Category: Uncategorized

8. Relief – at 04:00 am!

Turd

I wish!

Another day another dollar! I’m earning my passage today. Darling daughter, Ellen, has been supporting me all week whilst Elaine nears the end of her job at the University St Andrews (one week to go, yippee!). Now today we are returning the favour and re-locating her and all her mobile devices back to Glasgow. Setting off early, so the shower is going to have to cope with three heavy-user demands (Rank Ellen> Colin> Elaine; or something like that). We need to be on our way by 09:00am.

Speaking of passages, I had a bad evening last night – the 5 day thing happened again, but fortunately the earth moved at 20:00h, well actually a mole hill moved, but that is better than a worm-hole (infinitely smaller – literally!). I was in so much pain at one point I took a double dose of laxative. Hope I don’t regret it whilst we head for the M8.

Now, where are we, technically that is? Oh yes, diarrhoea, I suspect, but hope against. This is shit, let’s start again – technically!

I have a stomach cancer called a poorly differentiated adenocarcinoma. What does that mean? Fortunately there’s a system for better understanding what phrases like that really mean, and they can be helpful in determining treatment.

Pay attention, this is going to get easier and easier!

During embryonic, foetal, neonatal and later life most cells (cytology) in our bodies are growing and produce tissues (histology) such as the lining of our bladders, eyes, and of course our guts (epithelium-lined mucosa), and in my case a key bit – the stomach or gastric portion of the alimentary canal (intestine).

Other cells produce muscle layers (which may be smooth, striped or striated, or found only in the heart as cardiac type (also striated, by the way, but branched too); others produce connective tissues including fat, lymph, blood, bone marrow and so on; still others, develop nerve cells or neurones.

Some tissues and organs like the liver, kidney, spleen and lung mainly comprise one major type of tissue whereas others, such as the lining of fat around our internal organs, our omentum for example, may be very diffuse and have several types of tissue such as connective tissues, fat, smooth muscle, as well neurones and blood vessels. The latter are themselves very complex, having three or four layers depending upon wall thickness (from the inside to out: endothelium – special epithelium, smooth muscle, loose or fibrous connective tissue, and may contain blood vessels as well as nerve fibres and neurones too, sitting in the most outer layer, the serosa, again depending upon wall thickness.

Other cells (when looked at down a light microscope) however, can look very grand, special, (and even plump – if we are not being fattist) and distinguished from surrounding tissues, often with special names. The parenchymal cells of the liver are good examples; as are the epithelial cells lining the inner stomach – the square or tall, columnar epithelial layer. These contrast very well with the typically flat or squamous epithelial layers we have in the linings of hollow internal organs such as the bladder, vagina, lungs etc; or on the external parts of our bodies such as our head, hands and souls of our feet, (Great British Rock band of the 1970s, by the way. Try out “Head, Hands and Feet” on Island pink label Vinyl, 1971 Yummy!).

Head, Hans, Feet1

Head, Hands and Feet in concert in 1971 at TOGWT – find out!

All of these cell types take up stains to differing degrees when preparing tissues for examination under a microscope, and they produce beautiful, gorgeous coloured patterns. En passant, this helps histologists and pathologists (and histopathologists – mustn’t forget them!) identify when there may be too much or too little of some tissue component present – compared to what might normally(!) be expected – based on centuries of anatomy, and experience, of course.

So what, I hear you say? Well, this is key to describing cancers, but you need some more information first! In the embryo, most cells outwardly (if we have a light microscope to view them) look pretty much the same and might be said to be unspecialised, undistinguished or poorly differentiated. They reproduce themselves very fast by diving in two, grow bigger again, repeat then repeat – a signal-controlled process. Once a critical mass of cells is reached tissue formation takes place and specialisation or differentiation starts to happen, and thus we form all of our specialised tissues, organs and systems that make up the body.

If this signal process goes wrong, for example in cancer, cells that might normally (there’s that word again) differentiate don’t do so, and instead grow in an uncontrolled way, eventually forming a fairly ugly, undistinguished thing we call a “lump”.  Get that buggar (!) off me; have a ‘lumpectomy’ straight away (to be safe), if you find one (unless it’s a cyst, of course). Even then, you might have one removed – to be sure!

You need one more thing to complete the picture – sorry! So that (histo-)pathologists can have a whole branch of medicine’s nomenclature to themselves when cells and tissues start to become abnormal they give the type of tissues a new, but related name. So, abnormal epithelial tissues are named Carcinoma, muscle or connective tissue tumours become Sarcoma, as two large categories of cancers. A Lipoma (I have one on left shoulder) is a fatty lump!

