I have esophageal cancer, a “locally advanced adenocarcinoma of the esophagus” to quote the doctor.
It’s down inside the lower third of my esophagus.
I noticed difficulties swallowing. Food would get stuck and I’d need a drink of water to flush it down. At first I attributed this to tension and stress; it’s like that choking condition you feel with extreme emotion and it becomes hard to swallow.
“A hiatal hernia?” I guessed. That’s where part of the stomach gets pulled up through the top of the diaphragm. When that happens, the esophagus becomes a winding path with bends and kinks.
But the problem didn’t leave when the stress did.
Last October, I called my GP. He jotted down my complaint of dysphagia and signed me up for a look-see, an upper endoscopy.
Two-thirds of the way down to the stomach, they found it.
The tumor is about two inches (five centimeters) long and forms a plug about 75% the diameter of the esophagus. Only paste and liquid get by.
Biopsies confirmed the cells were cancerous.
Where the Hell did that come from?
Humans create about 240,000,000,000 (240 billion) new cells every day. That’s 2,000,000 (2 million) per second.
Each of them gets DNA-level programming for function. Some are red blood cells that move nutrients around. Some are skin that seal away our insides to keep the baddies out.
But all of them–well almost all–are programmed to grow to a certain size, stop growing, do their job, and then die.
That programming is in the genes.
But in cancer, the part of the programming that says, “Stop growing,” doesn’t work, or something else in the gene is switched on that starts wildly signaling, “Grow, grow, grow” and drowns out the “Stop growing” signal.
That gene that gets switched on that sends the bad signal is called an oncogene, a cancer-causing gene.
I’m guessing that most cells with faulty programming never make it past boot-up. Like a computer with a bad disk, most broken cells blink a couple of times and then shut down. They die.
Human DNA contains about 204,000,000,000 (204 billion) atoms. Jumbling a few is enough to change what the cell does, to activate an oncogene.
Atom-level jumbles in DNA occur all the time. We start life with some bad programming from our parents, genetic-level programming. Scientists call these “germ-line mutations.” These are conditions you don’t like, such as my tendency for gout and restless leg syndrome. Thanks, Dad. Or the arthritis in some of my joints. Love you, Mom.
Other mutations happen in the environment. A bad sunburn, chemicals and viruses can switch on an oncogene.
For the most part, the body recognizes the “alien” and gets rid of it. The body heals.
“Few mutations are bad for you. In fact, some mutations can be beneficial. Over time, genetic mutations create genetic diversity, which keeps populations healthy. Many mutations have no effect at all. These are called silent mutations.”
But you don’t catch cancer like other diseases.
Cancer is, in a sense, built-in. We make it ourselves. Or have a tendency for it. Scientists mapping the human genome will ultimately enable cancer researchers to identify oncogenes.
My Dad had esophageal cancer in his eighties. One possibility is that I inherited a predisposing condition. That is, he and I share an oncogene that made this particular kind of cancer, and we share some physical characteristics such as excessive acid production or maybe a weak valve between esophagus and stomach that triggered the oncogene.
Indeed, in my endoscopy, they saw evidence of Barrett’s esophagus. That’s a condition that develops when stomach acid re-fluxes up into the lower part of the esophagus and burns it.
My Oncologist said there’s a one-in-ten chance Barrett’s esophagus will progress into an adenocarcinoma.
While I could try to blame my parents for my acid re-flux, it’s far more likely I did most of the damage, most of the provocation to that gene, to myself.
For the past thirty years, I’ve traveled the world on a company expense account. And I admit to many fabulous meals at strange hours with odd sleep cycles.
In the early years, I knew acid re-flux quite well. I would verify the supply of Tums in my travel case before every trip because I knew I’d need them.
Looking back, I now recognize that, over time, I needed them less and less. The Doctor speculates my Barrett’s had scarred over by then and I no longer felt the re-flux.
More trips, more big meals at strange body-clock times and, voila, the odds caught up with me.
I did it to myself and the oncogene in probably one single cell near the bottom of my esophagus began shouting its “Grow, grow, grow” message.
Confirming that the tumor was malignant (cancer) is done with a PET scan.
Cells love sugar. They suck it up and burn it. Cancer cells are as ravenous as they come.
A technician injects sugar tagged with a short-lived radioactive something-or-other. The cancer cells gobble it up. Remember, they’re growing whereas most regular cells have heeded the STOP signal. Cancerous tumors then shine in the PET scan with the evil light of the radioactive sugar.
Detailed analysis gave the definitive numbers: My cancer is T2 or T3, N2, M0.
