Monday, June 21, 2010

More on health

Not a very good few days healthwise. as I tailed off the steroids I began to get colicky abdominal pains again. I have been reconsidering my diagnosis. The official diagnosis was adenocarcinoma with unknown primary, mainly located in the right iliac fossa. The terminal ileum and cecum were fibrotic and wrapped around a mesenteric lymph node with small peritoneal seedlings at this site. The histology showed fibrosis and inflammatory cells but no mucosal cancer, though in the lymph node well differentiated adenocarcinoma which was CEA positive, even though the serum CEA was very low. No primary could be found on extensive laparotomy.

Treatment with 5-FU and folinic acid plus oxaloplatin, given with a dexamethasone dose for anti-emesis resulted in a 75% shrinkage of detectable CT imaged disease by 3 months and a further 4 courses resulted in a no further shrinkage.

I was well until about 3 weeks ago when colicky abdominal pain followed by gurgling took me into hospital. No change was apparent on the CT scan and there was no full blown abdominal obstruction. Symptoms settled on dexamethasone 8mg iv.but now on two occasions as I have tried to withdraw the steroids the symptoms have returned, although not so severely. I am also on a low-roughage diet and I suspect that the latest pain is from large rather than small bowel.

I want to consider the possibility that my original diagnosis was Crohn's disease, in which carcinoma has developed, as it does in 3-5% of cases.

Crohn's disease occurs in the terminal ileum/cecum area and leads to tethering of the bowel to adjacent tissue like I had. Mesenteric lymph nodes become involved and the histology shows inflammatory cells such as lymphocytes, plasma cells and macrophages. Granulomas may be seen but they are not a constant feature.

A complication of Crohn's disease is an inflammatory stricture. Treatment is high dose steroids usually for 4-6 weeks. My case is being reviewed at the multi-disciplinary team meeting tomorrow and we may get some news later. Options include further surgery to relieve the apparent blockage.


Anonymous said...

Could be. Hard to say without modern imaging, isn't it? Are there tests that can rule it in or out?

Terry Hamblin said...


Pastongriffin said...

You have my sympathy. My daughter has Crohn's and had developed a fistula before she was diagnosed at 15. It took a while because it was assumed weight loss etc in a teenage girl was unconfessed anorexia. The stuff you drink before the laparotomy was the worst bit! She has it under control and is treated with infliximab as well as steroids and methetrexate...a horrid disease but possible to tame under the grace of God...will pray for you

J.R. said...

I don't understand all the medical terminology, but I will pray. Our LORD knows exactly the problem and how to rectify it. May He grant you comfort in the meantime.

And may I take this opportunity to humbly thank you for all you do for the CLL community as well as what you do in service to Jesus. I am blessed when reading your biblical commentaries. Even this far across the world we can encourage and lift up one another. Isn't it amazing!
Southern California, USA

Deb Light said...

I will be praying for you tomorrow Dr. Terry and may God surround you with comfort,love and peace.Be Well!

Thanks so so much for taking time to answer our CLL questions when you don't feel well yourself!

God Bless,
Debbie Light