The more distinguished a cancer turns out to be from a particular location in the body the even fancier a name it can have, such as microglioma or astrocytoma (specialised neurone tumours); or Leukaemia, Lymphoma (specialised connective tissue tumours of blood and lymph glands, respectively) etc. Do you know there’s a tumour called a Teratoma? It sprouts skin, hair and even teeth, sometimes, inside an enclosed sac, often very large.  If such a sac is located in or near female ovaries the ‘bump’ produced can be confused with pregnancy!  Much more information can be found at the Cancer Research Campaign web site (http://www.cancerresearchuk.org, Accessed 27 November 2015).

So there we have it. I have a poorly differentiated adenocarcinoma growing from around the middle of my gastric (stomach) inner mucosal lining. And sod’s law, wouldn’t you know, it has grown backwards through the mucosa, penetrated the smooth muscle of the stomach wall, its surrounding connective tissues of the serosa and into my abdomen. Fortunately, it has only spread to a few (well had – we don’t know what the new CT scan picture would reveal now) surrounding lymph nodes.  Maybe I’ll talk a little more about well-differentiated cancers later?  Watch this space   …..

When anyone asks you, “Now what’s Colin got again?”, you can tell ’em (in scientific discourse).  But don’t forget to tell them, he might not have had one at all if had he heeded earlier warning signs of a belly-ache!  So endeth today’s lesson!

I’m off to the shower before damned daughter gets up.

 

See ya’s all again tomorrow!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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6. An Interlude …..

After all that technical cancer stuff I think you need a break, I certainly do. So, what’ll it be?  I know, Rugby!

Part 1  The World cup is over, Ritchie and his boys kicked-ass, beautifully and legally, of course. Commiserations to Australia.

Ritchie's boys

However, they (Aussies) were a tad lucky to have that coward Joubert refereeing when they beat Scotland, perhaps unfairly, but we’ll never know. Can someone tell my wife why, if we was wrong in his decision to award a penalty (scored smartly by the way) that Scotland shouldn’t have been awarded the match post-play? (I’d like to know too!)

Having lived in both New Zealand (Auckland) and Australia (Melbourne) I think I have the flavour of their rivalries. A bit like Scotland (NZ) versus England (OZ). Though we spent longer in OZ I’ll admit my fondness for NZ, in parts, a place, like my own Patria, the North East of England (I may even be a wannabe Scot), where I grew up in my own childhood days of the 1950s.

I was recruited from the University of St Andrews to Unitec, NZ, Auckland in 2008 as their Dean (VP) of Teaching and Learning and never looked back. They knew me well, an ex-Captain of my own Grammar School’s Rugby First XV. On one of the five days of the recruitment and selection process, I got to watch the Auckland Blues firsts versus reserves teams, practice and then play on one of Unitec’s own training pitches – their home! Was I in seventh heaven, or what? How could I turn down the job offer after that?

I bet you’re wondering who he actually supports. Well I actually support great, free-flowing rugby, that’s all. So, in point of fact I don’t often mind who wins if there’s a great match.  Nevertheless, here’s my top 10 team my pecking order (with a National pride tinge):

Jonny
Jonny taking a dump – at goal!
  1. England (Always – I dreamed of being that damned number 10, fly-half, Jonny Wilkinson kid, in my own youth!)
  2. Scotland (We moved here and still reside in Fife)
  3. Wales (For my great friend, Anthony, who is Welsh but sounds like a posher Englishman than me)
  4. Ireland (So unlucky in this last world cup with injury and suspensions at just the wrong time)
  5. New Zealand (Need I comment?)
  6. Australia (Well, most of their really brilliant athletes play either Rugby League or that other thing called ‘footy’, or Aussie Rules, curiously still played with a rugby shaped ball. So, I feel sorry for them.)
  7. Argentina (What a revelation this world cup?)
  8. Canada (For my best friend, Brad, even though he doesn’t play, doesn’t watch many matches of any sort, but is truly patriotic!)
  9. South Africa (I can’t actually quite forgive the apartheid years)
  10. France (Who likes them? Well again actually, I do. I met some great French fans during the 2011 world cup in NZ; and they were also on the wrong end of that man, Craig Joubert’s poor decision making in the All Blacks v France final.)

Part 2  So, to the future.   England sacked their Director of Rugby, Stuart Lancaster, rightly in my view. His team selection was fraught even before the opening ceremony and the great win over Fiji that followed. What followed was a debacle. He was scared not to pick Burgess (an ex Bradford Bulls Rugby Leaguer, Sydney Rabbittoes Rugby Leaguer too, and then over to Bath to learn Rugby union at top level in less than a year). It was never on.

That and other strange selection changes in the Wales game sealed the deal – out you go sunshine! I’m glad. Not because we went out of the world cup ignominiously (which we did), but because it leaves open the possibility of someone (Japan’s now favourite son, Eddie Jones, it turns out) with an eye for flair, hard work and a passion to beat the shit out of the All Blacks next time up.

