Progress

10^th May 2018  

Usually the word progress is associated with betterment. Progression is associated with forward/upward movement or growth.

My cancer has progressed: Hardly surprising since I’ve had no treatment.

I had my first diagnostic scans in the first week of December last year and my second scans in late April, 5 months later. I wanted to know how the disease had progressed, so that I can decide whether to commence treatment.

Typically, when it spreads, Colorectal cancer will go to the liver, it can go to the peritoneum and the lungs. It can then go to other organs and the bones, sometimes to the blood and sometimes to the brain.

In my case it had already spread to the liver and peritoneum. I have not been tested for spread to the blood or brain and I’ve not asked for this. I’m happy to say that it has not spread to the lungs, heart or any other organs.
In the liver, there were three lesions in December (lesion: a region in an organ or tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumour). These have increased in size and been joined by one more. For medical purposes the liver is considered to be in 8 sections. There are two lesions in section 7 (consider it the outside right forward, in olden footie terms). The largest has grown from the size of a small ladies watch to the size of a pocket watch. The one in section 6 (below section 8 – so in midfield) from the size of a ball-bearing (5mm) to the diameter of an internal water pipe (15mm). The new one is in section 3 (outside left midfield) 5mm.

In the peritoneum, as well as those in the bottom front sections (where the sharp pains occur) there are now nodules in the top left front section and increased nodules in the back sections.

For the colon, whilst nothing new is reported, the CT scan doesn’t pick these up very well. There is still an intussusception (when one segment of the colon pulls inside the next segment and is prevented from returning – in this case by a polyp), but this isn’t causing a blockage.

The main issue I have is not knowing.

I don’t know if/when the cancer will spread to other areas. I don’t  know how much it matters which organ gets more cancer first. I don’t know how I will know how the disease is spreading. I don’t know what symptoms will indicate that it’s time to get ready to say goodbye.

The doctors and nurses have a mantra – “Everyone is different” – for Hippocrates’ sake, I know that! But everyone wants to know what has happened to other people in the same situation!

I do know what the signs will be if the liver packs up. I will go yellow and age like an unread library book.
I think I know what the signs will be if the polyps in the colon grow. I’ll stop going to the toilet. I’ll vomit. I’ll stop eating.
But the peritoneum? I think that growths on here may block the bladder and/or the colon. Patients often get ascites, the accumulation of fluid that fills the abdominal cavity and causes distension and discomfort. At first the fluid can be drained but it tends to re-accumulate quickly and is hard to manage.

How cancer spreads

19^th January 2018

Cancer cells differ from normal cells in several ways, one of which is that cancer cells are able to detach from nearby cells in order to invade and spread to other tissues. Normal cells make adhesion molecules which act like glue, holding similar cells together. Cancer cells lack these adhesion molecules allowing them to break loose and travel. Another difference is that normal cells communicate with other nearby cells—in essence, being reminded of their boundaries. Cancer cells have devised ways to ignore these communication signals. Once a cancer cell is “loose” and mobile, it is able to travel. There are several different ways in which cancer cells spread:

• Locally (regionally): When benign tumors grow they do so as a solid mass, as if there is a clear boundary containing them.  In contrast, cancer cells invade neighbouring tissues in an invasive manner which can appear like tentacles.  It is, in fact, the claw-like extension of cancer into other tissues from which the name originates; cancer being derived from the Greek word for claw.
  
  
• Through the bloodstream: Cancer cells can enter the bloodstream and travel to other regions of the body.
  
  
• Through the lymphatic system: The lymphatic system is another network through which cancer cells can travel.

• Through the airways (lung cancer): In addition to the methods of metastasis above, recent studies suggest that lung cancer, likely spreads through the airway of the lungs (aerogenous metastasis) as well, and this may be even more important than bloodstream metastasis for people with lung adenocarcinoma.

Cancer cells work in many more ways to fool or coerce the body into actions that will destroy the host. More of this later.

Blood test results and explanations

30^th December 2017

It’s in the blood.

I got copies of my hospital records a couple of days ago. One part was the blood test result from 29^th November.

Mysteriously they were headed steatorrhoea.

This probably means suspected pancreas disease – as I had overplayed the episode of fatty poo (a symptom of pancreas problems and therefore a cause of diabetes), in order to force the issue of colon problems.

Blood can be tested for many things. But the report only lists what the doctors are looking for, not for what else might be there.

Intriguingly the first result was to see if I was excessively bleeding or clotting (and taking Warfarin), The INR [i]count would be 2 to 3 rather than below 1.1 – mine was 0.9.

Next are the Cell Count results

WBC – white blood cells – normal – see https://www.healthline.com/health/wbc-count#normal-range

RBC – red blood cells – normal – see https://www.healthline.com/health/rbc-count

HB – haemoglobin – low – see https://www.medicalnewstoday.com/articles/318050.php

Hct haematocrit – low – see https://www.medicalnewstoday.com/articles/318050.php

MCV – low -

MCH – low – for all three see https://www.healthline.com/health/rbc-indices#threeparts

MCHC – low -

Platelets – size of – normal – see https://www.healthline.com/health/mpv-test

NRBC – nucleated RBC – normal – see https://www.labcorp.com/help/patient-test-info/blood-smear-details-on-rbcs%2C-wbcs

Neutrophils – normal – see https://www.healthline.com/health/neutrophils

Lymphocytes – normal – see https://www.healthline.com/health/lymphocytes

Monocytes – high – see https://www.healthline.com/health/blood-differential

Eosinophils – normal – see https://www.healthline.com/health/blood-differential

Basophils – normal – see https://www.healthline.com/health/basophils

Then

GGT (gamma-glutamyl transpeptidase) – normal – see https://www.healthline.com/health/gamma-glutamyl-transpeptidase

