137. Chemo A Possible Scenario nr. 2

Small recap:  FIT tests done in 2019 and 2021  (2 year interval.)  Result of 2019: normal.  Result of 2021: abnormal, with subsequent colon cancer diagnosis.

The surgeon who operated on me in 2021 by removing the colon cancer, stated that the disease had been a long time in the making: several years in fact.  He implied that the cancer had been slow-growing, a somewhat reassuring notion.  What wasn't so reassuring:  I had had a FIT test done in 2019, where no blood in the stool had been detected.  My burning question: Why had the FIT test in 2019 not picked up on any abnormality if the cancer was present and growing at the time already?

My oncologist on the other hand claims that the cancer had started more recently.  So then, let's assume that in the second scenario the cancer took hold after the "normal" FIT test of 2019 was done, between 2019 and 2021.   Referring back to post nr. 133 about the Jackalope and the HPV virus:  It has been suggested (and sometimes established) that some cancers may be caused or triggered by some viruses and/or bacteria.  

At the beginning of 2019 my FIT test came back "normal".  My husband and I went on a trip to Europe at the end of 2019, (so after the normal FIT test.) During that trip Dave and I ate pretty well the same foods most of the time.  Except for our last evening.  Dave ate fish and chips.  The fish came right out of the deepfreeze and went straight into the deep fryer.  Deep-fried fish was too greasy for my liking.  I chose shawarma. You know, that big slab of meat on a rotisserie. This turned out to be a huge mistake because during the night I ended up with a severe case of some kind of food poisoning.  Dave was fine.  He did not get sick.  2 years later I get diagnosed with stage 4 colon cancer. Hmmm Coincidence?

From an article in The Guardian:  "Discovery of Bacteria linked to Prostate Cancer hailed as a Potential Breakthrough".

From I-forget-the-source: 25% to 80% of people with Streptococcus bovis/gallolyticus bacteria have concomitant colorectal tumors.  It has been suggested that the presence of antibodies to Streptococcus bovis/gallolyticus antigens or the antigens themselves in the bloodstream may act as markers for carcinogens in the colon.

From Wikipedia:  Most E-coli strains are harmless but pathogenic varieties cause serious food poisoning which may increase the risk of colorectal cancer by producing the genotoxic metabolite Colibactin which is believed  to cause mutations leading to colorectal cancer and the progression of colorectal cancer.    

Of course, not every case of food poisoning leads to cancer.  That's not what I am saying.  But it may contribute if all the conditions are right for it.  A Perfect Storm so to speak.  This is just my hypothesis.  Do I know for a fact that this is what caused the cancer in me?  Of course not!  There could be all kinds of causes that contributed.  But if there is one message in my story, it would be, like the one you hear all the time: go easy on "the meats"!

Back in a while. I am planning a frivolous up-beat post for next time.  Take care! SanTeh!

120. Chemo 1 Year Follow-Up Colonoscopy

Yesterday I underwent a 1 Year Follow-Up Colonoscopy, i.o.w. it has been a little over a year that I underwent surgery for colon cancer and therefore  you automatically get scheduled for a colonoscopy one year hence.  The technical term for my surgery: a laparoscopic right hemicolectomy. (There's a mouthfull!)  In plain language: all of my ascending colon, a small part of my small intestine, 6 lymph nodes as well as my appendix were removed and the disconnected parts were re-assembled.  No, I did not end up with an ostomy (bag) thank goodness.  And everything healed up well, also a blessing! That was last year.  So it would not surprise you then that I was not looking forward to this  because I was dreading that more cancer might be detected.  It turned out that 1 polyp was found, removed and sent for biopsy.  Much to my relief nothing else was discovered! 😅  And I have 3 nice photos of the inside of my colon, much nicer pictures than the ones I was presented with last year let me tell you! The colonoscopy was performed by the same surgeon who did the above operation.  I was sort of awake through it this time and there were no after-effects such as pain, nausea or what have you.  I was a bit drowsy and went to bed early, but felt fit enough to join the women of our walking club this morning.  The surgeon said that I would not need another colonoscopy for the next three years.  But pending on the result of this biopsy, I may try to get a colonoscopy in another province in a year or so, even if that means I'd have to pay for it out of pocket.  I am not too confident that the cancer won't come back (see post nr. 21 about the FIT test) Here in Saskatchewan all our health care is covered.  I shudder to think what my cancer treatments  would have cost if we'd be living in the States with no health coverage.  I guess I might not get the care that I would need then?😢   Now if only we'd be able to also get this liver "thing" under control.  That would be awesome!

