Preliminary Diagnosis

tldr: Preliminary diagnosis of stage T3N1 rectal cancer. Go get a colonoscopy if you haven't already.

Around July of 2021, I started noticing some blood in my stool. It started happening on a more regular basis, usually first thing in the morning. By August I saw a primary care physician for the sole purpose of getting a colonoscopy referral. The colonoscopy was scheduled for Oct 20th, which seemed like a long time to wait. I was able to convince someone at Duke to get me an earlier appointment, in late September.

Take the prep, poop a lot of water, go get the procedure. Came to after the colonoscopy. Doc Crocker says there's a polyp too large for him to get that's the source of the bleeding. While still high on procedure drugs, I google up a doc in Duke's system that says he's got a special Japanese technique (ESD) for taking out large polyps. We wait on the biopsy, which comes back negative (i.e. not cancer). Seems like good news. Still, it has to come out.

The ESD doc (Dufault) says he can probably get it out. We have a great conversation about smoked brisket and how much I'm going to maybe miss it. Then we talk about the ESD process. What's great about that is he can use a hole I have instead of making any new ones. Simple, outpatient procedure. It takes 2 weeks, but we finally get that scheduled for Oct. 28th.

Big day comes. I go to get the 4 hour procedure, and get taken out of anesthesia after only about an hour. Doc says unfortunately procedure was not successful. Started doing some cutting, looked too ugly, stopped - Persistence, in this instance, would not have been virtuous. Woke me, broke me, got me a referral to a GI oncology surgeon - The one he'd use in my shoes.

Over the weekend, I'm wisely advised to push on imaging ASAP so we can evaluate staging. Thanks, Jed. Call, email, pester, get my appointment changed so that ct scan precedes talking to the surgeon.

Which brings me to today, which I spent at Duke. First for a contrast ct scan. The contrast they inject thru an IV. I'm a puker and a fainter when it comes to needles, blood and medicine. So I spent a few minutes white and sweaty while awaiting the ct. The fluid goes in, makes a metallic taste in the mouth and creates the sensation that I've wet myself. Would not wait in line to ride that again.

Then, off to see Dr. Migaly, a Duke GI oncology surgeon, for a 2PM appointment. I don't see his face until about 4PM. By about 5PM, I'm on a table having various implements inserted into my rectum. First, a rigid scope to determine if we'll call this colon cancer or rectal cancer (a matter of cm one way or the other - this one is just on the rectal side of the line). Next, an ultrasound machine to try to evaluate how far the tumor goes and whether any lymph nodes look upset. Finally, a flexible scope (a relief, as it's the smallest of the 3) so they can jab at the lesion and take enough samples to biopsy and get a positive cancer result.

Watching a metal set of jaws jab into my colon on the camera while under no anesthesia. Feeling the tug as little chunks of my colon were removed. Trying to joke with nurses who are likely tired of this surgeon pulling shit like 'we still got that ultrasound machine?' at 5PM. Moments I won't soon forget.

Preliminary results of all this day's testing and prodding is that the tumor looks like it is a T3, which I think means it goes past the wall of the colon. There looks like there is at least a single lymph node that is enlarged, which makes it about an N1. No proven metastases outside the colon (although there is a spot on the liver that they're mildly concerned about). Hopefully that makes it M0. What do all these terms mean? Go ahead and google them if you want to drop down a deep well of cancer stats and studies.

What it means for me is that, as of today, my likely course of treatment is:

0. More tests. MRI for liver, MRI for colon (may have to wait due to clips in there left over from ESD). Tumor presented at tumor panel, which seems to be some 'Hall of Justice' like meeting where all the Duke docs talk about what they'd do with this thing. Hopefully a positive cancer diagnosis on today's biopsy so we can shake it in the face of any Duke admin looking for justification for my use of various procedures/equipment/aircraft.

1. Some kind of chemo/radiation therapy to try to shrink the size of the tumor prior to operating on it. Side effects, while varied, seem uniformly unpleasant. I'm already skinny and bald, so I got that going for me.

2. Maybe 4-5 months from now - Surgery to pull a chunk out of my rectum/colon. Surgery that leaves me with a bag that the poop goes into until my rectum and colon have healed enough to be reunited.

Note: There are multiple technical terms for this bag. Most of those terms end with -ostmy. Few of those terms are more clear and succinct than poop bag.

3. Maybe 8 months from now - Surgery to get rid of the shit bag.

Is this course of treatment a 100% accurate description? Probably not. It's a decent gist of what I was able to retain after a day of having things shoved up my ass. Plus what I've been able to google in the interim.

That's it for now. Feel free to share, feel free to never look at this site again. I don't need everyone in my life all up in my ass (figuratively) - I'm pretty sure I don't want to have these conversations multiple times daily. So most updates will probably go here.

I've got more to offer than just the sum of my ailments.

~Ed