Six letters define my treatment, they don't define me.
GIRCRT. Those six letters.
It's an abbreviation. It's not even an acronym because you can't pronounce it. But those six letters are like a seed crystal around which the rest of my cancer journey will form. Let's take a few moments to unpack this protocol code's six letters and what they mean.
GI: Pretty simple; I have a gastrointestinal cancer so the general area of cancer treatment - GI - forms the start of my protocol code.
R: Rectal. Also not surprisingly, this further narrows down the area in my GI tract that is affected by cancer because my primary tumour was removed from my rectum.
C: Capecitabine. That is the drug that will be used as adjuvant therapy to eliminate any micrometastases that might have formed when cancer cells (from the blood vessels in the primary tumour or the affected lymph node that was involved around my rectum) flowed into my bloodstream and out to any other part of my body. These micrometastases can form anywhere, but most often form where there are very small capillary beds (kidneys, the lungs, liver, pancreas).
RT: Radiotherapy. My treatment will include radiotherapy to my pelvis to prevent a recurrence of rectal or colon cancer.
That's it. Six simple letters (or five if you consider that the R is used twice). They define my cancer treatment, but they don't define me.
My cancer has now been staged - for whatever that is worth - and I have been classified as having stage 3 rectal cancer. The positive lymph node is what pushed it over the threshold from stage 2 to stage 3, and that is also what makes me more motivated to pursue aggressive treatment.
BC Cancer has a very helpful patient information sheet that helps to explain this protocol as well as the three options within it and what common or severe adverse effects patients might experience when they are undergoing this treatment. If you want any more details about what I am facing, this would be an excellent resource for you. I'm not going to plagiarize this information but I will summarize a few things about what I am facing after one huge disclaimer.
I am already off the GIRCRT protocol.
Yep. I'm that kind of patient.
You see, all of the three options for GIRCRT involve giving chemotherapy and radiation before surgery. One of them involves five weeks of combined chemotherapy and radiation, then surgery and two of them involve one or two cycles of two weeks of chemotherapy followed by a week off then radiation plus chemotherapy and then surgery. All three options then give chemotherapy alone for the balance of (give or take) six months after 4-8 weeks off to recover from surgery.
But I've already had my surgery. So...
Yeah. I'm already off the protocol.
I know it seems like these protocols are hard-coded, but as a health professional who deals with chemotherapy protocols for part of my job, I know that treatment protocols are sometimes like the pirate code; they are really more of what you'd call guidelines than actual rules. So the GIRCRT protocol will generally apply to my therapy, but with some obvious changes due to the fact that I've already had surgery. From my initial consultation with the medical and radiation oncologist it seems like I will follow Option 1; five weeks of combined chemotherapy and radiation followed by the balance of six months of chemotherapy alone.
Who in their right mind would want to do this?
Well... that's a good question. And the truth is I don't want to do it. Seriously - I'd rather not take a drug that is specifically designed to kill cells in my body that are, for all intents and purposes, no different than any other cell in my body. I mean, there are a few differences that explain how they cause disease or can be identified, but the adenocarcinoma in my rectum started out as just normal cells. They share my DNA (more or less); they are not some infection that I got, some foreign organism that might still be lurking in my body somewhere. So any chemical that can shut them down will also have at least some effect on the rest of the cells of my body.
So I'm not in my right mind?
I guess that's one way of looking at things. But I think it's overly cynical.
Sure, given a choice nobody would want to take chemotherapy and have radiation blasted into their pelvis. But then again, who would want to be knocked unconscious and have their abdomen cut open and a big chunk of their colon cut out?
Yep. That was me too.
But focusing on the pain I would face is only one side of the coin. In my mind, it's really all about the benefits that I might face rather than the risks that go with it you see. And this protocol - while there are risks - offers significant benefits to me.
First and probably most importantly, the chemotherapy of this protocol will kill any tumours that are too small to show on a CT scan. My primary tumour was around 11 mm in diameter which was big enough to see on CT yet way too small to cause any symptoms. The lymph node involvement was on the order of 2-4 mm and it didn't show on CT or MRI, so there might still be a distant tumour somewhere that is this size or smaller. And if there are any metastases out there in my body that are this size, I would really like them gone.