Back tomorrow with some more info on Nanoknife and then on to more pleasant things.  SanTeh!

51. Chemo Husband: FIT as a fiddle

We've had a tense week in our house.  Correction: we've had a tense month.  After a 2 year interval, my husband sent his FIT stool sample in to the Screening Program for Colorectal Cancer  (read FIT Part 2 What went wrong) and the result came back as "abnormal".  Naturally we panicked.   He followed the usual enema protocol and went in for the subsequent colonoscopy yesterday.  We were bracing for the worst...  Imagine the consequences of him having colon cancer and needing chemo treatments also!  That meant... I would have to revert back to doing housework again:  cooking,  cleaning, laundry, vacuuming and so on instead of working on my blog!  Rats! 😖

Three small polyps were discovered, promptly removed and sent for pathology.  He has a follow-up appointment in 4 to 6 weeks, so we assume all is well.  It is recommended that he has a repeat colonoscopy in 3 to 5 years depending on the pathology report.

So I say: three cheers for the Screening Program!  Hip Hip Hurrah!  This greatly restores my faith that things can be caught at an early stage!  We are grateful!!!

If you know of anyone between the ages of 50 to 74 who is not participating, please tell them about the Screening Program for Colorectal Cancer and/or share my blog site.  I thank you!  And they may thank you in kind!

In the mean time I am doing some more digging/research.  That takes time.

No posts till Saturday, the "light" one that I promised.  And no posts on Friday.  What do you take me for?  A fool? Ha! Ha!😁😁😁 Take care!

49. Chemo A FIT Discovery

An interesting discovery on FIT...

Canada has 10 provinces and 3 northern territories.  12/13 have implemented the FIT screening test for their citizens;  Manitoba employs a slightly different test called FTg (fecal test guaiac).  With the exception of Manitoba and British Columbia, the FIT tests in Canada are supplied by 2 major manufacturers: Alfresa Pharma and Polymedco. (2016-2017)

Most types of cancer, including colorectal, have 4 stages, numbered 1 through 4, with stages 1 and 2 generally having the best survival rates.  The following data are taken from: www.canadianpartnershipagainstcancer.ca but dates unfortunately from 2016-2017.  Will try and find more recent, if available!

Province:    Stages 1 & 2      Stages 3 & 4

Alberta             57%                    43%

Saskatch           61%                   39%

Manitoba           65%                   35%

Ontario              56%                   44%

New Brunsw     60%                    40%

Nova Scotia       66%                   34%

Prince E I           63%                   38%

Newfdl + Lab     71%                   29%

Remember:  Stages 1 and 2 are generally better than 3 and 4:  so the higher the percentage in Stages 1 and 2, the "better"!  Data from BC,  Quebec and from the 3 Territories were not included.  So it got me wondering about what is happening in BC and about the Beckman Coulter Test used in Manitoba?  (worth digging into)  Notice that in the maritime provinces the cancer tends to get "caught" more at the earlier stages.  Notice the 10% difference between our province SK and NFL.  Population wise this could be a significant difference!  Why the difference, you ask?  Maybe because: Most provinces and territories require ONE sample collection for the FIT, with the exception of Prince Edward Island and Newfoundland and Labrador which require TWO!!  This may not be the only reason for the difference of course but I think it deserves mentioning!   Or perhaps we can attribute it to Newfoundland's famous screech? 😉 What do You think?

Back in a day or 2 and on a "lighter note"!😊

 

39. Chemo Getting a Colonoscopy

So I received the abnormal FIT test result letter on June 10th, 2021 and was promptly scheduled for a colonoscopy one month later which, being in the midst of a pandemic, turned out to be a very short wait time indeed!  I was very lucky that way!!

