[2021-12-15] More cancer
On November 15 (More surgery), I provided the first installment in my latest brush with cancer. Today, I share the second installment.
This morning, I met with my surgeon, Dr. Boushey, and his associate, Dr. Tropiano, to have stitches removed from my surgical incision to deal with perianal skin cancer. Dr. Boushey indicated that I am healing well—so well, in fact, that my stitches were difficult to extract (ouch!).
We also discussed next steps.
We know from the pathology report that I had both precancerous and cancerous cells in my perianal area. On November 15, Dr. Boushey removed the cancerous tumour in its entirety, but precancerous cells remain in the margins of the incision. As well, the gap between the cancerous tumour and the edge of the incision was as small as 1 mm in one spot. Because the precancerous cells could mutate to cancerous cells in the future, I haven't yet put this issue behind me.
To deal with the remaining precancerous cells, I have several options:
- Submit to ongoing observation (through diagnostic scans and regular exams) and be treated with surgery or radiation if the precancerous cells become cancerous
- Undergo additional surgery to try to remove the remaining precancerous cells
- Opt for radiation to deal with the precancerous cells
I wasn't keen on Option 1—essentially a wait-and-see approach—since the radiation oncologist I met, Dr. Jin, indicated that I had a high risk (at least 50%) that the precancerous cells would mutate and become cancerous.
Option 2—additional surgery—may not be ideal for a couple of reasons: (1) the precancerous cells are in a precarious position for surgery (and I haven't had an easy go recovering from my first round of perianal surgery), and (2) it's impossible to know how large the field of precancerous cells is.
Option 3—radiation—will treat the remaining precancerous cells, much like chemotherapy dealt with small tumours that remained after my ovarian cancer surgery. According to Dr. Jin, radiation is very successful for squamous cell carcinoma: 85% of people with anal cancers even more advanced than mine are cured after radiation, she said.
At this time, chemotherapy is not being contemplated. I have already had chemotherapy for ovarian cancer, and the effects of that treatment are cumulative. And because I am on a targeted therapy to avoid recurrence of ovarian cancer, chemotherapy to deal with a second cancer would be tricky. So the downsides of chemotherapy are as significant as the upsides, and may not be necessary. That said, I will have an MRI on January 3 to check whether I have cancer in my pelvic lymph nodes. If I do—though Dr. Gotfrit, the medical oncologist I met, felt that it was unlikely—I would undergo both chemotherapy and radiation.
I have already had a CT scan to prepare for radiation, which is scheduled to begin on January 5. The radiation itself takes only 5-7 minutes, so the whole process of checking in, getting radiation and checking out should take no more than 20 minutes. I will meet with Dr. Jin once a week. I will receive radiation treatment at the Irving Greenberg Family Cancer Centre on the campus of the Queensway Carleton Hospital. Given the number of treatments I will undergo (25 over a span of five weeks), a 10-minute drive from my home is preferable to the 30 minutes it takes to get to the General Campus of The Ottawa Hospital.
I would prefer not to be facing a second cancer, but I'm taking it in stride. I just keep putting one foot in front of the other, taking the advice of the medical professions and doing what I need to do to regain or maintain my health.
At the same time, I'm sharing this information with Jenesis readers as a public service. My message is this: if something doesn't feel right, get it checked out.
