Smith Claire
Diagnosis
For the first time, I went to the local village clinic to see a surgeon because I had been noticing heavy blood from the anus for a week, and it was not only on the paper but also in the toilet, in volumes like during menstruation. Of course, I delayed going to the clinic a little because the delicate area always prevents you from going right away. I hoped that it would pass; I assumed that perhaps it was an anal fissure, but there was blood every day after each bowel movement, even though the underwear remained clean. Anxiety and the assumption of the worst grew inside.
Of course, I opened the Internet, typed in the symptoms and treatment, and every article wrote that it was necessary to see a doctor, but they did not say which one. Out of ignorance, I went to a surgeon, but the local clinic did not have the necessary specialists. The surgeon palpated me and confirmed my assumptions that these were anal fissures, prescribed suppositories for them, venous tablets, a hemostatic agent, and chamomile baths. He prescribed a 2-week course. I took them, but the blood did not go away. I was worried and shared my health with a friend, and my friend made an appointment for me with a proctologist at an open clinic in London for a consultation. There, they also first examined me with their fingers, performed a rectoscopy, and gave a disappointing prognosis. They said that it was oncology. Cancer. And that it was located very low to the anus, that, most likely, according to the standard of treatment, they would perform a colostomy for life, and I would lose the ability to empty my bowels naturally. They advised me to contact a clinic specialising in colorectal cancer, the Royal Marsden Hospital. They said that they could try to perform an operation and form a reservoir (bag) inside the intestines so as not to have to perform a colostomy. At work, I was advised to contact the National Cancer Research Centre for a colonoscopy and a second opinion on the primary diagnosis, and I signed up for a paid appointment.
Adverse Reactions
After two rounds of chemotherapy, complications appeared on the soles of my feet. At first, I didn’t notice it. It was summer, and I thought it was just a blister, so I didn’t mention it to my doctor. However, the blisters didn’t go away. They only worsened and spread across the soles and toes. It became painful to step and walk. I had to walk on the edge of my feet where there were no blisters, which risked causing an ankle fracture.
After radiation, my chemotherapy regimen was adjusted due to the complications and palmar-plantar syndrome. They implanted a port system under my collarbone (the procedure lasted about an hour) and continued my chemotherapy using the Folfox regimen for another six sessions every three weeks. I had to stay in the hospital with a pump for 2-3 days since the pump dripped continuously for 48 hours. I no longer had to take Capecitabine tablets, except for the anti-nausea medication, Ondansetron.
Nausea
With each chemotherapy session, I felt nauseous on the second day. During the last session, I even threw up a little. Preparing for the next session was difficult due to the unpleasant feelings, but I managed to cope. The palmar-plantar syndrome persisted, with red, swollen soles, but the blisters gradually faded. My white blood cell and neutrophil counts dropped, and once at the clinic, I had to receive a stimulating injection.
I didn’t experience any particularly severe conditions throughout the treatment, except for the nausea during the final rounds of chemotherapy. The tingling in my fingertips and throat was bearable, although I was careful when touching things.
I also developed a strong intolerance to smells, especially food. The meat smelled rotten and worsened my nausea. I had no appetite and didn’t want to eat. In the hospital, unpleasant smells wafted from the dining room on the ward floor, and I tried to avoid walking past them. The ward also had a particular smell that made me feel sick. My roommates advised me to drink lemon tea to ease the nausea, which helped a little.
Another source of support came from the encouraging comments under my social media posts during chemotherapy. The disease somehow sorted out the people around me. Friends (or followers) I barely knew became more active in supporting me and communicated more often, while those I was close to became more distant. I believe that social media can be a source of support when there’s no one around to lean on. It’s tough to face your illness alone, but it’s not an absolute rule. In the hospital, there was a woman from another town who didn’t tell anyone in her circle—family, friends, or acquaintances—about her condition. After chemotherapy, she flew to a wedding. I think she’s a strong woman. But still, it’s better to receive some warmth and support than to carry everything alone. I know this from personal experience.
Radiation Therapy
After two rounds of chemotherapy, I was prescribed radiation therapy at the PET-Technology Oncoradiology Centre. For free treatment, you need a referral in the form F-57/u from your clinic.
I had 27 fractions, 2g each, on a modern Varian TrueBeam linear electron accelerator. The area to be irradiated was my small pelvis. I also took chemotherapy tablets (Capecitabine 3000mg/day) on the days of radiation therapy to enhance its effect.
I was very apprehensive about radiation therapy because, during my stay in the clinic for chemotherapy, I overheard patients who had undergone radiation sharing that they had experienced severe burns. I feared the same complications and pain, but fortunately, everything went well for me.
At first, I had to sign up and come in for the marking. Based on CT and MRI scans, they marked crosses with forcing (brilliant red dye) on my stomach below the navel and on both sides of my hips and instructed me to touch them up at home to prevent them from fading. These marks were used to set up the photon irradiation.