Colonoscopies are considered the "gold standard" for colorectal screening.  They may not only detect cancer but other colonic anomalies as well.  If small polyps are discovered, they simply will be removed; larger ones  get sent to a lab for a biopsy.

For the patient, the worst part is that you have to completely empty your bowels in preparation for the procedure.  Your endoscopist will send you a letter outlining how to follow a special diet.  Follow his or her instructions to a T.  There are small variations on this, so I won't elaborate here.  The worst part of the diet is that 24 hours before the procedure you have to drink a laxative solution, consume mostly liquids only and go to the bathroom often.  Most people find this the hardest part to endure.

When you go into the operating room you will meet the team, a very kind, knowledgeable and experienced group of people and you may receive a sedative or a very light form of anesthesia.  

In my case I was anesthetised and came to, after what seemed to be a very refreshing short nap.  If there is any discomfort afterwards, it may be from a wee bit of gas to open up the pipes a bit, so that the endoscopist can have an extremely good look around.  As a result you may feel a bit gassy for a day or two, but no doubt, you will come out "squeeky clean".   (More than 95% of people referred for colonoscopy do not have cancer, according to the Screening Program.)

 What happened in my case was that I went into the procedure with one endoscopist, but when I came to, a different young man appeared by my side.  He was friendly and introduced himself as being a surgeon and we chitchatted a bit.  He said he was going to take over my case and then came the three dreaded words that no one wants to hear: "You have cancer".

37. Chemo The Murky Period

I wish I could be more specific about the time between my positive FIT test letter and the subsequent colonoscopy.  But it all is muddled and murky to me.  You see, I had been losing more and more (invisible) blood and was suffering from Iron Deficiency Anemia without knowing it.  IDA is a condition caused by low levels of iron in the blood due to blood loss.  As a result I was constantly tired, lightheaded, dizzy, short of breath and close to passing out.  I also was still walking with the local women's club.  And it was during several of these early morning walks that I had the most peculiar sensation: I just wanted to lie face down on the ground and rest.  Later on I discovered that in some cultures people crave and eat clay or dirt when they experience a lack of iron in their diet!  That is not an unusual occurrence! 

33. Update on FIT Part 4 - March 2nd

Updated post on hysterectomy!  It was missing some information.  Thanks to Mary who pointed it out!!

29. Chemo FIT Part 7 Hemoglobin detection

As you recall, FIT detects blood in your stool, except that you may not be bleeding at the time you are collecting the sample.  Here is a recount of what happened to me with the FIT test last year, which was positive.

I received the kit in the mail around February 2021, (don't recall exactly because I did not keep a log at the time.)   It sat around for a while, till I finally decided to send it in to the lab in late May.  That, I remember vividly because my husband went on a fishing trip then and I was suffering from a BAD case of sciatica when he was gone. This case of sciatica was really bad.  So I did what I normally do when this strikes;  I take Robaxacet.  Except that supplies were still pretty low last year.   I could not find the usual Robaxacet, but found and bought Robaxisal instead (active ingredients in each caplet: (ASA) 500mg (NSAID) and methocarbamol 400 mg).  I took that medication for at least one week, but no more than the maximum recommended dose.  That was when I sent my stool sample in.  Now you may think I have gone off my rocker and I do not claim this to be gospel, but somehow I can not help but wonder if this medication helped the bleeding of the tumor? And resulted in a positive FIT test. Could there be something to it?  Possible.  Because on the package it says: do not use if you have or had an ulcer, are prone to bleeding; may cause severe bleeding, etc.  Could it just be a co-incidence? Also possible.  Maybe the tumor was close to bleeding anyway.  But so late in the game?  I shudder to think of it that I might have sent it in right away in February when I had no sciatica and possibly no blood might have been detected then.  Yikes!  I have some well meaning people point out to me that it probably was an aggressive tumor, but that is not what the biopsy report stated.  It states a Grade 2 tumor, Grade 1 being least aggressive, Grade 4 the most.  So it may have been hanging around for a (long) while without being detected.  Just unluck of the draw i.o.w. just bad timing?  Who knows?  What I also do remember is that after the sciatica episode, I became progressively more and more anemic as a result of blood loss, without me being aware of it.  But more about that another time.  Enough food for thought here. 

