Wednesday 11th March 2009

Hi All,

Unfortunately, the saga continues ...

I'll go into the detail as I have it so far in a bit, but the basic news from today's meeting with the surgeon is a mixed bag.

The histology itself is not good news, but threw up a big surprise which paints a better picture. The upshot is that they expect the cancer to return, but as and when it does, they have a lot more options open to them than usual, and a full cure is still not out of the question.

The surprise is that the tumour was not of the usual, expected kind and is actually extremely rare in the oesophagus (trust me to be special!). 95% of tumours here are what they call "adenocarcinoma", the other 5% are usually of another type (can't remember the name). Very occasionally they get an oddity, and that is the case here. My tumour is of the type "neuroendocrine", which is more usually associated with the pancreas (I'll need to do some research now as this is all new to me).

The histology shows that 7 out of the 24 lymph nodes extracted had tumour deposits - six of them close to the tumour, but one of them right at the margin of the sample removed near the main gastric artery (they think this lymph node was probably the rogue nodule). This is quite a high number, and also with one so near the edge being affected, there is the posibility that the next one in line which was not removed could also be affected.

There is also evidence at the "margins" of the tumour which is never good news, although there is nothing to suggest that they didn't manage to remove everything.

Given the above histology, had the tumour been the common type, it is likely that they would be telling me to expect the cancer to recur and kill me within two years. However, the good news is that as this is a neuroendocrine tumour, it means that it is likely to be much more slow growing than a normal tumour, so if there is any disease still remaining, or it does come back, the prognosis is better - these tumours can sometimes take many years, if not decades to grow (although nothing is certain of course).

The final aspect of the histology was regarding the chemotherapy - unfortunately there is little evidence that the cycles I had were really effective (this is quite common though).

So, what does all this mean? Short answer is a load more uncertainty.

Next step is to refer back to the Oncologist, and to probably bring in the pancreatic Oncologist, based in Leeds, for further help as he is more familiar with this type of cancer.

Although it was difficult for the surgeon to speculate in any detail, he suggested that this might mean further chemotherapy, but with different drugs. I'm not sure if this would be a short-term thing (after some recovery time from the surgery of course), or only if the cancer comes back - I have to find that out. What it is likely to mean though is that they will be keeping a close eye on me going forward, with further CT scans and ongoing tests to monitor the situation.

All in all, not quite what I expected, but then I have never really known what to expect throughout this process, and as usual it seems to be "cautious good news, with a healthy dose of uncertainty to look forward to" :)

All sounds serious, but as yet no death sentence - still plenty of hope going forward.

All of this is the interpretation of the surgeon however, and I will no doubt get more detail in a week or so from the oncologist.

So, more stiff upper lip and focus on the positive and just get on with it really. Can't change anything, and there is still everything to play for (like Spurs' fight against relegation really!) so, "Onwards and Upwards" as they say!

Cheers,

Colin.