The cancer hole

Next Friday I will undergo my 3rd major surgery in a year and a half. My hope from my last post was that this time would not be as intensive as the prior surgery. Well I guess I won't know until I have the experience but it certainly appears that this will rival my previous surgical adventures. 

I will be having a cytoreductive surgery with HIPEC. I believe cyto is derived from a Latin word meaning 'stupid !*$&%ing' cancer' and reductive means 'lets cuts the crap out of the stupid !*$&%ing cancer'. Essentially I will be cut open in the same manner as previous surgeries. They will remove the mass on my small intestine. They will scour the rest of the abdominal cavity for any other tumors and remove them. If at that point they think it is reasonable, my colostomy will be taken down and the little happy guy currently hanging out to the left of my belly button will be reattached to his good friend, the rectum. However I will not be resuming my normal bathroom reading time just yet. They want to ensure the colon reattachment heals properly so they will give that a couple months to relax. For now they will bring a piece of small intestine out of the same spot next to my belly button. Remember the old nursery rhyme about the digestive system/municipal sewer system, "the small bowel comes before the large intestine". Well that means my food won't be quite as digested when it exits and my bag will likely fill up more quickly. Luckily, after the two months are complete they will test the reattachment and if all is as it should be they will put me back together for good.

This surgery has a second part. HIPEC stands for hyperthermic intraperitoneal chemotherapy. After all the removing and reattaching is complete,  they will pump my abdominal cavity (officially known as the peritoneum), full of some powerful heated chemo that will circulate for 100 minutes. In my last post I said that metastasis to the small intestine is very rare from a primary colon cancer. I have since learned that metastasis to the peritoneum is not so rare. It's the second most common site of colon cancer metastasis after the liver (by the way everyone that has viewed my most recent scan thinks my liver is just fine). Cancer cells can float around in the peritoneal fluid and attach to any number of organs or the lining of the cavity. The purpose of this chemotherapy is to apply a high does of chemo to potentially impacted areas without impacting the rest of my body. I've been told I likely won't feel impacts from the chemo but I suspect that is because all the fun feelings from the surgery will be overwhelming. In fact I was told to expect around a 10 day stay in the hospital. This will be my longest stay to date so I've decided to record all the Kavanaugh hearings and watch them in the hospital. NO SPOILERS PLEASE!!!

So we won't know with any certainty the severity of the stupid !*$&%ing cancer until the surgery is complete. My oncologist is hopeful that the mass is just a single recurrence related to one of my surgeries. However, the surgeon I saw this week said the mass is not near the site where they removed some small intestine in May. He also seems to suspect the peritoneal metastasis a bit more. Regardless both doctors still stress we are still working towards a curative result. Today I even had a bit of a panic attack after descending into an internet cancer hole and emailed my oncologist. He says regardless of metastasis or not, "This is absolutely curative." and "I still feel more optimistic than not that we can get this treated definitively." For the next week I will put my faith in these words and focus on preparing for and then recovering from the surgery.