I may be back tomorrow.  I had a great treatment yesterday, which I need to write about.  And hardly any neuropathy!!  I can use my hands!!!  YEAH!!!!!!

28. Chemo FIT Part 6 More on Gender

If you read the last part of Fit (Part 4) you might recall that I touched briefly on gender differences.  Turns out something might be up with that.  I am relying on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415207 for the following information.  The title is Fecal Immunochemical test-based colorectal cancer screening: The gender dilemma.  (2017)   I quote: "Differences in FIT screening between men and women can be explained by a combination of factors.  It has been suggested that because men have a higher hemoglobin concentration in general, blood from bleeding polyps will contain more hemoglobin.  As FIT specifically detects globin in feces, blood from these polyps could be detected more frequently in men.  This is supported by the fact that differences in fecal Hb concentration have been found in men and women. 

 A second explanation could be that women have more right-sided lesions, as it is known that fecal occult blood testing may not be as sensitive for proximal lesions as it is for distal lesions.  Yet our data did not show differences in location of advanced neoplasia (AN) between men and women.

Another reason for gender differences in FIT test characteristics could be the differences in colonic transit time between men and women, with women having slower transit times.  A slower transit time could lead to more degradation of hemoglobin and could decrease the likelihood of blood being detected by FIT.  ...

In absolute numbers, more advanced neoplasia are detected and missed in men for all cut-offs (of detection).  Adjusting cut-offs based on gender can contribute to the efficacy of FIT-based CRC screening programs and optimize the use of available endoscopy resources.  At present, men and women are informed in the same manner about FIT-based Colorectal Screening. ...  Individuals invited to attend a FIT-based CRC screening should be informed accordingly about these gender differences." End of quote.  (I could not find a copyright so presume it is all right to quote.)

Biomedical research has demonstrated biological differences between females and males in virtually every organ and system of the body. Research has also revealed the genetic and molecular basis of a number of gender-based differences in health and disease, some of which are related to genotype — XX in the female and XY in the male.

These findings suggest that there are multiple differences in the basic cellular biochemistry of males and females that can affect an individual's health. Many of these differences do not arise from differences in the hormonal regime to which males and females are exposed, but are a direct result of the genetic differences between the two sexes.

Further studies on the relative roles of the sex chromosome genes is likely to illuminate the reasons for expression of some diseases within and between the sexes. Understanding the bases of these gender-based differences is also important for the development of new approaches to disease prevention, diagnosis, and treatment.

source: ncbi-nlm-nih.gov

25. Chemo FIT Part 5 Visible or Not

 To See or Not To See

That's the question.  I had vaguely been wondering if it was possible that, after the FIT test in 2019 came back negative,  and presumably I had a tumor already growing in me, it might have started bleeding after I had the FIT test done.  Turns out that it is very possible that at the time  you are dilligently collecting your stool sample it is not bleeding at all.   It could have been before and after and not during.  It even states that in the brochure "Understanding your FIT results" from SaskCancer.  "Polyps can develop over time and Bleed Intermittently, which is why you should complete the FIT every two years."  Intermittenly means "of" and "on".  Isn't that comforting to know?  Small wonder it wasn't caught earlier!

There's a bit more yet.  But I am very busy tomorrow.  Back on Friday.  Take care!

24. Chemo FIT Part 4 Gender differences and Hormone Replacement Therapy

Sorry folks, the colonoscopy part will have to wait a while because I am not done with FIT .  I do not have the answers I am looking for yet, but I think I am getting close(r).

So the screening program tests women and men aged 50 to 74.  It goes on the premise that "one size fits all".  Remember a while back when it suddenly came to light that women's bodies were not like men's and that women had very different symptoms than men concerning heart attacks?

Biomedical research has demonstrated biological differences between females and males in virtually every organ and system of the body. Research has also revealed the genetic and molecular basis of a number of gender-based differences in health and disease, some of which are related to genotype — XX in the female and XY in the male.

These findings suggest that there are multiple differences in the basic cellular biochemistry of males and females that can affect an individual's health. Many of these differences do not arise from differences in the hormonal regime to which males and females are exposed, but are a direct result of the genetic differences between the two sexes.

