Cancer – designing a plan

(Warning: you may find this to be TMI – it’s not really possible to talk about colon cancer otherwise. Also if you missed my first cancer post, and you’re like, “WHAT? CANCER?” The first post is here)

We had our initial consultation with the surgeon this morning, but we still don’t know whether it’s colon or rectal cancer. It matters because the treatment protocol is different.

The protocol for rectal cancer is much worse, because the cancerous lesion can’t as easily just be snipped out. Rectal cancer protocol can involve many weeks of chemo & radiation, then several weeks of rest, then surgery, then several more weeks of rest, then more chemo & radiation. The whole thing can take almost a year, and I’d have a temporary colostomy bag for about 6 months. This all sounds terrible.

On the other hand, if it’s colon cancer, I could simply have surgery soon (in a couple of weeks) and then probably a round of chemo afterwards (depending on the pathology report). No colostomy bag, no radiation. I’d be done in two months.

It all depends on how far up the intestine the lesion is located. This morning my doctor attempted to make a clear determination of exactly where it is. If the cancerous lesion is 20 cm or more up in there, it’s considered colon cancer. If it’s less than 10 cm up, it’s rectal. Between 10 cm and 20 cm is borderline.

The doctor who did the original colonoscopy in Albuquerque called it “at approximately 16 cm”. He was using a flexible scope, and it’s hard to measure with a flexible scope. So this morning my doctor in Boston put a rigid scope up my butt, trying to get a look at the lesion and get a more accurate measurement of how far up there it is.

Turns out I have what he called a “tortuous” colon, meaning it curves around a lot. Lots of twisting and turning. (Initially it sounded to me like he was saying “torturous”, which, although the procedure did hurt, wasn’t all THAT bad.) Because of the twists and turns, he couldn’t get his rigid scope far enough up there to see the lesion. He did get far enough to see the first set of “tattoos”, which were at about 10-12 cm.

I’m like, “tattoos”? At first I though he was joking. But apparently the GI doctors who do colonoscopies leave marks in the colon when they see something suspicious or cancerous, to guide the surgeons. The marks are called tattoos. So yeah! I got my first tattoo a week and a half ago, and I didn’t even know it.

My doctor in Boston (actually, he’s in South Shore, which is just south of Boston), is tentatively recommending we treat it as colon cancer, not rectal cancer. He is also recommending that I switch to a new doctor, a colleague of his in downtown Boston, who works at a larger hospital.

He’s recommending his colleague for several reasons. First, my current doctor in South Shore is booked until mid-March for surgery, and his colleague could get me in faster. Secondly, the bigger hospital in downtown has fancier equipment, including a robotic surgery aid that allows for a smaller incision. Thirdly, the new doctor does more of these kinds of procedures, and my current doctor wants a second opinion because of the borderline location of my lesion.

The new doctor in downtown Boston will give us a second opinion regarding whether to treat it as rectal cancer or colon cancer, and he’s the doctor who will probably do the surgery. My current doctor said he would contact his colleague today, and I should hear from one or the other of them by Monday.