Stuart Christopher, High Wycombe

In early December 2016 I developed a swollen ankle. Not exactly the usual opening to a story relating to bowel cancer but this, and subsequent events, eventually led to my diagnosis.

I made an appointment to see the doctor who prescribed anti-inflammatory tablets (Naproxen) but by Christmas I was aware of blood in my stools; not bright red blood, just streaks of crimson mucus. I was concerned the tablets were the cause and the leaflet accompanying the tablets indicated this as a possible side effect, so I went back to the surgery. This time I saw a different doctor who enquired whether I was taking any other medication. I told him I was not. He advised me to stop taking the Naproxen immediately and prescribed a course of Omeprazole to settle my stomach. A rectal examination found nothing unusual, however he suggested that I have blood and stool tests done as a precautionary measure.

When the blood test results came through, these gave no indication of any problems. But when I eventually saw the doctor about the stool test results, I was told these showed a much higher calprotectin level than normally expected. He said he could refer me for a gastroenterology consultation but offered no real indication of what the results could mean.

I did not see the gastroenterologist until May 2017. The blood seemed to have disappeared. I was not experiencing any unusual problems with my bowels and had none of the typical symptoms associated with bowel cancer. The consultant was not particularly concerned with the high calprotectin indicators and said that sometimes false/positive results could occur. However, he suggested a colonoscopy to check things out further. Still there was no mention of bowel cancer or any other possible cause, so I remained firmly of the opinion the anti-inflammatory tablets had been the cause of the blood I had seen. But to get peace of mind a colonoscopy was duly arranged for a date in June.

Everything looked fine until the discovery of two polyps, both of which were removed. One was 2mm diameter but the second was larger - 18mm. The site of the larger one was tattooed but no indication was given that there was anything suspicious about the tissue removed. However, as a precaution it would be sent for biopsy tests and the results would be known in 2-3 weeks.

A couple of weeks later I was contacted to have a CT scan. I did not recall being told a CT scan would follow the colonoscopy procedure and no explanation why was forthcoming from my GP surgery, so I assumed this just to be a routine follow up of the colonoscopy process. There was still no news on the outcome of the biopsy tests but, within days of having the scan, I was called for a general outpatient appointment. Still there was no indication of anything wrong so I attended the appointment on my own.

The consultant I saw was very pleasant, but I was curious why two nurses were also there. The consultant informed me that one of the polyps (the larger of the two removed) had shown evidence of cancer cells. Realisation dawned on me that the nurses were from the cancer support team. He then went on to tell me that the CT scan had revealed other issues; a cyst had been discovered on my liver but was not of great concern as this could repair itself, but would be monitored and, that I had a Dilated Ascending Aorta, so he would refer me to a cardiologist.

I suppose it is human nature to wonder how you would react if told you have a serious illness and cancer would probably up there near the top of the list. In processing all this information, my initial focus settled in on the aorta revelation. I recall thinking, cancer can be cured - but if the aorta should rupture, it could be a case of ‘Goodnight Vienna’!

The consultant explained he would like to operate and remove the section of bowel where the larger polyp had been found to see if it had broken through the bowel wall. Also, he wanted to do the surgery as soon as possible. I said that I really needed some time to think all this through. Afterwards I had a long chat with the cancer nurses who provided me with a huge bundle of information to read. Although some of the detail had sunk in, I think I was still a bit dazed by the revelations that had just been made and spent the next week going through all the information.

I had a follow up meeting with the consultant in early August and a hospital admission date was subsequently confirmed for a high anterior resection at the end of the month. I spent six days in hospital before continuing my recovery at home.

Three weeks later I had a further appointment with the consultant to discuss the biopsy results. Unfortunately, one of the 12 lymph nodes removed had shown evidence of cancer spread and I was given the staging diagnosis of T3 N1 M0 - the cancer having breached the bowel wall and into one of the lymph nodes removed. The consultant explained that I could undergo a course of ‘mop up’ chemotherapy to eliminate any ‘stray’ cancer cells that might still exist and what this would entail. If I was agreeable, he would refer me to the consultant oncologist. My thoughts were that I’d come this far and was not prepared to give up now. If there was any opportunity to eradicate anything that still lurked, it was well worth giving it a go.

I met with the oncologist in early October and the course of chemotherapy was explained in more detail. Originally the consultant surgeon had indicated eight rounds of treatment, but the oncologist felt that four rounds would be enough and equally effective. This was based on the findings of the ‘SCOT’ Trial which had indicated four further rounds of chemotherapy would have little added benefit in treating the cancer but could intensify any possible side effects.

I commenced my first session of chemotherapy in November. This comprised an intravenous infusion of Oxyplatin at hospital followed by a 2-week course of Capecitabine tablets taken at home, then a one week ‘break’ with no treatment. By now I was more aware of bowel cancer and its treatment so was prepared for the worst as far as side effects were concerned. On reflection I believe I was very fortunate in this respect; I suffered extreme fatigue and tiredness, a very erratic sleep pattern and, given the extreme weather we experienced over the winter months, the effects of the cold, particularly when venturing outdoors. The expected sickness and diarrhoea however failed to appear, and I completed my last session of treatment at the end of January 2018.

In April I had a further CT scan and, on my subsequent visit to see the oncologist was given the good news that everything was showing all clear. I am still under review, but all the indications are currently good. My last colonoscopy was all clear too and will be reviewed again at the three-year point.

I am participating in the ‘Add-Aspirin’ trial to assess the effect of Aspirin on cancer recurrence so currently remain under the oncologist’s surveillance. And the aorta situation?

The opinion there is that it could be a situation I have had since birth but have only become aware of through this journey. However, I have a cardiologist keeping an eye on that issue too.