Prepare for Battle

Due to a brief pause in my scheduled treatment, I had a bit of “normalcy” while my scans received a second look. I used this opportunity to catch up on work that has been piling up.

After the momentary respite, I met the last doctor on my cancer meet and greet tour, the colorectal surgeon. I was anxious to hear what the second look at the scans revealed and what an esteemed colorectal surgeon (ass cancer removal specialist) had to say.

The appointment started like all the others with a weight and blood pressure check, and then we headed back to the room. After a few minutes, a medical student came into the exam room to chat with us. She did a fantastic job gathering information and explained the different paths forward. Then she took this info back to the doctor so they could strategize.

After a short wait, the med student, surgeon, and a touring surgeon from China entered the room. My surgeon had an entourage, the analyst in me went into hyperdrive. An extra doctor and med student, is this good? Is this ass cancer Jesus, and are these his disciples? Were the scans that bad that he needed backup? That’s when I was snapped back to reality with a question that instantly made me like this surgeon. “Would you prefer to dive right in or do you prefer to chat a bit first?”

Naturally, I elected to dive in head first. The surgeon told me a university radiologist, and the chief of radiology both reviewed the scans.

He went on to tell me something all my friends and family already know about me; I’m an “interesting” and “controversial” asshole case.

Based on my vast knowledge from medical dramas, I knew the words “interesting” and “controversial” was the likely explanation for the other apostles in the room.

As it turns out, I’m an “interesting” case because the horizontal cross-sections of my scans confirm the findings of the original radiologist report, stage IIIB cancer with lymph node involvement, maybe… But here comes the controversial part, despite the scans being of high quality, they do not show enough to decern lymph node involvement. Hence the reason they made an educated guess and said it was stage IIIB. Then we get to the vertical cross-sections of my scans; they add yet more controversy as they tell a slightly different story. These scans show no discernible lymph node involvement and slightly less tumor penetration into the outer layers of the rectum. If it were based just on these scans, it would be stage II rectal cancer. So, the dilemma, which cross-sections do you believe? They came from the same machine, on the same person and yet they tell two different stories with slightly different treatments.

Stage II and stage III rectal cancers are both treated with chemotherapy, so luckily, we had time and at least a path to head down. Like any good medical drama, there always needs to be another element of suspense. In this case, the suspense element is the results of genetic blood testing.

Based on the biopsy results, we know this ass cancer is not a result of a hereditary genetic condition; however, if genetic screening shows I am predisposed to another type of cancer, this must be addressed at the time of surgery. If I have no genetic predisposition to colorectal cancer, the operation is a resection. A resection is where the surgeon removes the tumor, surrounding tissue and nearby lymph nodes and connects the remaining ends back together. Sounds simple, but it is a complex surgery with lots of fun complications.

If the genetic testing shows that I am the lucky recipient of a gene flaw, the surgery gets a bit more complicated. I’ve already gotten cancer at an early age, and a genetic predisposition means that I am highly likely if not assured, to get another form of cancer in the future. The removal of the entire colon is often necessary in this case. A drastic step, but if it prevents future cancer, who knows. Since we are still awaiting genetic testing results, I’ll leave this cliff hanger for another day.

After all that fun and excitement, it was on to the next piece of the puzzle, radiation. The initial plan, before my “interesting” and “controversial” nature, was revealed to the entire medical team, was to do eight cycles of chemotherapy followed by chemo + radiation for five weeks, followed by surgery. However, since the scans were inconclusive when it came to answering the “node involvement” question, this changes things a bit — queue more controversy.

While radiation has benefits for treating and shrinking localized tumors and lymph nodes, there are negative impacts as well. These range from localized tissue damage, to increased risk of side effects after resection surgery. In my case, it is not clear if it would be worth the risk to undergo radiation. At this point, the plan is to undergo four cycles of chemo and get another MRI to see how things respond. If the tumor shrinks, this is a positive sign.

Additionally, if they see some change in the lymph nodes from the previous scan, the doctors know some lymph nodes were involved. If they see growth in the lymph nodes, they know there is involvement and that additional treatment with radiation is needed. So, we will need to wait and see what happens after the first four chemo cycles.

At this point in the conversation, I’m feeling comfortable with the plan, and I thought we would be on our way home shortly. Nope. The doctor had another surprise in store for me. “Do you mind if we get a look at this thing so I can see what we are up against?” Sweet, nothing like a little impromptu show and tell.

We got upgraded to the deluxe scope suite, which had a nice front row seat for my wife so she could be in the middle of the action. As they were getting everything ready, the medical student was busy translating the multiple treatment pathways into an easy to read flow chart. Based on the fact that she took extra time to transcribe everything in this format tells me she is going to make an outstanding surgeon; however, she needs to work on her doctor penmanship, it’s too readable.

Unlike its bigger brother the colonoscopy, where I got to snooze comfortably through the procedure, I’d be fully awake as ass cancer Jesus, his disciples, my wife (that’s true love), and yours truly got to see my tumor in full 1080P.

The prep for this procedure was cake, just two enemas, and I was ready to party. Assuming the position on my left side, facing the monitor upon which I’d soon be seeing way more of my backside than anyone should ever witness of themselves, I patiently awaited the medical team to assemble. This time the doctor brought two more friends to the party, a delightful medical tech, and a friendly NP which would be running the scope. As a warm-up exercise, the doctor attempted to probe the tumor manually, unfortunately (probably fortunately for me???) he couldn’t reach it. Then it was scope time. To break the ice, I asked if the scope was smaller than his fingers. My humor must have caught the disciples off guard as there was a bit of uncomfortable laughter, but ass cancer Jesus was ready. He assured me that after his probing, I was warmed up and ready. I figure there is no need to be shy, they are staring at my ass, they might as well be laughing at it too. It was time, after several deep breaths, and channeling my inner zen; I finally opened my eyes to see the thing trying to kill me. It’s pretty gnarly looking which was made worse by the tattooing they used to identify the area.

Then they started to map things by taking measurements, so they had a baseline before chemo treatments. Funny fact, do you know how they orient themselves with what they see on the screen? They spray in some water to create a “pool,” that way they know which way is down (in this case, my left side). Having water sprayed in there is a very odd feeling. After several more measurements and blasts of water, they did something I wasn’t expecting. They turned on the suction to remove the liquid, and I experienced one of the strangest feelings I have ever felt in my life. It felt like a Major Gas-bubble was engaging in an all-out war against Colonel Montezuma in his last and final revenge. Without even thinking, I squawked, “Holy shit that feels weird!!!” I guess this comment snapped everyone out of medical land enough for them to tell me what I was experiencing. After a few more minutes, they had all their measurements and party time was over.

After I got cleaned up and dressed, my wife told me that she was unaware that she was seated in the splash zone. Ruh-roh! As I was getting dressed, her ringside seat caused her to get sprayed when they were cleaning off the instruments. Don’t worry; I assured her we paid good money for her poncho seat and it was all part of the show. All joking aside, that’s the sign of true love right there. I didn’t think I’d be cashing in this early, but we’ve arrived at the “in sickness and in health” part of our vows.

After all the poking and prodding, we finally have a treatment plan, that starts with my first round of chemotherapy this Friday.