On to the treatments...
Prior to the start of radiation therapy, and based on the location of my tumor, as well as taking into consideration all the organs and tissues in the region, the radiologist made a 3D map of the area to be irradiated. I then went for a special sort of scan and alignment marks were placed on my body, literally X'd on with a marker. A tech also drew outlines on my abdomen and hips, showing the area that would receive treatment. Additionally, they made a mold for my legs to rest in. The mold and the marks would make sure I could be perfectly positioned and remain so while radiation treatments were applied.
Then, for the next six weeks, Monday through Friday, I had an appointment at the same time of day to receive my radiation. It took longer to drive to the place than to get the treatments. With careful body positioning and the machine zapping me from top, bottom and each side, the whole process took maybe 10-15 minutes. I felt nothing. I just heard the clicks and buzzes and saw the movement of the machine around me. The techs were very friendly and I didn't have any problems at all going there 30 times for the quick treatments. I have the quantity and value of radiation I received somewhere, but I haven't felt the need to reference it.
During the same six weeks, I received chemotherapy. I only had to go in once a week and fortunately it was in the same building with the radiation lab, plus they tried to time my appointments so I could kill two birds with one stone.
My chemotherapy was Fluorouracil (5FU) and Leucovorin. It was delivered via 24/7 infusion pump, a little battery-powered device about the size of s small portable radio or big calculator. Half the machine was the pump and an LED readout showing progress of medicine delivery. The other half held the pouch of medicine which came out through a tube and went in through my port.
Each week I also had one needle stick in the arm so they could take samples for blood counts to make sure the chemo was not dangerously depleting my red blood cells, white blood cells, platelets, etc. If all my blood counts were okay, then my port was deaccessed and reaccessed to swap out one pump for another with a fresh bag of medicine therein.
So, my neoadjuvant (assistive pre-surgical) chemoradiation was six weeks, including 30 rounds of zaps and almost 1000 hours of chemo. Incidentally, because of my port and the handy pump that fit neatly into a fanny pack with the tubing under my shirt or blouse, I was totally mobile and unless I pointed it out, no one knew I was receiving chemo. I couldn't get the port area wet, like in a shower, but baths served well. I had enough tubing to hang the fanny pack up and out of the way then I could relax in the tub nearly up to the port location near my shoulder.
Monday, September 25, 2006
Friday, September 22, 2006
Chemo Port or Port-a-Cath
Before I began any treatments I was given options for how the chemo would be administererd. I could be injected as with normal shots, or a temporary catheter could be placed in my arm or chest for one or several treatments. I think that sort of thing leaves a tube hanging out of your arm or chest which must be safe-guarded until the chemo is over and it's removed. In any case, I didn't like the sound of these options. Medical people have had trouble finding and hitting my veins, so I certainly didn't want to be going through that any more than necessary. I was also a bit squeemish and concerned about the prospect of some tube hanging out of me.
Last, but most definitely best, in my opinion, was the option to have a 'port-a-cath' aka 'port' installed. While this required surgery, it was minor surgery and the port would be under my skin, unseen, except for a flat, rounded bump about the size of a button. The port is an access point which feeds a catheter tube that is inserted into a superior vein so the chemicals could be fed directly into my bloodstream. Again, all of this would be invisible to me.
Everytime the port is 'accessed', a special needle is inserted into the center of the port 'button' then all IV medications can be applied as needed from that one needle stick through an attached tube. I liked that whole idea much better. As I understood it, the port could be left in place for years, if need be.
So I picked the port option and my surgeon installed it. The only discomfort I had was from the small incision and the fact that the port is sewn to a muscle to anchor it so it doesn't move around under the skin. For a few days it just felt like I had pulled a muscle in my shoulder from lifting or throwing something too heavy.
Thus, I have a small bump high on my chest, near my left shoulder, which is barely noticeable. With the proper topical anesthetic and a numbing lidocaine injection near the port, I don't even feel the special needle going into the device, nor do I feel any of the delivery of medicine through that line. MUCH better than a lot of needle sticks or a waggling tube hanging out of a hole in my skin.
Last, but most definitely best, in my opinion, was the option to have a 'port-a-cath' aka 'port' installed. While this required surgery, it was minor surgery and the port would be under my skin, unseen, except for a flat, rounded bump about the size of a button. The port is an access point which feeds a catheter tube that is inserted into a superior vein so the chemicals could be fed directly into my bloodstream. Again, all of this would be invisible to me.
Everytime the port is 'accessed', a special needle is inserted into the center of the port 'button' then all IV medications can be applied as needed from that one needle stick through an attached tube. I liked that whole idea much better. As I understood it, the port could be left in place for years, if need be.
