Mystery Appointment With The Surgeon

It’s Monday, 11 days after The News.

I had to wake at 7 am today for the drive to Burlingame. The disturbing thing is I wasn’t all that groggy. I’m definitely coming down with a severe case of non-vampirism. I’ll need to seek help soon.

Mystery Appointment With The Surgeon

JT and I met with The Surgeon this morning. When I got there I asked if this was a consultation and nurse said it was. Thank God. I’d hate for JT to have come all this way only to wait in the lobby while I had a proctology exam.

The surgeon came in and said he’d gone over the CT and EUS, and started asking if I’d had any symptoms before – unexplained loss of weight, dizziness, constipation, etc. I told him the only sign might have been in March when I had a stool with a little blood. That wasn’t too unusual since I had hemorrhoids, and it went away after a day or two and I didn’t give it much thought at the time.

He then went to state what he saw from the CT and EUS, that it was a stage T3 tumor located in the mid rectum and it looked like the lymph nodes weren’t involved. The liver hypodensities were most likely benign but he’d order an MRI so they could definitively check if they were metastases. During the visit he mentioned that rectal cancer common metastasizes to the lymph nodes and the liver, but didn’t think the liver hypodensities were metastases.

The surgeon did a great job of explaining how mid (and upper) rectal tumors are handled. The standard protocol is neoadjuvant chemo-radiation to shrink the tumor, followed by surgery, followed by systemic chemotherapy. There is a new protocol which is becoming the standard for care which swaps the surgery and systemic chemotherapy. From what they’ve seen the effectiveness is similar, but for some patients there is a big psychological benefit for doing the systemic chemo first. The surgery at the end of chemo becomes a reward for finishing the chemo. In the standard procedure some patients feel wiped out by the chemo-radiation and surgery, and quit the systemic chemotherapy prior to completion. That of course doesn’t lead to optimal results.

During surgery an ileostomy would be performed to allow the rectum to heal. The ileostomy would be undone later, with the duration I’d have the ileostomy depending on my recovery time. My recollection is a bit fuzzy but I also think the surgeon implied if systemic chemo followed surgery then the ileostomy would be undone after chemo. In any case chemo could impair the healing and prolong the healing process, so the ordering of chemo-radiation, surgery, and systemic chemo is something to be considered.

The surgeon indicated that with a lower rectal tumor there are a lot of concerns since its close the sphincter. There is also some concern with mid rectal tumors as it in part determines how much margin there is – the goal is to have the rectum functioning after surgery.

Towards the end of the discussion JT asked what we should expect at the end and the surgeon replied, “Cured.” The cancer would be gone and I’d have full function. I might feel the need to go to the bathroom a little more frequently – every patient reacts a little different in that regard. I was prepared for full removal of the rectum and living with a colostomy. So this was welcome news, to say the least!

The surgeon did finish the visit off with a short proctology exam. As he put it, even with the EUS and CT scans he liked to see things himself. So Julia stepped out of the room and he got going. We chatted a bit and somewhere along I mentioned that I may be a gay man, but even I believe some parts of our bodies are intended for exit only! The surgeon just replied, “To each his own.” After the exam he commented that the tumor was in a good position sufficiently far away from the sphincter. So we’ll keep our fingers crossed surgery will be straightforward.

It was a great meeting. The surgeon spent a lot of time explaining things and answering JT’s and my questions. It seems like he does rectal surgeries quite frequently which is also reassuring. He also seems like a good, personable individual, like the other specialists on my PAMF care team. And on top of that we discovered we lived within a block of each other 15 years ago! (I suspect we never crossed paths, though, medical people being creatures of the day and me being nocturnal.)

As we left the building JT and I were chatting about the alternative orders of systemic chemo before or after surgery. We agreed that the focus should be on whatever provides the best long-term prognosis regardless of short-term challenges. She assured me that I will finish the chemo. She’d make sure of that. Even if she had to drag my limp body out of the house and to the clinic herself! What a great friend 🙂!

To be honest I’m a bit skeptical of being “cured”. I know cancer can come back so want to explore that further, perhaps in the upcoming meeting with the medical oncologist. JT was definitely much more thrilled and gently chastised me for omitting that from the daily email I send to keep her and my sister apprised. Even if “cure” means a low chance of recurrence it is indeed extremely good news. And to have only a temporary ileostomy is icing on the cake.

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