The Case of the Sinking Sigmoid

Having cancer is one giant lesson in anatomy. My Coordinating Nurse at Peter Mac told me early on that every cancer is different. She is right.

During the first review of my cancer, the Multidisciplinary Committee at Peter Mac noticed that my sigmoid colon (the part of my colon where my cancer is) is 'hanging lower' than it should be. After the meeting they called to let me know that this could be because (1) this is just how my sigmoid colon is, or (2) the tumor has grown through the colon wall and attached itself to some tissue in my lower pelvis. Anyone going for option 2? No, didn't think so.

Anatomy attack:
1. The sigmoid colon is like a set of traffic lights for poo, it red lights poo (up to seven hours!) until it is ready to leave your body
2. The sigmoid colon has its own membrane and actually has a bit of mobility (its position is not fixed in place like other organs)

The CT scan (see my first post) does not show enough detail so the Team wants me to have an MRI. Like the CT machine, an MRI machine looks like it comes from the future. And MRIs involve crazy physics that make my head hurt.

MRIs were clearly brought back from the future

MRI in a nutshell: MRI uses magnets to change the way the atoms in my body are lined up, then it uses a radio wave to excite the atoms, then it measures how they slow down once the radio wave is turned off. The magnet has to spin around my body to do this.

Am I worried that the tumour may have grown through the wall of my colon and is now acting like Pacman trying to eat anything in its path? Of course I am. 

Am I staying positive and looking forward to a scan I haven't had yet that will give me cool images to use in school shows when I get back to China? Absolutely.

When I tell people my sigmoid colon is hanging low they say that it must be because I am tall (see, you don't really need a medical degree to comment on complicated anatomical structures). When I told one friend, she said that it is because I have been living in China for four years and have spent too much time squatting while using my sigmoid colon (doing you know what).

I hope Naomi is right.

No date for surgery yet, but colons are cool

While we wait for a date for my surgery, let's get inside my colon.

The colon is the last part of your digestive system, where water is absorbed from poo and where bacteria help to break down some last minute materials.

Deliberately confusing sentence: The colon is called the large intestine because its diameter is larger compared to the small intestine but it is smaller in length than the small intestine. Why weren't they just named the long and short intestine?

Colons are like roller coasters for poo. The colon goes up, across,  down, does a few bends, and then stops to let the cargo off.

1: Ascending colon 2: Transverse colon 3: Descending colon 4: Sigmoid colon 5: Rectum

This image is loaded with analogy

My tumour is in the bendy bit (in section 4) - the bit that's supposed to be the most fun on a roller coaster. About 30% of colorectal cancers are found in the bendy bit. That's not fun.

The colon is long - about 1.5 m in the average person, but I'm not average (Mum says I'm 'special' all the time) and so mine should be longer because of my height, right? Nope. The length of your colon is not related to height, but is instead related to how much you weigh and your gender.

Male colons are longer than female ones, and heavier people have longer ones than lighter people. But measuring a colon is hard - surprisingly hard. In the olden days they used to force thin tubes down people's throats to measure the length of the whole digestive system, but the results from this method were all over the place because, as you can imagine, sticking a 5 m object down your throat isn't natural and changes the shape of the intestines. They now measure this stuff on dead people that have donated their bodies to science, but bodies change when they die and so this way can also be inaccurate.

For pub trivia purposes, just remember that the colon is about 1.5 m long.

I was sad to learn that mine was not bigger than his

Stats don't scare me

My cancer is common, but my cancer in people my age is not. Colorectal (colon + rectal) cancer is the third most common cancer in men, and the fourth most common cancer in women. It is the fourth most common cause of death from cancer. Australia has one of the highest rates of colorectal cancer in the world, three times higher than the incidence in China.

I'm not sure why but I'm not scared of reading about the number of people that die from colorectal cancer. The rates are not 100% which means every day people go on living after having this type of cancer.

Would you read the following paper in my situation: "Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term"? At first I didn't want to read it, but then I remembered that scientific papers always have crap titles, so I did.

Luckily for me I found three interesting points:

1. The tumours of young people with colorectal cancer tend to be found later than for older people. This is because only people over 50 are regularly screened. If you have any symptoms like I did (see my first post) then ask your GP to be screened for colorectal cancer.

2. Young people, despite having colorectal cancer that is a little more advanced at the time of treatment, have better chances of survival than older people. Insert smiley face.

3. The first 20 months will be the real test, but after that my chances of survival GO UP, not down like in other cancers. Cancer survival is usually measured as 90% of people survive after 2 years, 70% survive after 5 years and so on. This paper suggests that the chances of survival improve after the first 20 months for young people with colorectal cancer. Insert smiley face.

I think my training as a scientist has made me familiar with numbers and how they are analysed. I understand though that these numbers can be hard for others to hear.

Peter Mac

I have chosen to have my surgery and any chemotherapy I need at The Peter MacCallum Centre. This is Australia's only cancer dedicated hospital, and I'm lucky that it is only 5 km away in East Melbourne.

The surgery to remove my tumour is called an anterior resection. If my tumour was closer to my bot bot I would have needed some radiation therapy first to make the tumour smaller. Because I have about 30 cm of unaffected rectum below my tumour though they can go straight in and remove it.

The surgery, in a nutshell:

• 3-4 hours long
• 4 laparascopic entry points plus a further cut to remove the actual tumour and colon
• 3-10 days in hospital
• 4-6 weeks recovery

I've also been told I will need to visit their Familial Cancer Centre - because colorectal (colon + rectal) cancer is unusual in people under 40, let alone 28. The experts will want to work out if maybe something is up with my DNA and that's why I have this type of cancer at such a young age.

The Other C Word

Quite a few people have been interested in the events that lead up to me hearing "the other C word" and "you have" in the same sentence. So here is a quick run down.

In September 2010 I got a little sick, had some gastrointestinal cramping, weight loss, small amounts of blood during bowel movements and runny poo (remember I live in China though, I don't remember what a normal poo is). Tim and I were performing in schools in southern China and so at the time I just put it down to dodgy dumplings.

From October to December I was busy building a science communication empire with my best mate Tim. We are quite famous in Beijing and our egos have grown accordingly.

On January 3 I flew from Beijing to Melbourne to sort out my Chinese visa and have a colonoscopy as the cramping and bleeding had continued off and on since September. The colonoscopy revealed a lesion in my sigmoid colon and pathology revealed that it's a malignant adenocarcinoma (malignant means cancer; adenocarcinoma is the medical term given to a tumour that begins growing in a cell layer that produces mucous - the colon has lots of these cell types).

A CAT scan (the time-portal looking machine to the right) revealed no other tumours around my colon or in my liver or lungs. The doctors were particularly interested in the lungs and liver because these are common places that colon cancers  spread to.

Although there is a chance I have cancer cells hiding out in places around my body, knowing that we only have the one tumour to battle at this stage is a huge relief.