I'm thinking of all the people I love and who I know love Betsy and me. We've both very much appreciated all of your emails and phone calls. Our story follows.
During the third full week of July, 2008, I noticed a change in by bowel movements and had some mild tenderness accompanied by a minor stitch in my lower right abdomen. I went to my general practitioner and was sent for a CT scan to rule out appendicitis.
Appendicitis was ruled out, so they scheduled a colonoscopy for the next day with the same gastroenterologist who had done my baseline colonoscopy six months earlier and who then removed a polyp that turned out to be nothing. He was very surprised (Betsy says "visibly shaken") when he reported to her while I was still in the recovery room that he now saw what he believed to be cancer, as well as some inflammation of lymph nodes and spots on my liver.
It appeared to him that the cancer had grown on the outside of my colon, which was why he couldn't have seen it six months earlier, but had now pierced the colonic wall and spread both into my colon and further outside as well.
On 4 August I had about nine inches of colon and my entire peritoneum removed, along with a wedge of my liver, all biopsied. Last evening, the surgeon (who was excellent in every way) verbally presented Betsy and me with the results of the biopsy of those tissues. Dr. Maher, my gastroenterologist, had been substantively correct: cancer that originated in the wall of the colon had spread into the colon and outward to my liver at the same time, and fast. That's why the original colonoscopy couldn't detect it, it was hidden from view. 18/53 lymph nodes were malignant and my peritoneum was also found to have lesions, so it was removed also. That makes the cancer officially "stage IV".
The cancer is a "neuroendocrine carcinogen, high grade, poorly differentiated." This means that it is likely to be quite aggressive. They're not talking about being able to cure it; rather the conversation is about how to give me a good quality of life for the time I have, which may or may not be extended some with aggressive chemotherapy and maybe some experimental treatments.
Dr. Bowers, the surgeon, arranged for a local oncologist with whom he works closely and knows well, to stop by my hospital room early this morning, and he is already reviewing my case. They are both highly competent, very well educated, board certified in multiple fields, and they communicate with each other frequently, making the seams of the handoff very tight and efficient. Betsy and I both already like the oncologist, Tom Rado, a Ph.D. as well as MD.
I am recovering well from surgery and hope to be discharged from the hospital today or tomorrow. The stay has been exhausting and my blood pressure has responded to the high side accordingly.
Thanks to everyone for giving me time to recover. The remainder of this story will evolve in the journal. What I've provided here are the basic clinical details as we now know them.
The meaning of all of it is yet to be determined; how what appears to be a shorter life expectancy might produce extraordinary outcomes, both good and bad. I'll do my best to keep in touch. I am far more concerned about Betsy than I am about myself.