Meeting the Cancer Team

After finding out I have stage IIIB rectal cancer and deciding to receive care at a local university medical center, it was time to meet with even more doctors. The next stop my doctor tour took me to a radiation oncologist. Unlike the medical oncologist, who prefer to kick cancer’s ass via chemical bender; the radiation oncologist elects to use a more nuclear option in the form of highly focused ionizing radiation.

When the doctor walked in, I was treated to a surprise, a two-for-one special, she had a resident with her! After reviewing the usual schpiel, of symptoms that lead up to my diagnosis, and my understanding of what was going to happen with my treatment, it was the doctors turn to discuss her specialty, how she was going to irradiate my ass. I knew the basics of radiation therapy, but I had no clue how much planning went into the treatment. She described the practice/modeling session where they take a CT scan of me laying on their table, with their physicists (yes, plural) present to make a ton of measurements. Then I learned I would be getting my first (external) tattoos which help radiation technicians line me up correctly for each session. I say external because the surgeon who discovered my ass tumor during the colonoscopy tattooed the inside my colon to mark its location.

I won’t lie, I was geeking out at how much tech goes into modeling radiation therapy and the fact that they can get things with 1-3MM or precision. Then the conversation pivoted back to reality land with side effect and complication talk. The first item on the agenda was possible infertility. A few words into the “sperm bank” talk, I stopped her and said that wouldn’t be necessary. She immediately knew what I meant by that, but the poor resident was sitting there with a confused look on his face. This is when the “teachable moment,” “met comedy gold”… The doctor looked at the resident and said, “he’s fixed Jimmy, you can’t bank, what you don’t have.” I laughed so hard I had tears rolling down my face.

Ok, I really like this lady, which is good because she was about to dive into some unfortunate realities of radiation therapy. The first of which is rectal radiation can cause bowel obstructions later on in life due to damage to surrounding tissues. Then there is the possible skin damage due to the radiation beam, and of course, the possibility of getting secondary cancer due to the radiation. She then explained the treatment would last for five weeks with daily (M-F) treatments. She told that weeks 1-3 usually go pretty smoothly, but the last two weeks are pretty rough. It was then she found out that I lived 45 minutes away from the university medical center, which made her concerned. Apparently, after the three weeks, there is enough irritation in the rectum, some gnarly things start happening. Put bluntly, I was going to be painfully shitting myself non-stop.

I knew there was a reason I was compelled to buy a pickup… I’m sure there is a way I can fasten a blue boy and seatbelt to the bed of my truck. Needless to say after that news, it’s a good thing this doctor had already earned some comedy gold karma points.

Then the radiation oncologist wrapped up the meeting by letting me know she would be in touch with the rest of the care team to stay in sync along the process since radiation usually occurs after chemotherapy. She also said that she would like me to meet with the rectal surgeon so she could loop him into the treatment discussion as well. Then we parted ways.

Four hours after returning home, my medical oncologist called to let me know that he had spoken to the radiation oncologist. It turns out she had some concerns after she reviewed my MRIs during her initial planning discussion with her resident and physicist. At this point, my heart sank, more bad news? He went on to explain that she doesn’t believe the radiologists at the 3rd party imaging company misread the MRI.

I could feel the anxiety building, I managed to squawk, “Ok, does that mean things are…” Apparently, my sudden resurgence of vocal puberty signaled that I was freaking out because the doc cut me off by saying, “this is good news.” At this point I was thinking, WTF dude, you couldn’t have started off the call saying that!? Just hours ago, I had a doctor explain how she was going to irradiate my nether regions so much that I’ll be shooting double blanks and shitting myself uncontrollably. Anyway, I digress. It turns out that when the radiation oncologist and her resident were looking at my MRI, they did not see clear evidence that there was lymph node involvement. This could mean they were a bit too aggressive when they staged me at IIIB, it maybe III or IIC. She submitted an order to the university radiologist to have him re-read my scans to give her opinion. As a result, my chemotherapy appointment that was scheduled for that Friday was postponed by two weeks until they could have me meet with the rectal surgeon, and get the second opinion on the scan readings from their radiologist.

Talk about stress! As odd as it sounds, I was looking forward to executing on the plan. Not because I look forward to getting incredibly sick from chemo or crapping my pants, but because I wanted to feel like we were accomplishing something. More bluntly, I am getting tired of all the “hurry up and wait.”

I’ve been playing catch up with these posts, but now you get to wait with me, as I’m done recapping my journey thus far. My appointment with the rectal surgeon is tomorrow morning, and by the end of that appointment, we should have a solid plan. The results should be back from the secondary read of my scans so we should have a better picture on any restaging that may occur. Restaging (if any) won’t alter the plan too much, but it could change the medication dosages or the radiation approach used and/or the order in which the surgery is performed. So for now, all we have to do is hurry up and wait.