So I picked the port option and my surgeon installed it. The only discomfort I had was from the small incision and the fact that the port is sewn to a muscle to anchor it so it doesn't move around under the skin. For a few days it just felt like I had pulled a muscle in my shoulder from lifting or throwing something too heavy.
Thus, I have a small bump high on my chest, near my left shoulder, which is barely noticeable. With the proper topical anesthetic and a numbing lidocaine injection near the port, I don't even feel the special needle going into the device, nor do I feel any of the delivery of medicine through that line. MUCH better than a lot of needle sticks or a waggling tube hanging out of a hole in my skin.
Wednesday, September 20, 2006
Determining Cancer Stage
The inital assessment was Stage III due to the size of my tumor, however, there are two other important staging factors: (lymph) node involement, and metastic spread. After reviewing xrays, bloodwork, CT scans, and an ultrasound, it was determined that my cancer was Stage III, particularly T3N1M0.
T3: T is the extent to which the cancer or tumor has grown and possibly invaded the surrounding area. My T3 meant that the tumor had grown completely into the layers and through walls of the rectum but not into nearby organs or tissues.
N1: N refers to lymph node involvement. N1 means one to three lymph nodes in the area may be involved. There are lymph nodes all over the body and since they communicate with each other it is sadly common for them to 'transmit' cancer to other parts of the body. I don't know how this works, but I think that's the gist of it. Any cancer is more serious if lymph nodes are involved. In my case, only one of the several lymph nodes in the rectal area appeared to be enlarged and was therefore suspect.
M0: Metastic disease, ie spread of cancer. A primary cancer is said to have metastasized if cancer has begun to appear in another organ or areas of the body, particularly at some distance, such as a patient who has rectal cancer as well as kidney or lung cancer. In my case, there was no evidence of cancer anywhere else.
T3: T is the extent to which the cancer or tumor has grown and possibly invaded the surrounding area. My T3 meant that the tumor had grown completely into the layers and through walls of the rectum but not into nearby organs or tissues.
N1: N refers to lymph node involvement. N1 means one to three lymph nodes in the area may be involved. There are lymph nodes all over the body and since they communicate with each other it is sadly common for them to 'transmit' cancer to other parts of the body. I don't know how this works, but I think that's the gist of it. Any cancer is more serious if lymph nodes are involved. In my case, only one of the several lymph nodes in the rectal area appeared to be enlarged and was therefore suspect.
M0: Metastic disease, ie spread of cancer. A primary cancer is said to have metastasized if cancer has begun to appear in another organ or areas of the body, particularly at some distance, such as a patient who has rectal cancer as well as kidney or lung cancer. In my case, there was no evidence of cancer anywhere else.
Tuesday, September 19, 2006
Meeting with My Team
Each team member, due to their specialties, gave me a different angle on my condition. Though I met with them individually, these doctors had worked together for a while, so the picture they were painting was cohesive, yet each one was focused on a particular aspect.
As I understand it, the surgeon is the lead. The biggest goal was to get the cancer out of my body. In support of this goal, I would have chemoradiotherapy, ie, both chemo and radiation, concurrently. This is referred to as neoadjuvant because mine was advanced and rather large, he would have to remove the entire rectum and then reconnect the good end of the colon directly to the anal sphincter (coloanal resection). IF that was successful, there would obviously be changes in my bowel function, as the rectum is a sort of reservoir and provides most of the cues and voluntary muscle control for proper/normal waste elimination.
Furthermore, the surgeon cautioned that because the tumor was very close to the anal sphincter, it was very possible that a coloanal resection would not work and I would have to have an abdominoperineal resection (APR) which meant the removal of the rectum and anus, which further meant a permanent colostomy. I understood that. I therapy, as in pre-surgical, assistive therapy.
The radiologist would use his technology to kill off and shrink the tumor as much as possible, thus stopping any spread of the disease and making it easier for the surgeon to remove. The chemotherapist's goal was to weaken cancer cells to make them more susceptible to the radiation. So, it was a layered attack.
The surgeon's assessment was cautious. He made me aware of the possibilities. Yes, he may be able to completely excise (surgically remove) the rectal cancer. However, would be 'bagged' for life, and in my mind, mutilated. I really could not dwell on that or I would lose it. That was the very worst thing I could think of to ever happen to me. Honestly, given a choice, I'd rather sacrifice a limb, I thought.
The meeting with the radiologist was easier to take. I like technology and I easily got the gist of what he could do. Radiation would be beamed into the diseased area and kill off the cells there. As the tumor, or parts of it died, it would presumably shrink and become easier to remove later. The cautions here were that the radiation could not tell the difference between good tissue and bad, plus the rectum is located where other important and sensitive organs reside. The entire region would be irradiated and thus affected. The extent of effects on good tissue depend on the amount of radiation I'd receive and my own body. Each person is different, though it was clear there would be side effects as damage was done to good tissue as well as bad.
