Ok, met with the triple team of doctors (chemo, radiation, surgical) at the Juravinski Cancer Center (aka JCC) in Hamilton yesterday. I'm meeting with the surgeon from St. Josephs (Dr. Miller) tomorrow.
The JCC team says the following:
Pros:
- Cancer tumor surgery removal was "complete" and successful. Size was about that of a large egg. 3x3cm round for most of it, with largest measurement around 4.6cm. (yay that is gone!)
- Cancer was not present at the top of the esophagus removed, and not present at the bottom of the stomach removed. So cancer had not spread as far as surgery was performed (yay).
- Cancer had not spread up the nerve sheaths that trigger digestive fluids in the stomach, so risk of cancer spreading up the nerves to other areas of the body is negative. (yay)
- Cancer tumor did not break free of the stomach/esophagus lining. The stomach has 4 layers: mucas, the one above mucas (forget its name), muscle tissue then a final cell membrane. Tumor had breached the mucas and 2nd lining, but was just starting to touch the muscle lining. So the tumor was contained to the surgical area and therefore risk of missing some of it was negative. (Yay).
Cons:
- Lymph nodes sampled around esophagus, stomach, liver tested positive for cancer cells (not full tumors, just microscopic cells).
- 13 nodes sampled, 5 tested positive for cancer cells.
- That means roughly a 20% chance of those cells developing into tumors later in my life
Solution:
- To reduce the 20% chance of reacurrance down to 10%, it is recommended that a combination of radiation treatment and chemotherapy be done.
- Sep 7th they will start radiation daily for 5 weeks.
- After that, I will go through the same chemo as last time for a couple of months.
Radiation Info:
Radiation is quick, just like a regular X-Ray, so appointment will be 10-15 minutes long, tops. Travel will be the killer. However, they have shuttle service as far as Toronto to Hamilton and already have some Milton clients. So I'll hitch a daily ride with them to save on fuel, ETR407 and parking fees.
The intestines don't allow more than 45 rad units before damage, but they want to pump 65 rad units into my affected areas. So I will be getting a chemo drug that will enhance radiation sensitivity in the lymph nodes so that a 45 rad unit dosage will do 65 rad units worth of attack therefore not damaging the intestines (which won't increase in sensitivity and will only receive the 45 dosage level).
Side effects will be general fatigue, possible redness (like sunburn) in folds of the skin only over time. Side effect of chemo drug *may* be inflamed mucus membrane from my mouth all the way to my anus (let's hope I don't get that side effect).
Last week of August they will compare old CT scans of my organ locations to a new CT scan of current organ locations and apply tattoos to my skin to indicate where my the radiation is to be sent, and at what dosage level. After that, I will not be permitted to gain or loose weight at all, as that can stretch, shrink my skin and therefore the tattoo locations. (That will be a challenge.) I will have the help of a dietitian but if I have difficulties, then they will insert a feeding tube into my stomach and directly influence my eating habits.
Chemo Info:
Chemo will be the same as last time, but because my swallowing hole is too small for pills now because of the surgical scars, they will attach a pick line to me and a pump that looks like a baby bottle. The bottle pump will slowly pump the chemo into me 24/7 and will only need to be replaced / flushed once per week.
It does mean that daily activities and showering are complicated by the pick line and the bottle though. But it also means fewer "missed" dosages due to nausea or vomiting or just plain old forgetting to take the pills.
Chemo treatment will take me into November. So with a few months of recovery, it looks like I won't be back to work until 2011 some time.
Regards,
Shane