That means it appears to be mostly localized but has grown through some (T2) or most of the layers of the esophagus (T3). There appears to be some minor lymph node involvement (N2). [The lymphatic system is one of the paths the cancer cells will follow if they break away and metastasize.]
But it does not appear to have metastasized (M0).
The latter means surgery could be the final step in the treatment plan.
Surgery–cutting the damn thing out and throwing it away–is the surest cure. Once gone, the bad cells can’t go elsewhere and start a new tumor.
It is considered a complete cure when 100% of the cancer cells are removed. That’s the goal of chemo plus radiation plus surgery.
Unfortunately, the PET scan can only see things about a quarter-inch in diameter or bigger. If cancer cells are lurking about in small groups, they won’t be in the picture.
And since bad cells could go for a walk-about at any time, it’s important to deactivate the main source ASAP.
Today, I’m several weeks into tri-modal therapy. That means I’m getting three different therapies.
Once a week for five weeks, I’ve been sitting with a drip plugged into my arm for a couple of hours. Each time, they squirted in two anti-nausea drugs and then two poisons. The poisons, Paclitaxel (Taxol) and Carboplatin (Paraplatin), drenched everything inside. All of the poison not absorbed by the cells is then pissed away in about 48 hours.
The poison that is retained affects growing cells more than those that are not.
Cancer cells are growing. The poison weakens and kills them.
Hair follicles busy pushing out gray (used to be brown) stalks may go on break. Also, bone marrow that is busy making new red and white blood cells throttles back.
Injecting enough poison to kill renegade cancer cells roaming about the body is the goal.
… while not killing the body’s other cells, of course.
I got my last dose of poisons Monday.
Good news: I still have all my (gray) hair.
Also good news, my blood tests report my red, white and platelet counts are down.
So, the effects of the poisons are, in my case, mild but definite. I’ve had no nausea and, other than some lower colon gear shifting, no other issues.
Looking at many of the other patients in the Infusion Ward at Mayo, I am somewhat embarrassed. Many of them are going through far, far more trying ordeals.
But I know that if as few as one renegade cancer cell succeeds in hiding from chemotherapy, it could start a new tumor.
If that happens, I’ll be back for a second, probably more trying, round of chemo.
The goal of radiation–a proton beam, in my case–is to kill the primary tumor.
Wouldn’t surgery first make more sense?
This is where experience and statistics come to bear.
Surgery is a trying ordeal. It’s hard on the body. If you do it first, the body is less able to withstand chemotherapy. And it’s the chemo that’s going to stop the escaped renegades.
So, in the tri-modal therapy approach, you get chemo and radiation first. And then several weeks after they body has recovered, surgery.
Every weekday for a month now, technicians have clamped me into a plastic harness. It positions my body into the same two to three millimeters, about an eighth of an inch, each time.
There’s a synchrotron in the basement of the Mayo Clinic Cancer Center here in Phoenix. It uses strong electromagnets to give protons the exact energy needed. The beam, about the size of a pencil lead, penetrates skin and bone, but then stops at the tumor. Unlike Xray (or photon) radiation that keeps on going, protons stop! All their energy dumps into the tumor.
Zap and sizzle!
I finish my time “on the rack” next Tuesday after radiation treatment number twenty-five.
Sometime in early March, the surgeon will open me up. About half of the cancer-damaged esophagus and a good portion of the stomach will go. The goal is to remove all the cancer, dead or otherwise. By taking more than is visibly diseased, they hope to get all the cancer.
What’s left of the stomach will be pulled up above the diaphragm and reshaped. The doctor says I’ll be eating six small meals a day instead of three excessive ones.
“There are three kinds of lies: lies, damned lies, and statistics.” (Samuel Clemens)
If you look on the web for cancer survival statistics, please note a couple of things. First, statistics on medical results have to wait until patient outcomes are known. For cancer, that’s several years.
But techniques and treatments are changing all the time. Thus, by the time statistics have become knowable, they’re also out of date. In other words, they no longer apply.
Second, we’re “growing” new cancer cells all the time. When someone gets cancer a second time, it could be a new cancer, not a replay. There’s no way to know. So the statistics include everything. Again, not only are they wrong, they’re also pessimistic.
Statistical cancer survival rates, therefore, are worse than reality. And because medicine is always improving, they’re also immediately out of date.
Don’t believe them.
I’ll add one final point.
Physicians know that a patient’s attitude and spirit are essential. I’m lucky to have the skilled experts guide me through this. But when it comes down to my part, I can tell you I’m gonna whip this cancer’s ass!
I’m gonna kick it, shoot it, stomp it and boot it the Hell away.
Cancer is gonna be one sorry ass for ever messin’ with me!
Now, go back and play again that video at the beginning of this post.