Eddie Jones
Eddie Jones – Ex_aussie, Ex-Japan and now incumbant England Coach

I’ll just name you two of possibly three or four back lines steady Eddie could pick. The first is my favourite:

  • Will Youngs (9), George Ford (10), Jonny May (11), Luther Burrell (12), Jonathan Joseph (13), Anthony Watson (14), Mike Brown (15)
  • Danny Care (9), Danny Ciprianni (10), Jack Nowell (11), Henry Slade (12), Kyle Eastman (13), Semesa Rokoduguni (14), Ben Thoden (15)
Ford_Farrell
The Dilemma: Kicking or Running?  Owen Farrell versus George Ford

Looks mouth-watering doesn’t it, especially if the ex-Aussie, ex-Japan coach gets the forward pack playing like Japan’s Samurai warriors: tackling anything, hooking (yes, hooking the ball at scrum-time, almost unheard of for the last three years) and playing a fast free-flowing game, scoring tries by the bucket-load?

On a sad note, we also saw the passing of Jonah Lomu an ex-All Black extraordinaire; ex-Auckland Blue; and universally agreed, the gentlest yet most powerful wing three-quarter to have ever played the game – like a gentleman, too. The good die young often, don’t they?

Jonah Lomu
Jonah in action in his prime!

 

Well on a happier exit I like Jethro Tull’s motto, “Too Old to Rock ‘n’ Roll: Too Young to Die”.

Jethro Tull

That’ll do me!  ‘Til tomorrow folks, CYA.

 

5. Back to the Future – Part Deux

Back to the Future Part Deux

Now, where was I? Yes, my stomach cancer.

As revealed through multiple medical and scientific screening tests (CT scan, Gastroscopy and tissue biopsy histopathogy) followed by consideration of the data by a multidisciplinary panel of experts I can now declare that I am the proud owner of a gastric, poorly differentiated, adenocarcinoma (Stage IV – don’t omit that bit). This is really important because that is what makes it inoperable – it has spread into my abdomen and is not confined within the stomach wall – unfortunately for me.

cancer-cells-growing-through-normal-tissue

I used to teach some of this stuff – brings back fond memories of my Bradford University days in the School of Biomedical Sciences (1977-1996).

So, as far as us inoperable types are concerned chemotherapy is pretty much the only option. Inoperable, eh? Well, actually I can ride a bike, drive a car, have flown a small plane, and oh yes, been sick on a boat, ferry and even atop my Cuban-heeled boots from the 1970s, so I can operate some things, so there!

As mentioned previously, a recent discovery that some people (about 10%) have a very specific gene (HER2) confers an advantage to them. They may have longer periods of dormancy of their gastric cancer following treatment with their Chemo. In other words, it allows a Chemo regime that contains Herceptin. This is a monoclonal antibody (MAB) that binds to cells that have the HER2 protein expressed on their surface, after which the cells become more sensitive to the killing (cytotoxicity) of the chemicals in the drug cocktail. In this case the cocktail has two components: the MAB called trastuzumab (or Herceptin) given together with Chemo, but only for patients in a clinical trial to determine if having higher doses of Herceptin alongside chemotherapy will help more people than the standard dose currently used.

There are also other trials ongoing, but hey, I’m not getting one of those potential benefits, so who is kidding who here, am I bovvered, right now anyway?  I am actually, but I thought I’d try to look cool using that famous Tony Blair Red Nose Day  word!

Another trial is looking at another MAB called onartuzumab with chemotherapy for advanced HER2 negative stomach cancer (that’s me, I’m one of them!). This is more like it, maybe I’ll survive long enough for there to be some published outcomes of targeting a receptor on cancer cells called Met. The people in this trial have cancer cells with large numbers of Met receptors. “The researchers want to see if onartuzumab and chemotherapy is better than chemotherapy alone, and to learn more about side effects.

Oh my, isn’t science and medicine complicated, but wonderful? Finally, (for me anyway – me brain is hurting nearly as much as me belly!), the REAL3 trial examined how well a MAB called panitumumab (Vectibix), a drug which acts like a growth factor blocker, worked together with my own very Chemo combo: standard EOX chemotherapy (epirubicin, oxaliplatin and capecitabine) on advanced stomach cancer. Unfortunately, the study didn’t find any benefit from having pantitumumab (Vectibix).

I have Weetabix every morning these days, perhaps I should start my own trial?   Back to the drawing board, eh?  Me too!!  CYA tomorrow; LOL.  Now is that cool enough? Nearly – like a ‘cold cap’, eh?

PS You can find (really detailed) information about biological therapy trials for stomach cancer if this little lot is not enough for you, via the Cancer Research Campaign website (http://www.cancerresearchuk.org, Accessed 25 November, 2015) on their clinical trials database.