11. A Forest

31 May 2019 – Friday

The northern forest circles the globe through Russia, Scandinavia, and North America, covering approximately 13.8 million km² it is the largest forested area in the world. Nearly twice the size of, not just the Amazon, but all the forests of South America. Fortunately, the forests and land currently have little commercial value, so do not suffer the same levels of deforestation.

It seems that I’m not out of the woods yet, but that I’ve taken the first step into A Forest. 

I’m recovering very well from the bowel operation. Everything working, little to no pain. I even jumped on the exercise bike for 2, 20 minutes sessions yesterday and had a 1.5mile, 30 minute walk this morning. No problems, but Never Enough, so more today.

However, I met with my excellent bowel surgeon yesterday to get the results of the histology on what they had removed, and also the results of the MRI scan on the liver.  In summary, I have 2, still suspicious, spots on the liver, plus 9 others they think are no problem, but are too small to be 100% certain.  7 of 26 lymph nodes taken were positive for cancer, but the margins at the edge of the tissues taken showed clear. The bad news is that it has broken out of my bowel and spread to my peritoneum (the lining of the entire abdominal cavity).

There may be Six Different Ways to treat most cancer, but peritoneal cancer is not easy to detect or treat. The peritoneum has a poor blood supply which means that scanning technologies like MRI, CT, CT-PET, etc which use colour contrast dye introduced into the blood can’t see it. Chemo drugs target cancer cells, but do so through the blood stream too. So hard to see, hard to kill. The only way to know it is there, and the extent of it, is to have a physical look – this is what my surgeon noticed during the operation and cut some out for histology analysis. 

Not long ago there was no Cure for peritoneal cancer it was untreatable, more recently new treatments have been created which involve physical surgical removal (cytoreductive surgery), plus immediate (the same operation) heated chemo ‘bathing’ placed directly in the abdominal cavity – HIPEC (Hyperthermic intraperitoneal chemotherapy). HIPEC can be cancelled in the middle of the operation if they count too many cancer spots – it will not be effective.

Trying not to leave any stone unturned I had researched peritoneal cancer, liver cancer and treatment in advance of my meeting the surgeon. It seems the best liver surgeon in the country operates from Basingstoke hospital and the associated Hampshire Clinic has the most experience of HIPEC treatment and they are Close to Me. My bowel surgeon mentioned the same names I had already found – good confirmation. He is preparing a referral letter. I put my Faith in him and he has seen me through this first step.

The Walk in the forest. 

1. Meet oncologist
2. Baseline CT-PET
3. Start standard chemotherapy
4. Probably 8 cycles – 2 weeks per cycle, 1 week – chemo, Inbetween Days – rest. 
5. Meet liver specialist
6. Meet HIPEC specialist
7. Progress CT-PET
8. Cytoreductive surgery, visual peritoneal inspection to continue to HIPEC.
9. More mop up chemo (I expect)

The 3 year, survival rate for my age and condition from CRs and HIPEC is about 50%. I intend to be on the positive side. I’m doing all that I can to ensure that positive outcome – exercise, diet, research, best medicine, best medical approach, best professionals. After all, Boys Don’t Cry.

And while writing this I’ve listen to one of my favourite songs – A Forest.