Beyond the benefits of chemotherapy, the radiotherapy in this protocol has been shown to reduce the risk of recurrence of colorectal cancer by 50% (relative risk reduction from 10% to 5% in my case). While I got through my surgery really well and have recovered quickly, I really don't want to go through it again.
Like, ever.
I like my surgeon, but I'd rather just work with him rather than - as my daughter joked - both win and lose a knife fight to him again. And I'm already coping with a changed anatomy and would really rather not deal with an even further changed anatomy in the future.
There are risks to my treatment, but the most likely one is some diarrhea from the chemotherapy and possibly long-term from the radiotherapy. I'd rather not have diarrhea or half again as many bowel movements per day than I currently do (spoiler alert, this number is already higher than you might guess), but that's really a pretty minor price to pay if I can live an otherwise healthy and productive life. It's also something that I can deal with by using different medications, so it's really not such a big concern for me.
Both the radiotherapy and the chemotherapy can make me lethargic, but right now I don't have to worry about work so if I'm tired I can take a nap. This will only be for six months, after all, and beyond that time I will return to my normal energy levels. If I need to take it easy for six months so that I can live a really good life for thirty years beyond that, I am definitely on board with that.
The chemotherapy might cause suppression of my bone marrow resulting in lower hemoglobin or immune system function. My blood work will be closely monitored though and the dosing for the chemotherapy will be adjusted if this happens. Again, this is a short term risk and even if it happens, it can be managed with dose reduction and antibiotics.
The capecitabine might cause cracking of my hands and feet, something that is rather unique to it. This would be a little off-putting (to say the least) and of greater concern it might allow bacteria to get into my bloodstream while my immune system is suppressed. Again though, there is no guarantee that it will happen and if it does there are some highly effective creams (including one with the best name EVER) that will help to keep my hands and feet healthy and intact.
So... that's the treatment plan. It might change moving forward (either subtly or dramatically) but it's a plan that I can get behind.
Hop!
It's an abbreviation. It's not even an acronym because you can't pronounce it. But those six letters are like a seed crystal around which the rest of my cancer journey will form. Let's take a few moments to unpack this protocol code's six letters and what they mean.
GI: Pretty simple; I have a gastrointestinal cancer so the general area of cancer treatment - GI - forms the start of my protocol code.
R: Rectal. Also not surprisingly, this further narrows down the area in my GI tract that is affected by cancer because my primary tumour was removed from my rectum.
C: Capecitabine. That is the drug that will be used as adjuvant therapy to eliminate any micrometastases that might have formed when cancer cells (from the blood vessels in the primary tumour or the affected lymph node that was involved around my rectum) flowed into my bloodstream and out to any other part of my body. These micrometastases can form anywhere, but most often form where there are very small capillary beds (kidneys, the lungs, liver, pancreas).
RT: Radiotherapy. My treatment will include radiotherapy to my pelvis to prevent a recurrence of rectal or colon cancer.
That's it. Six simple letters (or five if you consider that the R is used twice). They define my cancer treatment, but they don't define me.
My cancer has now been staged - for whatever that is worth - and I have been classified as having stage 3 rectal cancer. The positive lymph node is what pushed it over the threshold from stage 2 to stage 3, and that is also what makes me more motivated to pursue aggressive treatment.
BC Cancer has a very helpful patient information sheet that helps to explain this protocol as well as the three options within it and what common or severe adverse effects patients might experience when they are undergoing this treatment. If you want any more details about what I am facing, this would be an excellent resource for you. I'm not going to plagiarize this information but I will summarize a few things about what I am facing after one huge disclaimer.
I am already off the GIRCRT protocol.
Yep. I'm that kind of patient.
You see, all of the three options for GIRCRT involve giving chemotherapy and radiation before surgery. One of them involves five weeks of combined chemotherapy and radiation, then surgery and two of them involve one or two cycles of two weeks of chemotherapy followed by a week off then radiation plus chemotherapy and then surgery. All three options then give chemotherapy alone for the balance of (give or take) six months after 4-8 weeks off to recover from surgery.