For a month, I visited for radiation therapy on weekdays. The procedure didn’t last long, about 2-3 minutes, but there were long waits in the queue. The irradiation itself was painless. The doctors warned about potential burns to the intestinal mucosa and advised me to buy ointments, creams, and suppositories for treating burns. I bought everything they recommended and applied them daily.
I knew that radiation would affect my ovaries and cause my menstruation to stop. I also developed acne like a teenager (due to my liver), and my pubic hair fell out unnoticed. I couldn’t bear needing to go to the toilet, so I rushed as soon as I felt the urge. It was unpleasant that my underwear would get wet due to uncontrolled urine leakage. I used pads, changed them often, and feared that this would be permanent, but fortunately, it passed.
Cystitis and proctitis developed, and my liver ALT and AST levels rose. Plantar syndrome worsened due to the pills. It became increasingly painful to walk. After chemoradiation therapy, the tumour scarred.
Given the detected toxicity in my body, it was recommended to halt chemotherapy and monitor the tumour with control exams every 2 months and MRI scans of the pelvic organs every 3 months.
Problem
After radiation therapy, I stopped menstruating and hoped it would return with time, but it didn’t. I entered menopause with all the typical symptoms. At first, I was tormented by hot flashes (it was hot and stuffy), and my mood fluctuated. My gynaecologist couldn’t prescribe anything due to my cancer, fearing hormonal treatments might stimulate tumour growth. I asked if the drugs would help me recover and whether menstruation would return, but she said no, the drugs would only alleviate the hot flashes. I decided I could cope with the hot flashes without medication. Of course, I still lack information about therapies for supporting women’s health that could be used in my situation.
My attending physician is Dr. Edward James Millar. He has been very considerate, polite, and kind. Communication was immediately good and trusting. I relied on his opinion, experience, and professionalism. I felt he genuinely wanted to cure me. I was terrified of everything and asked many questions, which he answered patiently and in detail. A respectful relationship with your doctor is very important and free from rudeness. For instance, I observed a tense relationship between a woman in the ward and her attending doctor’s assistant. When the doctor came for an examination, it was uncomfortable for everyone in the ward, and you could feel the emotional strain in their communication. I wouldn’t have been able to focus on recovery under such psychological pressure, and that patient was also struggling.
Rehabilitation
I wasn’t given any restrictions; perhaps there are many after surgery, but I didn’t have any. I visit the clinic regularly for digital exams every two months. In November, my first colonoscopy post-treatment showed that everything was fine; the scar was smooth and unchanged. The next exam is in February. In addition to these exams, I also undergo pelvic MRI scans, which I pay for at another centre.
Six months after treatment, I had a chest X-ray to check for possible metastases. I also had blood tests and liver function tests once during this time. All tests came back fine. I still need to take tumour markers, but due to the quarantine, I can’t get to an oncologist for referrals.
Since I still have the port system, I must care for it every 4-6 weeks. On the one hand, I want it removed, but on the other hand, if a relapse happens, I don’t want to damage the veins in my arm again, so I continue using the port. It lasts for up to 1.5 years.
Three months after treatment, a new complication arose in my knee joints. There was a crunch, so I had an MRI and consulted with an orthopaedist. I was diagnosed with stage 2 osteoarthritis.
As the doctor explained, our body constantly renews cells. Perhaps this issue was caused by chemotherapy, which is designed to stop the growth and division of cancer cells but also affects healthy processes.
I plan to treat it; I don’t want to destroy my joints. However, it’s unclear if this has affected my other joints and how to treat them.
I recommend not being shy when contacting doctors, even for the most delicate issues. It’s best to start with a local or private clinic, preferably with recommended and trusted doctors. Unfortunately, it’s very hard to find a good doctor who will cure you, show kindness, and help guide you.
I was fortunate. A good doctor was recommended to me, which I was able to verify personally after treatment and entering remission.
You shouldn’t compare your medical history to others, especially those with tragic outcomes. You can’t assume you’ll have the same complications from treatment. We have a unique body, immune system, and internal motivation. You need to trust in successful treatment and can’t lose heart or give up.
If complications arise during treatment, please tell your doctor immediately and seek advice.
Life after cancer
My lifestyle hasn’t changed much. I’ve started eating less junk food and trying to avoid alcohol. However, my doctor advised me not to go to the beach during the summer due to the intense sun. I went to the coast in September to stay out of the sun during the hot midday hours and only go out in the early morning and evening.
I’ve been in remission for 11 months. Gradually, I’ve adapted to life without chemotherapy. I’ve almost forgotten about the stages of treatment, and when I remember, I can’t believe I’ve overcome it all. But I have! I try to stay positive and not dwell on the possibility of relapse. I consider myself healthy.
My recovery took 9 months from diagnosis. It began suddenly and ended suddenly, as one day, when I went in for another chemotherapy session, they didn’t do it and sent me home, saying my tumour had fully responded to treatment and chemotherapy was no longer needed. From then on, I would only come for routine check-ups.
I was initially lost as I had become accustomed to the established rhythm. I asked my colleagues what to do next and received a simple response, which I’ll leave you with to end my story:
“And then you will live!”