Further studies on the relative roles of the sex chromosome genes is likely to illuminate the reasons for expression of some diseases within and between the sexes. Understanding the bases of these gender-based differences is also important for the development of new approaches to disease prevention, diagnosis, and treatment.  Taken from: ncbi-nlm-nih.gov

Well, lately I have been wondering about a typical woman's problem.  Both Karen D. and myself had hysterectomies quite a while back (she at age 48, I at age 38) and were put on Hormone Replacement Therapy (HRT) at some point in time.  We also went off the treatment about 5 years ago because there was some controversy over whether or not it was contributing to breast cancer.  I went on the ncbi.nlm.nih.gov website from the U.S. and found at least 2 scientific papers that state that estrogen and HRT give protection against colorectal cancer.  Isn't that interesting?  So you are trying to prevent one cancer and unknowingly end up with another one.  Please check out the website if it interests you.  I am not a scientist.  If you can make any sense of all the information on estrogen and how it relates to all the different cancers I would like to hear about it because it is confusing at best!  In short: a continued estrogen supply might have given both Karen and I some better protection.  

I added this today, April 21, 2022:

"Epidemiological data and finding of a significant reduction in colon cancer risk related to Hormone Replacement Therapy (HRT), and in particular the length of HRT, indicate that progesterone/progestins have a preventative effect.  This has NOT been shown with postmenopausal estrogen replacement therapy (ERT) alone. (source: https://pubmed.ncbi.nlm.gov/17943538)

"Clinical studies indicate that the incidence of colon cancer is lower in women than in men and data from the Women's Health Intitiave (WHI) indicate a significantly reduced incidence of colon cancer in postmenopausal women receiving combined HRT: estrogen PLUS progestin.  (source: ncbi.nlm.gov/pmc/articles/PMC2373424)

I should add that I had been on PREMARIN, which contained only estrogen to my knowledge and no progestins, as was recommended for women who had had a hysterectomy at that time.  If you were put on HRT without having had a hysterectomy you may have had the combined HRT: estrogen and progesterone.  Worth checking into I think.

Also, Margaret, a walking buddy from the Women's Walking Club, had some form of natural HRT prescribed by her doctor and seems fine.  She is also in her 60's.  Coincidence?

 

21. Chemo FIT Part 3 Screening Program

Chemo   FIT Part 3

The Screening Program for Colorectal Cancer

Let me begin by saying that if it hadn't been for the Screening Program for Colorectal Cancer I would really be up "Schitt's Creek" by now.  Their FIT program detected the blood in my stool.  Hurrah!  Having said that the program has it's limitations and, you, the public need to be informed about this.

1.  It only screens people aged 50 to 74.  Knowing that the prevalence of cancer increases as we get older, where does it leave our elderly and what about the younger than 50 crowd?  These days there is a trend of more and more younger people being diagnosed.  It could be your adult child.

2.  It screens only every two years.  There was a 2-year interval between when I was diagnosed last year in 2021 and my previous test in 2019.  Two years is fine if you don't have cancer; not so fine if you do.  I can attest to that.  And so can my friend Karen, and Peggy, and so on, and so on.  The two year interval leads you to believe that everything is fine when, in our case, it was not.  It gives you a false sense of security.

3.  There was never any mention anywhere that you have an option to be screened yearly in consultation and collaboration with your doctor.  Some doctors may not be aware of this also.  Is the screening program aiming to be a monopoly?

4.  And I would like to know:  At what stage of colorectal cancer does the FIT  start picking up these invisible traces of blood in the stool?  I have asked some people in the cancer industry and no one seems to know.  What's up with that?  Perhaps they don't know it themselves or perhaps I am asking the wrong people?  As far as I can tell from talking with other patients I have yet to come across a patient in the clinic who had an "iddy biddy" bit of colorectal cancer.  The screening program keeps harping in their website and elsewhere about early detection.  Stage 3 and 4 colorectal cancer can hardly be described as being "early".  But I don't claim to know everything of course.  So if anyone could shed some light on this it would be MUCH appreciated! 

