T4N1M1

Did you spot the whirlwind over Springhead earlier this week? That was the home help that hit my home on Tuesday.  Shall we call her Mrs. C from now on? I knew from firstly having spoken to her on the phone, and then the subsequent ‘interview’ that we would get on fine and she would be just great at what I wanted her for. Having seen her in action on the first day I have no reason to doubt my judgement. She arrived whilst I was upstairs in the bedroom with two gorgeous ladies – District nurses. Yes, there were two ! Apparently they don’ get the chance to see wounds like mine very often and so a student nurse was brought along just for the experience. Another will be coming later this week. Please, form an orderly queue! I lay back and thought of England (well it was St. Georges day) as they poked and discussed my wounds and scars, and discussed further ways of keeping me out of pain. They’re bringing another type of cushion next time in an attempt to make sitting more comfortable, and there is still a 3 – 4 cm stubborn area of what used to be my bum that refuses to heal. This along with the internal stitches is what is causing me pain. In all honesty pain is tolerable as long as I am lying down, and considering the frequency of morphine I’m still taking, this is not a problem as I soon drift off to dream world.

By the time I had finished in the , ahem, bedroom, Mrs. C was underway in the kitchen. Quite obviously she thought this was the area that needed attention first, and who was I to disagree. She was well underway, rubber gloves on, cleaning agents everywhere, and my kitchen looking like it had been hit by a hurricane. I felt like an intruder (more embarrassed at the state I had let everything get into) and so retreated to the bedroom again for a rest. I emerged 2 hours later after my rest had transformed into a sleep, and my kitchen had transformed into, well, a well-kept kitchen I suppose. Everything was gleaming, and where it should be (as opposed to where I had it), in a couple of hours I seemed to have gain an awful lot of extra space. If you knew my kitchen, extra space is a godsend. I have a feeling that any attempt by me to ‘put things back  in a handy place’ will be scorned upon. I daren’t try. I have already learned that ‘do you want to keep this’ means “why are you keeping this junk?”. Mrs C nipped home, just around the corner, returning with a microwave plate to replace the one I had broken some six months ago, a new sink tidy, one she had spare at home, and some plant pots for those seeds she found in the carrier back (that’s where they were!). She quizzed me on what the dietician had advised me the previous day, and decided that as she lived just round the corner, that it would be no problem popping round with the odd meal or two. “One more plate won’t make a difference, and now your microwave is working again…..”. I conceded to this, no surrendered, only on the understanding that I would pay extra for this, over and above what we had agreed for her home help services. Oh, and she’s also got a tumble dryer….should I need it. The old me would have bluntly (and probably rudely) refused this extra help, and would have had the kitchen rearranged by the time she was back at her own front door. The new me has decided to accept her offer of help gracefully. She is genuinely concerned for my health and welfare, and it looks like I am lucky to have found such a gem. Before she left she had nipped to the shop just to get me a few things I needed for the fridge (things she thought I needed, not me) changed my bedclothes even though she admitted that she’d had a fight with the quit cover (I’m glad it’s not just me) and took my letters that needed to be posted on her way home. Oh, and she’s got a caravan by the coast should I ever want to use it when I’m well enough, “it’ll do you good”.  There are a few ground rules that need to be enforced before we go any further – I don’t put eggs in the fridge……that’s MY coffee cup, and there’s’ no need to apologise for putting BBC 6Music on whilst I was asleep, I am just grateful it wasn’t Radio 2.

Those of you who read my blog regularly will know that Thursday was the day I returned to The Christie to see Mr. S. I knew I wasn’t going to learn anything new, other than the results of histopathology. This is the pathology reports after detailed examination of the tumour following surgery. The first time that an accurate ‘staging’ of the cancer could be made. The result is a staging of T4N1M1 or using the older staging system, Dukes stage D. The only new bit of information from the TNM system is N1. T4 indicates the tumour size and how far of whether it has grown through the bowel wall. 0 being the lowest and least complicated, 4 being the worst. The M describes whether distant metastases (secondary tumours in other parts of the body) are present, 0 meaning no evidence and 1 meaning that there is. We knew that before surgery, the cancer has spread. The only new bit of information from the TNM system is N1. N represent Lymph nodes, and is confirmation as to how many lymph nodes the cancer has spread to. The higher the number of nodes affected the higher the chance that the cancer will/has spread to other parts of the body (other than liver/lungs). The surgeon would normally try to harvest between 10 – 1 nodes during surgery. Mr S had already warned me that this might not be possible as they may already have been destroyed by radiotherapy. As it was he removed 25 ! Quite an astonishing number, and out of the 25, only 1 was found to contain cancer. That is a brilliant result, and is an indication of  both the surgeons skill and the amount of bowel removed. The conclusion from this is that the cancer is more likely to have spread through my blood stream rather than the lymph system, and hopefully the spread is likely to be contained to my liver and lungs. It’s hard to grasp good news when you’re talking about advanced cancer, but I have to look at these results as being very positive. Mr. S warned me that there are no guarantees that the cancer won’t return in my bowel at some stage in the future, I’ll be monitored very closely for any sign of this in the years ahead, but overall I and he were very pleased with the outcome of surgery. Pathology had also found that the tumour had ‘grown back on itself’ burrowing through the bowel adjacent to the source of the original tumour. Radiotherapy had killed of this part of the tumour, leaving a large hole in my bowel. Perforation of the bowel is considered very serious, and justified the decision for bowel surgery first. It also explained the considerable pain I had been in for the last few months. Mr. S told me that the surgery had been both difficult and challenging, complicated by the damage from radiotherapy and the need for the insertion of a stent. I am just amazed that all this was carried out using laparoscopic surgery. I’ll always be grateful to Mr. S and his team, it‘s hard to pre-judge exactly what he‘s done for me, but in the meantime I’ll be grateful to him for probably saving my life. Considering the ordeal, I am recovering well. Unfortunately there was some damage to the nerves surrounding my bladder, and I have been prescribed yet more drugs to try to alleviate problems resulting from this damage. Again, I will be monitored over the next three months to see if there is any improvement, but it is likely that I’ll be referred to the urologist with a view to repairing any damage with further surgery.

So, Mr. S has finished with me for the time being. I’m not sue to see him for another 3 months. I’ve now been passed over to Oncology, to allow them to commence work on the spread of the disease, using their various drugs and toxins to stop any further spread of the cancer, and hopefully shrink that already present in my liver and lungs. Mr. S has warned me that this is not going to be pleasant, and I need to concentrate on getting fit and well before the planned, more aggressive chemotherapy begins. I think this represents part I completed. Bring on the next stage, I’m ready for a fight.

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This entry was posted in Be Loud Be Clear, Beating Bowel Cancer, Bowel Cancer, Bowel Cancer UK, Cancer, Cancer Research UK, chemotherapy, coffee, colonic stent, Health, Liver, Manchester, Manchester Blog Awards, Metastatic Bowel Cancer, Oldham, radiotherapy, Saddleworth, Springhead, The Christie, Uncategorized and tagged , , , , , , , , . Bookmark the permalink.

3 Responses to T4N1M1

  1. This all sounds very good & encouraging. Mrs S sounds a real treasure. Enjoy a bit of ‘mothering’ while you recoup & gather strength for the last laps (arms held aloft to cheers from your cyber supporters)

  2. Mrs C – I mean – not Mrs S !

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