But I've already had my surgery. So...
Yeah. I'm already off the protocol.
I know it seems like these protocols are hard-coded, but as a health professional who deals with chemotherapy protocols for part of my job, I know that treatment protocols are sometimes like the pirate code; they are really more of what you'd call guidelines than actual rules. So the GIRCRT protocol will generally apply to my therapy, but with some obvious changes due to the fact that I've already had surgery. From my initial consultation with the medical and radiation oncologist it seems like I will follow Option 1; five weeks of combined chemotherapy and radiation followed by the balance of six months of chemotherapy alone.
Who in their right mind would want to do this?
Well... that's a good question. And the truth is I don't want to do it. Seriously - I'd rather not take a drug that is specifically designed to kill cells in my body that are, for all intents and purposes, no different than any other cell in my body. I mean, there are a few differences that explain how they cause disease or can be identified, but the adenocarcinoma in my rectum started out as just normal cells. They share my DNA (more or less); they are not some infection that I got, some foreign organism that might still be lurking in my body somewhere. So any chemical that can shut them down will also have at least some effect on the rest of the cells of my body.
So I'm not in my right mind?
I guess that's one way of looking at things. But I think it's overly cynical.
Sure, given a choice nobody would want to take chemotherapy and have radiation blasted into their pelvis. But then again, who would want to be knocked unconscious and have their abdomen cut open and a big chunk of their colon cut out?
Yep. That was me too.
But focusing on the pain I would face is only one side of the coin. In my mind, it's really all about the benefits that I might face rather than the risks that go with it you see. And this protocol - while there are risks - offers significant benefits to me.
First and probably most importantly, the chemotherapy of this protocol will kill any tumours that are too small to show on a CT scan. My primary tumour was around 11 mm in diameter which was big enough to see on CT yet way too small to cause any symptoms. The lymph node involvement was on the order of 2-4 mm and it didn't show on CT or MRI, so there might still be a distant tumour somewhere that is this size or smaller. And if there are any metastases out there in my body that are this size, I would really like them gone.
Beyond the benefits of chemotherapy, the radiotherapy in this protocol has been shown to reduce the risk of recurrence of colorectal cancer by 50% (relative risk reduction from 10% to 5% in my case). While I got through my surgery really well and have recovered quickly, I really don't want to go through it again.
Like, ever.
I like my surgeon, but I'd rather just work with him rather than - as my daughter joked - both win and lose a knife fight to him again. And I'm already coping with a changed anatomy and would really rather not deal with an even further changed anatomy in the future.
There are risks to my treatment, but the most likely one is some diarrhea from the chemotherapy and possibly long-term from the radiotherapy. I'd rather not have diarrhea or half again as many bowel movements per day than I currently do (spoiler alert, this number is already higher than you might guess), but that's really a pretty minor price to pay if I can live an otherwise healthy and productive life. It's also something that I can deal with by using different medications, so it's really not such a big concern for me.
Both the radiotherapy and the chemotherapy can make me lethargic, but right now I don't have to worry about work so if I'm tired I can take a nap. This will only be for six months, after all, and beyond that time I will return to my normal energy levels. If I need to take it easy for six months so that I can live a really good life for thirty years beyond that, I am definitely on board with that.
The chemotherapy might cause suppression of my bone marrow resulting in lower hemoglobin or immune system function. My blood work will be closely monitored though and the dosing for the chemotherapy will be adjusted if this happens. Again, this is a short term risk and even if it happens, it can be managed with dose reduction and antibiotics.
The capecitabine might cause cracking of my hands and feet, something that is rather unique to it. This would be a little off-putting (to say the least) and of greater concern it might allow bacteria to get into my bloodstream while my immune system is suppressed. Again though, there is no guarantee that it will happen and if it does there are some highly effective creams (including one with the best name EVER) that will help to keep my hands and feet healthy and intact.
So... that's the treatment plan. It might change moving forward (either subtly or dramatically) but it's a plan that I can get behind.
Hop!
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