Officially, I am now a “cancer survivor.”
If you’re facing something like this, take heart. It is hard, but the doctors are great, the nurses wonderful, and the technology is fabulous.
I got through it. You can, too.
What follows is from 2017, six years ago.
I have esophageal cancer, a “locally advanced adenocarcinoma of the esophagus” to quote the doctor.
Hard to Swallow
I noticed difficulties swallowing. Food would get stuck and I’d need a drink of water to flush it down. At first, I attributed this to tension and stress; it’s like what you feel with extreme emotion when it becomes hard to swallow.
“A hiatal hernia?” I guessed. That’s where part of the stomach gets pulled up through the top of the diaphragm. When that happens, the esophagus becomes a winding path with bends and kinks.
But the problem didn’t leave when the stress did.
Last October, I called my GP. He jotted down my complaint as dysphagia and signed me up for a look-see, an upper endoscopy. Two-thirds of the way down to the stomach, they found it.
The tumor is about two inches (five centimeters) long and blocks about 75% of the diameter of the esophagus. Only paste and liquid get by. Biopsies soon confirmed the cells were cancerous.
How Did That Happen?
Humans create about 240,000,000,000 (240 billion) new cells every day. That’s 2,000,000 (2 million) per second. Each of them gets DNA-level programming for function. Many of them are red blood cells that move nutrients around. Some are skin that seal away our insides and keep the baddies out.
Cells are programmed to grow to a certain size, get to work, and then retire and go away.
But in cancer, the part of the programming that says, “Stop growing,” doesn’t work. Or sometimes something else in the gene is switched on at the wrong time and starts wildly signaling, “Grow, grow, grow” so loud it drowns out the “Stop growing” signal.
Human DNA contains about 204,000,000,000 (204 billion) atoms. Jumbling a few is enough to change what the cell does, to activate an oncogene.
Fortunately, most cells with faulty programming don’t survive. They never make it past boot-up. Like a computer with a bad disk, most broken cells blink a couple of times and then shut down. They die.
Atomic-level jumbles in DNA occur all the time. We start life with some bad programming from our parents in genetic-level programming. Scientists call these “germ-line mutations.” These are conditions you don’t like, such as my tendency for gout and restless leg syndrome. Thanks, Dad. Or the arthritis in some of my joints. Love you, Mom.
Other mutations happen in the environment: a bad sunburn, chemicals and viruses, a passing sub-atomic particle while riding in an airplane at high altitude, all these can switch on an oncogene.
For the most part, the body recognizes the “alien” and gets rid of it. The body heals.
You don’t catch cancer like other diseases.
We make it ourselves. Or have a tendency for it.
It’s a crap-shoot. Luck, or bad luck, of the roll of dice.
In my endoscopy, they saw evidence of Barrett’s esophagus. That’s a condition that develops when stomach acid re-fluxes up into the lower part of the esophagus and burns it.
My Oncologist said there’s a one-in-ten chance Barrett’s esophagus will progress into an adenocarcinoma.
While I could try to blame my parents for my acid re-flux, it’s far more likely I did most of the damage, most of the provocation to that gene, to myself.
Tease the Beast
Confirming that the tumor was malignant, that it is cancerous, is done with a PET scan.
Cells love sugar. They suck it up and burn it. Cancer cells are as ravenous as they come. For a PET scan, Positronic Emission Tomography, a technician injects sugar tagged with a short-lived radioactive something-or-other. The cancer cells gobble it up. Remember, they’re growing whereas most regular cells have heeded the STOP signal. Cancerous tumors then shine in the PET scan with the evil light of the radioactive sugar.
Detailed analysis gave the definitive numbers: My cancer is T2 or T3, N2, M0.
That means it appears to be mostly localized but has grown through some (T2) or most (T3) of the layers of the esophagus. There appears to be some minor lymph node involvement (N2). But it does not appear to have metastasized (M0).
The last part means surgery could be part of the treatment plan. Cutting the damn thing out and throwing it away is the surest cure. Once gone, the bad cells can’t go elsewhere and start a new tumor.
Kill the Monster
A “cure” is adjudicated when there’s been no evidence of cancer for five years. That’s the goal of chemotherapy combined with radiation and including surgery: Get rid of the cells, and make sure that any that’ve snuck away elsewhere are also poisoned and killed.
The priority is to deactivate the main source ASAP, and get the mopping up in progress at the same time.
Today, I’m several weeks into tri-modal therapy. That means I’m getting three different therapies.
Once a week for five weeks, I’ve been sitting with a drip plugged into my arm for a couple of hours. Each time, they squirted in two anti-nausea drugs followed a few minutes later with two poisons. The poisons, Paclitaxel (Taxol) and Carboplatin (Paraplatin), drench everything inside my body. The poison not metabolized by cells, good ones and bad ones, is pissed away in about 48 hours.