Followed by Liver function tests – see https://www.healthline.com/health/liver-function-tests#types

Bilirubin – normal

Alkaline Phosphastase - normal

ALT - normal

Albumin - normal

The a section headed UE

Sodium – high-ish - https://www.healthline.com/health/sodium-blood

Potassium – normal - https://www.healthline.com/health/potassium-test

Urea - aka BUN - normal - https://www.healthline.com/health/kidney-function-tests#types

Creatinine – normal – see https://www.healthline.com/health/creatinine-blood

eGFR (MDRD Calculation) – see https://www.healthline.com/health/kidney-function-tests#types

eGFR (If patient is black)

And finally

C Reactive protein – normal - https://www.healthline.com/health/c-reactive-protein

A total of 5 samples of blood had been taken, but there were only two reports – the second was just for

Tissue Transglutaminase Antibody IGA – this is a test for Celiac disease. Mine was 0.7, which is well below the 6.9 threshold.

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[i] A prothrombin time (PT) is a test used to help detect and diagnose a bleeding disorder or excessive clotting disorder; the international normalized ratio (INR) is calculated from a PT result and is used to monitor how well the blood-thinning medication (anticoagulant) warfarin (Coumadin®) is working to prevent blood clots.

Bad news

5^th December 2017

Baddestist news possible?

Dr Hollington didn’t tell me that he had booked a 2-week-wait appointment (2WW), nor that he’d requested two sets of CT scans, one urgent, the other not.

The 2WW Lower GI-Gastroenterology appointment at Lister with Dr. Greenfield was on Wednesday 29^th November. He prodded and probed with no great enlightenment. He seemed puzzled at the site of the pain, which he concluded was from the bone in the groin/pelvis area.

He booked me in for a colonoscopy – but said that the results of the CT scan happening on Friday might obviate the need for the colonoscopy.

I’ve not heard from him since, although he did write to Dr. Hollington.

I phoned the hospital on Thursday, as I had two separate CT scan appointment dates. I managed to persuade them to do them both together in the morning. So on Friday off I toddled. They now tell you to put on two gowns, one the right way round (open at the back) the other the wrong way round (open at the front). Why don’t they just tell you to come in your pyjamas? They put in a cannula so that they can inject an iodine-based contrast once the scanning process is underway.

I asked the nurse what the difference was between a CT scan and a PET scan – she didn’t know. (See end of this blog).

On Monday 4^th December Mr Raey-Jones did the colonoscopy. The night before you have to take stuff to clear the bowel. Man that is not nice! Row drove me down because I was to be sedated; but awake enough to watch the screen showing the path of the endoscope and I watched in dismay as lumps were found and I watched with foreboding when a sample was taken of one of them.

And I listened in shock when Mr Reay-Jones told me of his findings.

The next shock was being sent for a lung MRI scan on that Thursday at the QEII hospital.

But the mindnumbingliest biggestist shock was the meeting with Mr Reay-Jones on 14^th December. It’s cancer. It’s spread. It’s not curable.

Mr Reay-Jones is in the right job. He is an arrogant arse-hole who is clearly up himself. In view of my previous experience with cancer meetings, where your brain shuts down, I told him that I would be recording the meeting. He said no. He said I would have had to have got permission before hand. He said it was his preference.

Those who know me from my worklife will not be surprised to learn that he backed down. He could not explain WHY it was his decision/preference/choice. He stood up and tried to CANCEL the meeting. So I told him quietly that I was angry and I explained that as a result of his action I was even less likely to hear anything he said. Do you know what the arrogant man said next – On this occasion I will allow it – like when is he ever going to tell me again that I’ve got terminal cancer.

So the meeting was recorded. His opening statement: “For my benefit, tell me what I told you last time”. I looked at him. While I mentally got around doing this “For his benefit” and while I got round the enormity of what he’d told me.

His remorseless approach in the following minutes was designed to suppress all hope. There’s no point in getting fit. There’s no point in changing your diet, either to get healthier or to gain weight prior to treatment.

His relentless despite of people continued with the statement “You have issues with your tummy”. Even when I asked if he meant peritoneum, he would not disclose information. So I asked for a print of my medical records and he said no. He said I would have to apply for them. He said he didn’t know how that was done. He didn’t offer to find out.

He said the next step was to meet with the oncologist in over a month’s time, and after a second examination of the biopsied polyp in the colon had taken place. The nurse said 10^th January and she explained how to get my medical records.

CT vs PET

A CT (computed tomography) scan uses x-ray technology to create detailed images of the body and inner body structures. CT scans expose the body to a moderate amount of radiation. CT scans are quick, painless, and completely non-invasive.

PET (positron emission tomography) scans are most commonly used to detect cancers, heart problems, brain disorders, and problems with the nervous system. PET scans utilize molecular imaging. Molecular imaging is a very precise way of detecting disease on the cellular and molecular level. PET scans work by injecting a tiny amount of radioactive tracers into the bloodstream, which the PET scan machine can then detect and analyze via 3D images. PET scans take between 2-4 hours to complete, and are significantly more expensive than CT scans. The radiation exposure of a PET scan is about the same as an x-ray. PET scans are excellent at analyzing the biological processes of the body and at detecting pathology such as cancer at the very earliest stages.

For  better explanation that also compares MRI scans, see

https://www.quora.com/Whats-difference-between-PET-scan-CT-scan-X-Ray-and-MRI