Having said all that, cancer is an industry.  It employs a lot of people.  800 plus people work for Saskcancer.  I am not clear on what departments that all entails.  But just look at this: 800 plus people making a conservative $40,000/yr.  That's at least $32,000,000 on wages alone.  I have no qualms about the care I am receiving at the cancer clinic.  It is excellent and very efficient.  But it makes me wonder how much of the total budget goes to actual prevention?

So, my last FIT test in 2021 came back positive and I was scheduled to undergo a colonoscopy about 4 weeks later.....

Again I would like you to pass on my blog site to family and friends and anyone and their dog who could even remotely be interested in this!!  Thank you and take care!

 Thank you to Margaret who is following also!  Yeah Margaret!!!

More info on FIT and screening mid-week!

20. Chemo FIT Part 2 What went wrong

Chemo   FIT Part 2 

What went wrong in my case.

The following are my husband's and my record of having FIT done: 

                 Irm               My   Husband

2012: no FIT done / FIT  through program

2014: no FIT done /  FIT  through program 

2016 : FIT program/ FIT  through family doctor 

2017: no FIT        /    FIT through family doctor

2019:  FIT program/ FIT through program

2020:  no FIT done/  FIT through doctor

2021:  FIT program/  no FIT done

2022:      chemo  /      FIT through program

At first, I was not aware of the program.  I can't recall getting a FIT kit in the mail in 2012 and 2014.  I probably did because that is what my records show at the Screening program, but I have no recollection of that.  Neither do I recall participating in 2016 and maybe vaguely in 2019.  I also had no idea that my husband was checked on a regular/yearly basis.  And I definitely did not know that at times his family doctor was involved.

My mistakes were that after I did become somewhat aware of the program, I frankly did not take it very seriously.  After all, colorectal cancer does not run in our family!    So I thought I was immune to this.  Also, when I received the kit in the mail, it sat on the shelf for a very loooong time, much to my detriment.  And I am ashamed to say that I  came close to pitching it into the garbage.  I acted much like a large part of the population.  I am no different in that regard.   What saved my bacon was that a friend who used to work for the company that mails out these kits had put a little note in it for me.  She could have lost her minimum-wage job over this.  But because of her note I did not throw it out.  She may very well have saved my life.  Funny how a little gesture like that can make all the difference!  And another mistake was that our long-time family doctor retired in 2012.  Dave found an excellent physician right away and I have been struggling for the last 10 years.  When I did find someone good, she ended up moving to Toronto.  So I moved from doctor to doctor for a while.   I think that last fall I finally found a "keeper".  I am hoping with all my heart that she will stay!

More info on FIT and screening mid-week

19. Chemo FIT- Part 1 In General

Get Serious about Getting FIT

 The FIT I am talking about here has nothing to do with going to the gym and everything to do with having or maintaining a healthy "plumbing system".  FIT stands for Fecal Immunochemical Test.  This test detects blood in your stool That Is NOT Visible To The Naked Eye, i.o.w. you could be having this right now and not be even remotely aware that this is happening to you, unless you have the FIT done.

Lucky for us, the government decided to implement a country-wide testing program to specifically target the population age 50 to 74, a high-risk group. In our province, a special program was formed called the "Screening Program for Colorectal Cancer".  It was fully operational by about 2012.  As a citizen of this province, possessing a valid Health Card, and being between 50 to 74 years old, you are Automatically Enrolled in the program.  A testing kit is sent in the mail Every Two Years, Free of Charge!  Isn't that wonderful: a freebie sent by the government!  That alone should be an incentive to use it!  The kit comes complete with paraphernalia and instructions on how to use it.  Straightforward.  It does have an expiry date and needs to be sent to the lab right away, either you drop it off at a lab or send it back in the mail in a special envelope.  Dropping it off in an outdoor mailbox at minus 30 C is not a good idea.  The mailing part, no doubt, could be a hindrance to people living in remote areas and up north. 

Other than being squeamish about mucking with your own stool, there are NO SIDE EFFECTS to this test.  What I would give right now to have NO SIDE EFFECTS!!

Don't forget that to qualify for getting the kit send home to you, you have to have a valid provincial health card and an up-to-date address!