I have to double-check how many weeks have passed since I was discharged from hospital – it’s two weeks but some days it seems like one and some days like five. For the first week it was just a case of getting through the day – a blur between sleeping when lying down was the only comfortable position. Now, every day I am doing a little more. This includes starting back to work, but for only an hour or two per day.

Earlier this week I went to hospital out-patients for an appointment with my Oncologist, Mr Wilson. It was a chance to ask questions about the results from the pathology lab – what was the negative lymph count for example? Answer, 7 in 14 for me, in a test where the recommendation is that the surgeon scoops out enough “stuff” during the bowel resection to include at least 12 lymph nodes for analysis. How many they can “harvest” depends on where the cancer is situated, and other factors such as age. Getting 14 nodes from a low rectal cancer is a good result – reflects well on the surgeon who did the job.

There was a view that unless the surgeon got at least 12 nodes (‘ideal minimum’), it didn’t provide a good enough basis to estimate survival. Basically, the more you examined, the more evidence you’d find. That view is in some doubt now. So now the key element is seen as the lymph node ratio (LNR) – the bad as a % of the good. But it’s hard to interpret what these ratios mean – in one sense it only confirms that it is late stage i.e. spread to more than 3 adjacent lymph nodes. But is 7/14 (50%) good or bad?

I’ve looked at a couple of studies and it seems popular to divide LNR into 3 groups or bands. The problem is that they use different min/max numbers. There seems to be a view that Low is less than 15%, Medium is less than 66%, and High is above that. So, I am medium according to that measure.

Next, they can correlate disease-free survival (DFS) and overall survival (OS) with the LNR, basically measuring how many days (i.e. 365, 730, etc) people live after their surgery. Problem (?) again is that other variables come into it – not every patient is eligible for follow-on (adjuvant) chemotherapy; some had metastases in the lung rather than liver (and some in both).

I could go on, but the sane thing is to just make two conclusions for now:

  • I’m eligible for adjuvant chemotherapy and the liver tumour has been comprehensively dealt with;
  • I would be a fool to imagine that I am “home and dry” where cancer is concerned

They want to start the follow on chemo (“chemo #2” I call it) as soon as I am ready, which is not before 2-3 more weeks. This will be a cycle of 3 weeks per session – start with intravenous injection of Oxaliplatin over 2 hours into a vein, plus two weeks of oral Capecitabine, then one week recovery. There will be 6 cycles i.e. 18 weeks in total. I’m guessing it will start around October 12, so that makes an end date around early February 2010.

I wake to sleep, and take my waking slow.
I feel my fate in what I cannot fear.
I learn by going where I have to go.

This shaking keeps me steady. I should know.
What falls away is always. And is near.
I wake to sleep, and take my waking slow.
I learn by going where I have to go.

Theodore Roethke – The Waking (1953)

dEUS feat Karin Dreijer Andersson – Slow