I am a 60 year old male who was picked up by the national bowel cancer screening fecal occult blood test program which every adult gets sent in the UK at 60.
I am experiencing absolutely no symptoms at all, don't smoke, have a healthy diet, do a lot of walking and am not overweight and so it was a real surprise and shock to find out that I had rectal cancer.
They did a CT which did include the liver, but for some reason the initial MRI did not include the liver.
There are unfortunately 2 or 3 liver nodes that have cancer in them and the tumour tumour extends <1 mm beyond muscularis propria.
In the TNM system it is T3A N1 . There is no evidence of CRM involvement or EMVI.
A further thing which is causing me concern is that the CT found 3 very small lesions in the liver. One is a Haemangioma which is a benign tumour of the liver which my consultant says never becomes cancerous so we can ignore that. The other 2 are extremely small, too small for a biopsy apparently, and too small for the CT scan to identify what they are.
I don't know why they didn't do an MRI of the liver initially but they are now going to do one and hopefully that will tell me what they are and whether they are cancer or not and complete the staging. If one or both of these small lesions is cancerous then I have a stage 4 rectal cancer, 2.9 cm in length, 12 cm from the anal verge. If they are not cancerous, then I have a stage 3B which corresponds to T3a N1 M0.
I have had the CT scan to measure me up for radiotherapy. Treatment is starting on 19/12/18 (I pushed for it to start earlier several times, but this is the UK National Health Service which is free so I don't have a huge amount of leverage and they refused saying it wouldn't make any difference to outcome, a claim I am sceptical of). From initial colonoscopy to start of radiotherapy will be 5 weeks and 3 days which feels far too long to me but I am not sure if I am right.
I have a performance status of 0 because I can do all normal daily activities with no problem.
If the lesions in the liver are not cancerous treatment will be:
five and a half weeks daily radiotherapy with daily oral Capecitabine chemotherapy.
Then rest for 8 to 10 weeks whilst radiotherapy/chemotherapy continue to have an effect after finishing.
Then surgery to remove the tumour and a margin of surrounding tissue as well as affected lymph nodes. Temporary ileostomy to allow the rectum to rest. Reversal of temporary ileostomy a few months later. They said with rectal cancer you have to do the final staging after surgery.
If the small lesions in the liver turn out to be cancer, these will be treated (I think by surgery) during the 8 to 10 week gap after the end of radiotherapy and chemotherapy.
I am obviously very concerned as I have seen the poor survival rates for Stage 4 rectal cancer (12% according to cancer.org, the American Cancer Society website). My consultant said that as I am fit and relatively young and they are very small lesions I would have a better chance than this, but I would welcome any information on how to improve my chances and would welcome any comments drawing on all your wealth of experience.
Warm best wishes,