The poison that is retained affects growing cells more than those that are not. Cancer cells are growing so the poison weakens and kills them, and since they’re growing fast, they are more susceptible than regular cells. But hair follicles are busy, in my case, pushing out gray (used to be brown) stalks. The poison may shut them down–temporarily or permanently. Also, bone marrow that is busy making new red and white blood cells gets whacked.
Injecting enough poison to kill renegade cancer cells while not killing the body’s other cells is the trick.
I received the benefits from half a century of trial-and-error, and got my last dose of poisons Monday.
Good news: I still have all my (gray) hair. Also good news, while my blood tests report my red, white and platelet counts are down, they’re not terrible. And throughout the process, I never suffered any nausea or any particularly debilitating effects other than some lower colon gear shifting, I ate (mushy foods), walked about, did chores, slept more or less normally, and went about life mostly unaffected.
Looking at the other patients in the Outpatient Infusion Center at Mayo, I soon realized I was … lucky? Some of them were going through far more difficult ordeals. The side-effects of the chemotherapy poisons added to the poisons and effects of the cancers were heart-rending. And the sufferers knew things were bad. They tried to smile through their ordeals, but there was no denying the desperation, the fear, the certitude, in their eyes.
The goal of radiation–a beam of protons in my case–is to kill the primary tumor. (Chemo is for that, too, but more so for the ones trying to get away.) Radiation is targetted.
“We’re gonna zap it right there.”
You can point a finger at it.
But wouldn’t surgery first make more sense?
This is where that half century of experience and statistics since my Dad’s time come to bear.
Surgery is a trying ordeal. It’s hard on the body. If you do it first, the body is less able to withstand chemotherapy. And it’s the chemo that’s going to stop the escaped renegades.
On the other hand, if you weaken the body with chemo and radiation, it makes recovery from surgery more difficult.
Six of one, half a dozen of the other.
But experience has demonstrated, my oncologist said, that with esophagael cancers such as mine, it’s best to do chemo and radiation first, and then surgery after.
For the radiation, technicians have clamped me into a plastic harness every weekday for a month now. It positions my body into the exact same area of three dimensional space, within about two to three millimeters (an eighth of an inch) each time.
This is unlike Xray (photon, not proton) radiation that keeps on going. Xray therapy burns cells on the way in, and again on the way out.
Proton therapy, however, puts on the brakes. Zap and sizzle the cancer cells only.
I finish my time “on the rack” next Tuesday after treatment number twenty-five.
Sometime in early March, the surgeon will open me up. All of the cancer, about half of the damaged esophagus, and a good portion of the stomach will go. The goal is to remove all the cancer, dead or otherwise. By taking more than is visibly diseased, they hope to get all the cancer.
The procedure, named for Ivor Lewis who first reported on his approach to esophagectomy in 1946, is a big deal. Originally performed in two phases (two surgeries), it is now more commonly done in a single, long session. After removing the cancerous area and “margin”, what’s left is pulled up to join the part coming down. This moves the stomach above the diaphragm where it is reshaped. My surgeon says I’ll be eating six small meals a day instead of three to accommodate my smaller stomach. [2023 Addendum: I’m eating three meals a day now, and most of them smaller simply because I’ve learned I don’t need as much. Getting older, I guess.]
If you look on the web for cancer survival statistics, there are a couple of things to keep in mind.
First, statistics on medical results have to wait until patient outcomes are known. For cancer, that sometimes means the numbers are really known for several years. If your case falls in the interim, there won’t by many results to look at.
Second, techniques and treatments are changing all the time. By the time statistics have become knowable, they may also out of date; they no longer apply.
Third, our bodies are producing cancer cells all the time. The body gets rid of most of them. And when someone gets cancer a second time, it could be a new cancer, not a replay. There’s no way to know for sure. So the statistics that get published have to include everything because they just don’t know. Because of that, the numbers (for recurrences) look worse than they really are.
Because medicine is always improving, it’s also immediately out of date.
Physicians also know that a patient’s attitude and spirit are essential. I’m lucky to have the skilled experts guide me through this. But when it comes down to my part, I can tell you I’m gonna whip this cancer’s ass!
I’m gonna kick it, shoot it, stomp it, and boot it the Hell away.
Cancer is gonna be one sorry ass for ever messin’ with me!
Officially, I’m a survivor.
I’ve been cancer free for more than five years.
I have a few, very minor residual effects. I get full when eating, although my new stomach has stretched and I only need to eat three (or less) times a day, and I bruise easily. But I’m doing pretty much everything I want, learning new things, having wonderful experiences, and hardly ever think of what I’ve been through.
Because that was yesterday.
And I’m living for today, and planning for tomorrow!