to report off the back of the scans she said “No. Well, yes.” We had a good twenty minute conversation during which she told me first the good news – the bowel tumour had receded more following the radiotherapy, the liver lesion looked much the same – then the bad news. “They’ve spotted some nodules in your lung”, she said slowly. “Shit” I said equally slowly.

It turns out that this may not be as bad as it may sound. Certainly in my ever-optimistic head it’s not as bad as it may sound. Nodules in the lung are defined as “spots” on the lung that are less than 30mm in size – I have three which are between 2mm and 4mm each. Until they are 10mm in size, they cannot even be seen on a chest X-Ray – mine were spotted in the CT scan and I understand that they appear in about 1 in 100 CT scans of the chest overall. In general terms, 60% of nodules found are not cancerous although given my condition, I suspect it is likely that they are cancerous, I’m afraid. But they are still so small that the radiologists report stated that he wished for me to have another scan in 3 months time to see what had changed so it’s not exactly like they’re panicking at this stage. And therefore neither am I. It’s just (yet) another hurdle to jump.

The next cancer-related event was a further trip to London to meet the liver surgeon, Mr Mudan. He was a nice fellow (aren’t they all?) but, as ever, during our meeting the goal posts were moved yet again. He told me that there is a kind of pathway towards a liver resection, which is a course of chemo first followed by surgery. My plotted course according to my lead surgeon was the other way around – operate first, then chemo. Mr Mudan and his colleagues have decided that this is not going to be, which is a frustration. This means that, come 14th November, they will operate on the bowel tumour only and not the liver. In brighter news, however, there was no rectal exam in this particular meeting, which was a first.

The meeting still heralded progress though, if not the progress we had expected. While I am “open” during surgery, Mr Mudan intends to dive in with his ultrasound machine and biopsy equipment in order to definitively confirm, once and for all, whether or not the lesion on the liver is actually a metastasis of the primary tumour. He has also spoken to my oncologist (in whom, despite her short period of alarming radio silence, I still have total confidence) and they have agreed that, once I have recovered from surgery, a short course of hopefully, this time, non-life-threatening chemo will be undertaken. My understanding is that this will, with a little luck, have a triple whammy effect – to “mop up” anything that may be left of the bowel tumour, and to shrink both the liver lesion and the lung nodules.

As we know, trying to predict what’s around the next corner is a dodgy game, but there should then follow further surgery to remove the iffy bit of the liver and then we will start work on the lungs if necessary.

So the next events in the diary are two trips to London this week – first for a consent meeting with my main surgeon, Mr Jenkins, and a pre-assessment where they check I have a heart beat etc, and secondly for another PET scan in order to ascertain the exact and latest status of all my disease(s) before they operate next Monday. Next Sunday will be spent in a forced evacuation of my bowels in preparation for surgery on Monday. Oh joy.

And then we’ll see. They predict I will be in hospital for anything up to 2 weeks with a further month’s worth of recovery at home thereafter. Chemo should then start early in the New Year.

As I said to Bekky the other day, there is a Utopian fantasy buried in the depths of all this –that the liver turns out to be an NCDRI (non-cancerous drinking-related injury) and the nodules turn out to be freckles. But I fear this may be hoping beyond hope. What we do know is that we are still a long, long way from the end of the road and seemingly an equally long, long way from the end of this particular journey. We’ll just have to wait and see what’s around The Next Corner...

#bowel #bowelsurgery #MRI #CTScan #Lung #Nodule #lungnodules #liver #liversurgeon

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