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The Cancer Specialist

azathioprine tablets

How easy it is to go from the surreal to the very real…

Today was C-day. As in see my cancer specialist day where I’ll find out what my likely treatment and prognosis is.

I’ve been hardly sleeping. Visions of chemotherapy, radiotherapy and the like have been careering through my mind. My hair will fall out, I’ll be sick as a dog, I may get secondary tumours…

And maybe, no matter what they try, my TIME IS UP.

At the Cancer Centre

chemotherapy drugs for cancer treatment

Chemotherapy drugs used for cancer treatment

The skin cancer centre that I’ve been sent to is fine really. It’s part of St. Georges Hospital, which, to be brutally honest, needs knocking down and starting again, but the Rose Centre is a specialist unit dedicated to skin cancer amongst other things. It’s a new building with new equipment.

Not that that makes much of a difference. I’m shitting myself.

Sitting in the waiting room, I am watching the seconds on the clock tick agonisingly by as I clutch my appointment letter in my sweaty palm. Then, all of a sudden, my name is called and I’m sitting in front of my consultant – Professor Barry Powell. Apparently he is the National Clinical Advisor for Skin Cancer for the NHS. He seems like a nice guy.

He gets straight to the point, which I prefer.

Questions & Mind-Shattering Answers

He starts with the usual ‘sorry about your bad news’ preamble that he must have done thousands of times before. He asks me to tell him the history of my damaged fingertip and how I ended up in front of him.

Then he starts asking me a load of questions:

  • Do I smoke? No.
  • Do I sunbathe a lot? Nope, don’t really like it.
  • Is there a history of skin cancer in my family? Or other cancers? No.
  • Then a load of questions about my general lifestyle, diet etc. Most of my answers he likes.

Then he moves on to my sarcoidosis, how it affects me and what drugs I take to manage it. And here’s where he drops a subtle, but deadly, mind-shattering bombshell. The immuno-suppressant drug I’ve been taking ‘won’t have helped‘, as he put it. It’s called Azathioprine and, as I googled later, is heavily linked with certain cancers including skin cancer. And I’ve been swallowing the maximum dose of 150mg per day for a good few years now. As I’m trying to absorb everything he’s throwing at me, I start to feel really pissed off that the Sarcoidosis experts who put me on this poison never mentioned that. There and then I promise never to take those little white devil pills again.

Professor Powell then proceeds to manually examine my finger and my lymph areas up my left arm and under my armpit. The good news is that he can’t feel any lumps or swellings and, as I feel fine, seems a little more optimistic.

My Skin Cancer Treatment

Next, he moves on to treatment and what he would like to do with me. Apparently as I’m ‘young’ – I’m 49 – they treat this kind of cancer aggressively. And we don’t know if my cancer is just in my fingertip or whether or not it’s spread – mestasised. But on one of my earlier hand x-rays, there is some evidence of bone damage there too. Which is not good.

distal phalanx diagram

Diagram of the Distal Phalanx

So here’s his proposed course of action:

  1. Amputate the top part of my middle finger on my left hand where the cancer is – from the distal phalanx up. Oh My GOD!!!
  2. At the same time, perform a lymph node biopsy in two places: by my left elbow and under my left armpit. The reason is that skin cancer, when it spreads, typically spreads to your lymphatic system.
  3. If the biopsies prove to be clear, then I will go in to ‘surveillance’ mode where they check me for any signs of the cancer returning. For the first 3 years, it’s every 3 months; then the next 2 years, every 6 months; then once a year thereafter. If all goes well, that is.
  4. If the cancer has spread but not too much, then I face further surgery to remove many lymph nodes and glands.
  5. If the cancer has really spread then we face a ‘bigger beast‘.

But the picture is more complicated than that. As I have sarcoidosis I may not be able to survive surgery under general anaesthetic. The alternatives is a course of radiotherapy on my fingertip, but surgery is by far the most effective form of treatment for most skin cancers. I’ll find out at my pre-op check next week to see whether or not my lungs can handle the anesthetic.

Next, I’m introduced to my keyworker nurse who is ‘there for me’. She’ll answer all my questions and provide emotional and psychological support to me and my family if I want it. I don’t. I’m not knocking it, but it makes no real difference to me what she says and as she rattles on about the procedure on 13th January, how my kids might react and so on. I’m really not paying attention.

And then it’s over, and I’m back amongst the living ambling aimlessly towards the bus stop. Now, I know the time has come: I have to tell my partner and kids. To say I’m not looking forward to it is an understatement.

But how and when’s the best time exactly?


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