The chemo fellow sort of repeated part of the warnings. Cancer treatment chemicals injected into the body are intended to kill cells, usually rapidly-growing cells, the main indicator that they are cancerous. Cancer cells are what they are because they don't know how or when to stop growing like normal cells. Alas, there are lots of other cells in the body, normal cells, that are also fast-growing and these would be killed off or damaged as well. For instance, red blood cells (RBCs) are usually a concern. They reproduce rapidly so the chemo targets them. But of course we normally produce a lot of RBCs because we need a lot of them. They carry oxygen through the body, which is obviously important. Anemia, ie diminished RBCs, easily wears a person out because there just isn't enough oxygen being circulated.
As I understand it, the surgeon is the lead. The biggest goal was to get the cancer out of my body. In support of this goal, I would have chemoradiotherapy, ie, both chemo and radiation, concurrently. This is referred to as neoadjuvant because mine was advanced and rather large, he would have to remove the entire rectum and then reconnect the good end of the colon directly to the anal sphincter (coloanal resection). IF that was successful, there would obviously be changes in my bowel function, as the rectum is a sort of reservoir and provides most of the cues and voluntary muscle control for proper/normal waste elimination.
Furthermore, the surgeon cautioned that because the tumor was very close to the anal sphincter, it was very possible that a coloanal resection would not work and I would have to have an abdominoperineal resection (APR) which meant the removal of the rectum and anus, which further meant a permanent colostomy. I understood that. I therapy, as in pre-surgical, assistive therapy.
The radiologist would use his technology to kill off and shrink the tumor as much as possible, thus stopping any spread of the disease and making it easier for the surgeon to remove. The chemotherapist's goal was to weaken cancer cells to make them more susceptible to the radiation. So, it was a layered attack.
The surgeon's assessment was cautious. He made me aware of the possibilities. Yes, he may be able to completely excise (surgically remove) the rectal cancer. However, would be 'bagged' for life, and in my mind, mutilated. I really could not dwell on that or I would lose it. That was the very worst thing I could think of to ever happen to me. Honestly, given a choice, I'd rather sacrifice a limb, I thought.
The meeting with the radiologist was easier to take. I like technology and I easily got the gist of what he could do. Radiation would be beamed into the diseased area and kill off the cells there. As the tumor, or parts of it died, it would presumably shrink and become easier to remove later. The cautions here were that the radiation could not tell the difference between good tissue and bad, plus the rectum is located where other important and sensitive organs reside. The entire region would be irradiated and thus affected. The extent of effects on good tissue depend on the amount of radiation I'd receive and my own body. Each person is different, though it was clear there would be side effects as damage was done to good tissue as well as bad.
The chemo fellow sort of repeated part of the warnings. Cancer treatment chemicals injected into the body are intended to kill cells, usually rapidly-growing cells, the main indicator that they are cancerous. Cancer cells are what they are because they don't know how or when to stop growing like normal cells. Alas, there are lots of other cells in the body, normal cells, that are also fast-growing and these would be killed off or damaged as well. For instance, red blood cells (RBCs) are usually a concern. They reproduce rapidly so the chemo targets them. But of course we normally produce a lot of RBCs because we need a lot of them. They carry oxygen through the body, which is obviously important. Anemia, ie diminished RBCs, easily wears a person out because there just isn't enough oxygen being circulated.
Thursday, September 14, 2006
In the Beginning...
I got the news on September 14th, 2006. Immediately after the diagnosis, and I mean, the very next week, I had an oncology team and met with each member to learn about my condition and the game plan. My team consisted of a colorectal surgeon, a radiology oncologist and a medical (chemo) oncologist. I was also fortunate that the assistant to my gastroenterologist, having been the one to tell me of my diagnosis and upon discovering other difficult life circumstances I had, volunteered to be my companion through these initial meetings and to assist me in any way I needed as the plan progressed. She was invaluable and I am ever so grateful to her for the time she devoted to me and for her additional expertise.
I highly recommend that anyone going through this sort of thing should have such a companion, someone who can go with you to appointments and be a second set of ears, someone who can be available at nearly anytime for anything, even just for venting about the situation. Whether or not you make full use of such a person, it is a great comfort to know they are there. I actually found it helpful that my companion was not a previous friend or family member. She could retain her perspective and help me keep a handle on mine.
I highly recommend that anyone going through this sort of thing should have such a companion, someone who can go with you to appointments and be a second set of ears, someone who can be available at nearly anytime for anything, even just for venting about the situation. Whether or not you make full use of such a person, it is a great comfort to know they are there. I actually found it helpful that my companion was not a previous friend or family member. She could retain her perspective and help me keep a handle on mine.
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