Awaiting Trial

The picture was taken on Wednesday at The Belvedere Arms, Sunninghill during lunch with my wife and daughter after my appointment with Dr Middleton, the oncology consultant. The pained smile reflects the fact that my esteemed crowning glory (glowing golden in the sunlight, above) had potentially just been given its marching orders. The explanation rests in this summary of my current situation following the latest news revealed earlier in the day by the good doctor and Mary Townsend, the Nurse Specilaist, who, prior to my appointment and inbetween her ward round and clinic, kindly managed to squeeze me in for a long chat so that I could run a few things past her.

So what is the current state of play? 

The long and the short of it, having now had the opportunity to discuss my situation at length with three members of the MDT, is that Goliath* is a Stage 4 cancer consisting of a T3 tumour of approx 10cm in the lower end of the oesophagus (from 35-44cm). The cancer has spread to nearby lymph nodes in the form of small peritumoural nodal disease, and to a larger (approx 19mm) node in the hepatogastric ligament (between the liver and stomach) . There is also an infected node in the thoracic inlet (in the region of my neck). It is also staged as M1 because of secondary (metastatic) cancer in the L3 vertebrae of my lower (lumbar) spine and also a suspicion of metastases in my liver and lungs.

Because the nodal disease in the thoracic inlet is inoperable there is no curative treatment available and so palliative chemotherapy is the option open to me as the best way forward.

According to Dr Middleton the nature of the primary tumour and the node in the hepatogastric ligament give good indications that, subject to a further CT scan and tests, I may well meet the criteria for inclusion on the Real 3** research trial at St Lukes Cancer Centre, Guildford. Dr Middleton has outlined what this would involve and I am very amenable to the idea; despite the fact I will lose my hair as the result of a known side effect of epirubicin. Other considerations in this respect include diarrhea, (I may live to rue the day I said this, but in view of how all this started out,a change is as good as a rest as far as I'm concerned - see anecdotes), PPE, which effects the susceptability to cold in palms of the hands (never been known to drink cold ale anyway) and soles of the feet, and angina.

So it's back down into the tube (the one where the workers aren't striking) for another CT scan before the final decision is made. I appreciate the fact that all three main advisors are in the same team and are all singing from the same song sheet but I detect no discordant notes and trust their harmonised judgement implicitly. Hence at this juncture I feel totally comfortable with disregarding any thoughts about a second opinion; a point of view endorsed during a call to a Macmillan nursing advisor.

I have to admit that incurable was not where I wanted to be after this time but it could be a damned sight worse. If I am accepted for the research trial then I will have the best of a bum deal. And at least, on the basis of a marked disinterest amongst the professionals, I have shaken off the gremlin of what I envisioned to be the consequences of the secondary tumour in my spine which had me on the verge of booking a ticket to Switzerland on Air Dignitas! 

So though the trial is yet to start, I'm relatively happy with the sentence. 

On a lighter note, today at Fleet Pond I managed to persuade some of my dog walking compatriots that a quick adrenalin rush from a spin on a makeshift tree swing would do us all a world of good: I have no intention of growing old gracefully.

Caroline

Anna

Jeanette

David

 * How I inadvertently came to dubbing my adversary with this most appropriate of names is recounted in the anecdote pages.

** "A randomised open-labelled multicentre trial of the efficacy of epirubicin, oxaliplatin and capecitabine (EOX) with or without panitumumab in previously untreated advanced oesophago-gastric cancer"