Wednesday, December 07, 2005

An Unwanted Journey: Day 0013 - Rectal Cancer

It’s like having your own personal National Geographic special!

That’s what Robin Williams is supposed to have said when he watched the video screen for his colonoscopy. I can’t say if the story is apocryphal or not, but now I know what he means. Today, I was admitted to the day surgery department of St. Mary’s Hospital in Kitchener where I had both a flexible and rigid sigmoidoscopy. This time I was given a choice, so I opted not to be sedated but to watch the events unfold on the video screen, including the excising of two biopsy specimens.

The objective of the sigmoidoscopy was twofold: first, to measure the distance from the anal verge to the distal point of the tumour (11 cm); second, to obtain another biopsy to confirm carcinoma, something which the first biopsy sample was unable to do. Now that the surgical oncologist has the measurements confirmed, I am an eligible candidate for preoperative (neoadjuvant) chemoradiotherapy treatments before surgery to remove the tumour.

Friday, I have a CT scan and then next Tuesday I have an MRI. Both of these are to help determine whether there is any lymph node involvement as well as get a better estimate of the size of the tumour and whether or not it has penetrated through the rectal wall into the abdomen. The chemoradiotherapy will then attempt to shrink the tumour. Surgery will use the total mesorectal excision technique to remove completely the mesorectum surrounding the part of the rectum to be excised. I won’t know for sure about whether or not a colostomy will be required until the time of the actual surgery, although the TME technique offers not only hope for a lower recurrence rate of cancer in the bowel but a greater chance to preserve sphincter control, nerve preservation and sexual function. TME is not as widespread in North America as it is in Europe. Brigham and Women’s Hospital has an archived webcast of a total mesorectal excision.

So, I guess my journey is really just beginning – a journey and a fight against rectal cancer. I trust Dr. C. Everett Koop, former U.S. Surgeon General, was right when he said, “The best prescription is knowledge.” All I really know now is the diagnosis and the treatment protocol. But this National Geographic special has really just begun.

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