“Take one day at a time; always look on the positive side; and never give up.” This is what Ruchi (name changed) has to say as she battled a life changing event in her life when in May, 2012, she was diagnosed with rectal cancer that had spread to her liver. She was 32, recently married and planning to have a child.
Signs and symptoms of rectal cancer
Ruchi noticed something was wrong when she had multiple bleeding bouts over a span of 14 days. She had been diagnosed with haemorrhoids years ago and thus attributed her symptoms to haemorrhoids flaring up. She hoped the bleeding and urgent need to use the washroom was temporary and what she was experiencing was just a one-time flare up. However, over the next few weeks, the bleeding became more frequent and urgency continued. By the end of November, Ruchi’s symptoms stayed and she was forced (as she says) to seek appointment with me. Ruchi’s energy level had dropped so low, she was having trouble performing her job working.
Bleeding with stools can be due to many reasons and should never be ignored. One of the reason for this could be a cancer of the lower colon or rectum. Many a times these bleedings are attributed to piles and thus managed without seeking a doctors consult. If this bleeding is because of a cancer, we lose chance of picking it up early and thus ensuring cure.
I examined Ruchi and found that she had external haemorrhoids. However on examination of her back passage I found a tumour in her rectum. Rectum is the last portion of the intestines, where stools are stored. This area can be examined digitally with a gloved finger right in the outpatient clinic. I ordered tests which also included a colonoscopy. Her haemoglobin was low because of her bleeding. In colonoscopy, I found a large tumour in the lower rectum, 2 cm away from her anal opening. I took biopsies which came as cancer. Her CT scan revealed that she also had a solitary tumour in the liver and thus she was diagnosed to be having stage 4 rectal cancer.
Counselling about rectal cancer and outcomes
I sat down with Ruchi and her husband and broke the news to them. I explained about the disease and various treatment options. I also gave hope as stage 4 rectal cancers can be treated successfully and almost up to 30 percent patients have a good survival chance. The session lasted for almost an hour. I called them again next day to further discuss her treatment plans as well as answer any more questions they had. They were of course devastated at the news. Stage 4 rectal cancer requires chemo as well as radiation, followed by surgery. Her ova had to be procured and saved for future so that she can have babies.
Ruchi describes getting the news she had cancer as shocking, but she says that she didn’t feel scared. “Even though both of us were crying, I was sure I was going to face it with courage”. She knew that she could rely on her husband’s support. She was also sure her parents would also help her in the crisis. She was very determined to remain positive.
Surgery, chemotherapy and radiation for rectal cancer
Stage 4 rectal cancer has many pathways for treatment depending on quite a few factors. After a tumour board meeting, it was decided to treat her with chemotherapy followed by radiotherapy and then surgery if required. With chemotherapy her liver tumour vanished and rectal tumour became small. After radiotherapy, the rectal tumour was difficult to feel but she had problems with incontinence.
So APR surgery was planned for her. In this major surgery the rectum along with back passage is removed and the patient is given a permanent stoma called end colostomy. Ruchi underwent surgery to remove the tumour and got a permanent colostomy, where the end of her colon was brought out through a hole created in the abdomen wall on left lower abdomen. This allows wastes (faecal matter) out of the body, which is collected in a colostomy bag, that has to be emptied regularly.
Life with a permanent stoma for rectal cancer surgery
Ruchi says that the colostomy bag was a big mental block for her. She had been counselled about her permanent colostomy by a stoma therapist in my team, but Ruchi was still apprehensive. However the stoma therapist had multiple meetings with her and her husband and slowly she adjusted to life with a stoma. Her main focus remained about the cancer being completely eliminated and thus a favourable biopsy report after her surgery elevated her mood.
“At that point, I started thinking about a future and that helped me. I was so focussed on my cancer that my communication with my husband were always about my cancer, treatment and outcomes. One month after the surgery, when I was told that the cancer at that stage had been eliminated from the body, I felt so relieved. My liver looked good and thus no further treatment was required.” Ruchi was now learning to live with her stoma and changed life style. We encouraged her to start thinking about normal chores and getting involved in managing her house. We also started her on daily exercises, walks and trips to the park.
Ruchi was also counselled about her relationship and sex life. She was encouraged to roll back into the relationship at her pace. Her partner was also counselled about living with a person with a stoma. Having an understanding partner is very important; Ruchi was very lucky on that front.
Surveillance for Rectal Cancer
We made a 7 year surveillance plan for her so that we remain on the lookout for the cancer coming back. A three monthly visit to the clinic and yearly plan for scans and colonoscopy was planned.
No bag after rectal cancer surgery
8 weeks after surgery, the stoma therapist started teaching her about stoma irrigation, which allowed Ruchi to be without a bag throughout the day. That was another turning point in Ruchi’s life. “Being without a bag the entire day was a very positive event in my life. I started going out to the market and that helped me feel better. As my strength came back, my negative thoughts stated disappearing. My surgical team started encouraging me to buy new clothes as I had lost weight and my old clothes had become very baggy. My nurses encouraged me to go for a session with my saloon and I had a new hair style. I started feeling very chic in my new wardrobe and that is where I started becoming confident of my body. Life felt so good”
Three years later after treatment for stage 4 rectal cancer
Ruchi tests stayed negative for cancer. She started working from home. She was blessed with a lovely baby girl, who is now 6 months old. Life is back to normal for Ruchi. “I was a fighter and at times highly strung, but these days I prioritize what’s a big deal and what isn’t. My baby and husband are a handful and I am very happy and positive. I take life one day at a time and enjoy every moment of it”. We tell her we are happy too ….