~ The third and the final step of the package~
Good News from PET SCAN
I completed the 28th session of radiotherapy at the Sanitorium on 23 March 2021. I could finally take a break to rest and not having to moving around. Dr Ma did not want to waste much time, organized another PET CT scan on 9 April 2021. The scan was to assess the effectiveness of radiotherapy. The result was really encouraging, it says in the report:
I interpreted it as I was clean, no more tumor! Initially I hoped that the tumor would shrink but seeing “no tumor detected”, “no metastasis” in the report, I was thrilled. Dr Ma said this was very good result, however, I must go for the surgery to remove part of the gut where the tumor was. This was to ensure that I had a clean cut, not to allow any residue to stay in my body. She urged me to have the surgery in about 4 to 6 weeks when my body should recover from the radiotherapy.
I shared the news with my family, Cecilia, Shelagh and others. All were very happy for me. I hesitated about the surgery if it was still needed now that there was no more tumor. A surgery while achieving the purpose of cutting clean, also causes damages to the body. I didn’t want to take action unnecessarily.
The Surgeon’s Opinion
Dr Poon, of course, was opinion that I must have the surgery as soon as possible. He would conduct a keyhole surgery (laparoscopy) which should allow for faster recovery time, less pain and bleeding after operation as compared to the traditional open surgery.
Dr Poon mentioned that he would remove the whole rectum where my tumor was. Rectum is the last several inches of the large intestine closest to the anus. It acts as a temporary storage sit for undigested food, i.e the stool. By removing the rectum, I wouldn’t be able to store my stool as I used to be able to. Dr Poon said patients have to go to toilet more often to empty the waste. It might be more difficult in the beginning as adaption is required. It could take a few months then eventually I should be able to control better my poo moments to like 3 to 4 times a day.
Because of the position of the tumor, there was the risk that the sphincter might be affected during the surgery. That means I might not be capable to have normal bowel functioning. Sphincter is a ringlike band of muscle that surrounds the opening of the anus, constricting and relaxing as required for normal bowel functioning.
Carrying a Stoma Pouch
Dr Poon also said that after the surgery, the wound needed time to recover so it must stay quiet not to be disturbed. He would create a stoma at the beginning of my small intestine. A stoma is an opening on the abdomen that is connected to my digestive system to allow waste to be diverted out of my body. It is a small pinkish, circular piece of flesh that is sewn to my body.
Over the top of the stoma, I would have to wear a pouch which has an opening at the bottom. All the waste would come out through the stoma. I would have to clean the stoma pouch few times a day just like going to toilet, and I have to change the pouch to a new one once every few days for hygiene purpose.
I would have to keep the stoma for around 3 months to allow for the wound to rest enough then Dr Poon would do another surgery to close the stoma. If, unfortunately, the sphincter would be damaged during the surgery then I might have to keep the stoma for the rest of my life, ouch.
This was not an easy decision, the risk that I had to take would probably cause huge inconvenience to my daily life. I did not like the idea to have to carry the stoma pouch for the rest of life either. Though Dr Poon said he was confident that he should be able to save the sphincter but he must tell me all the pros and cons about the surgery.
Sigmoidoscopy
I thought I should not make the decision without further information. As Cecilia suggested, I attended a sigmoidoscopy with tissue biopsy. It was endoscopy into sigmoid colon, multiple biopsies were taken at the mid rectum. The diagnosis came back as follows:
I was disappointed, but it told me the fact. I knew then there were residual cancerous cells remained at the Rectum.
It was clear then I had to go for the surgery. Cecilia pointed out though I might consider the possibility that the tumor was still dying at this stage. The residual could continue to diminish and eventually to vanish. It made sense to me. However, at the time I thought that I needed the peace of mind to have nothing at all in my body.
I did not arrange for the surgery too soon. I followed Cecilia’s advice to allow my body to rest fully before going into another battle. I confirmed with Dr Poon to have the surgery on 29 May 2021. This was 9 and a half weeks after the completion of radiotherapy.
