I have seen the consultant surgeon this morning. Not very much new, I'm afraid. My main problems are colicky abdominal pains and diarrhea for which I am taking an anti-spasmodic and codeine phosphate. Th surgeon thinks these symptoms are caused by the mechanical effect of the presence of secondaries in the peritoneum and that the remedy is chemotherapy. I am seeing the medical oncologist this afternoon.
The special stains do not tell us anything new. They were negative for carcinoid, but even that is not helpful since the histology of adenocarcinoid can change to adenocarcinoma when it metastasizes, indeed such patients have a rather better prognosis. Although he thinks that the appendix is the most likely source of the tumor, he cannot be sure. The other option, large bowel, has been searched through very thoroughly on several occasions without finding a primary. The overwhelming majority of appendix tumors start life as carcinoid.
Were it not for the colic I would be very well. I have lost 14 pounds, but the weight loss has reversed and I have put on a couple of pounds since the nadir. My nutrition is important now, and the only restrictions on my diet are to avoid high residue products like peas and beans, sweet corn and cabbage, skins and pith.
I was encouraged when my friend George Stevenson brought me in a paper by Yan et al (Annals of Surgical Oncology 2008; 15:1440-6) which describes adenocarcinoid of the appendix that on peritoneal dissemination lacks the neuroendocrine component and appears as adenocarcinoma. Such patients have an improved survival over those who retain the carcinoid appearance, with a cumulative survival of 70% at 4 years and no further deaths thereafter.
This afternoon I saw the medical oncologist, Tamas Hickish. I will have a baseline CT next week with insertion of a Hickman like, starting chemotherapy at the end of next week of the beginning of the week afterwards.
Yesterday we watched the movie of 'The Kite Runner'. Although perhaps not as complete as the novel, it was a moving story and a rebuke to those who wish for an accommodation with the Taliban. These are appalling people who were quite justifiably deposed by George Bush and his allies. It is a common phenomenon found in the Western Democracies that they fail to complete the task that they embark on. They seem to lose heart when adversities stand in their way. Obama is talking about an exit strategy in Afghanistan. Will he be condemning millions of women to a second class life that includes no education, beheading for being raped, genital mutilation and forced marriage. Will the beard police return?
How this contrasts with the attitude of Christ who does not give up on us. "He who began a good work in you will carry it on to completion until the day of Christ Jesus" (Philippians 1:6).
I continue to receive messages of encouragement. From the Manabats in the Philippines and from Mary and Milena, two former colleagues of mine at the hospital whom I happened to meet in the corridor. Sometimes we despair when we have this diagnosis. When we know so many people are praying we wonder whether God is listening. Then he will send the chance meeting to encourage us and to let us know that he certainly is listening - so keep praying.