124 – Treating Margaret’s Cancer, Part 1: 21 December 2024

While I busied myself with the Postcard research to try and cope with the reality that Margaret was dying, Margaret’s cancer did its best to ensure that she did in fact die.  From the perspective of the cancer, there was nothing personal.  The cancer surely bore no malice towards Margaret.  It simply wanted to grow and thrive, but the place it chose to grow and thrive was inside Margaret’s body.  As the cancer grew, Margaret steadily came closer to death.

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 I took the photo shown above in 2001 when Margaret was 51 years old and so full of life.  She definitely had no cancer inside her when we had out housewarming celebration in late 2001.

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I also took this photo of Margaret in 2001.  I had almost forgotten how healthy she looked back then.

 

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The surgeon had another look at Margaret’s tumour on 28 November 2020.  This again involved overnight hospitalisation.  The surgeon’s report on that operation says this.

Findings

The ampullary lesion was seen in D2.  It was villiform and covered by bile stained material.  On EUS, there was a 1.8 x 1.2 cm oval lesion at the ampullary region and extended into the distal CBD by 1.8 com.  The lesion obstructing the CBD, causing it to dilate up to 10 mm.  The lesion is limited to the ampula/ CBD only.  The PD was not affected and was normal in calibre (1.2 mm)”

[EUS = Endoscopic Ultrasound; CBD = Common Bile Duct; PD = Pancreatic Duct]

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When the surgeon operated to check on the progress of the cancer in November 2020, he took a tissue sample.  This sample was then examined by a pathologist who said this.

Conclusion

1.      Ampullary biopsy: ulcerated, moderately to poorly differentiated invasive adenocarcinoma arising from high-grade adenomatous surface.

2.      Distal CBD biopsy: moderately differentiated invasive adenocarcinoma

By 28 November 2020, the cancer was thriving; it was destroying Margaret’s body and Margaret was most certainly dying.

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In early December 2020, the oncologist suggested radiotherapy and chemotherapy as a possible way of trying to slow the growth of the cancer.  He thought it might gain Margaret an extra two to four months, but candidly told us it might not actually postpone her death.  The oncologist had previously told us that chemotherapy and radiotherapy were not possible at all given the location of Margaret’s cancer in her ampullar. 

Margaret agreed to give the treatments a try, but stipulated what chemotherapy drugs she would not allow to be used.  Margaret had been a cancer nurse for 30 years and had intimate knowledge of the side effects from the various chemotherapy drugs used to treat cancer.  There were some side effects that she would not put up with even if it might mean a slightly shorter life for her. 

Chemotherapy and radiotherapy started on 7 December 2020. 

Chemotherapy was administered by means of a plastic bag on Margaret’s arm.  The bag had a pump which slowly administered the chemotherapy drugs over a 7 day period until the bag was empty.  The chemotherapy from the plastic bag dripped into a plastic tube which was inserted into Margaret's body.  The tube snaked through her body to a location next to her heart.  We went back to the clinic every week to have the empty chemotherapy bag replaced by a new one. 

Radiotherapy was administered once per day mostly on five days every week.

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In week one, Margaret received radiotherapy on the following dates:

·                                Monday 7 December 2020;

·                                Tuesday 8 December 2020;

·                                Wednesday 9 December 2020;

·                                Thursday 10 December 2020; and

·                                Friday 11 December 2020.

 

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In week two, Margaret received radiotherapy on these dates:

·                                Monday 14 December 2020;

·                                Tuesday 15 December 2020;

·                                Wednesday 16 December 2020;

·                                Thursday 17 December 2020; and

·                                Friday 18 December 2020.

 

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In week three, Margaret received radiotherapy on these dates:

·                                Monday 21 December 2020;

·                                Tuesday 22 December 2020;

·                                Wednesday 23 December 2020; and

·                                Thursday 24 December 2020.

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In week four, Margaret received radiotherapy on these dates.

·                                Monday 28 December 2020; and

·                                Tuesday 29 December 2020.

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In week five, Margaret received radiotherapy on these dates

·                                Monday 4 January 2021;

·                                Tuesday 5 January 2021;

·                                Wednesday 6 January 2021;

·                                Thursday 7 January 2021; and

·                                Friday 8 January 2021.

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In week six, Margaret received radiotherapy on these dates.

 

·                                Monday 11 January 2021;

·                                Tuesday 12 January 2021;

·                                Wednesday 13 January 2021;

·                                Thursday 14 January 2021; and

·                                Friday 15 January 2021.

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Week seven was the final week of both the chemotherapy and the radiotherapy.  In week seven, Margaret received radiotherapy on the following dates.

 

·                                Monday18 January 2021;

·                                Tuesday 19 January 2021; and

·                                Wednesday 20 January 2021.

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In total, Margaret received 29 doses of radiotherapy, plus the continuous infusion of chemotherapy over a period of six week and three days.  The chemotherapy bag was removed on 20 January 2021 when Margaret had her final dose of radiotherapy.

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Over that whole Christmas/ New year period that Margaret had her treatment, I thought I was living through a vile, foul horror story which had only two positive aspects – Margaret was still alive and I knew I would never again have to go through another Christmas/ New Year period like this.  I was only half correct.

I was correct in knowing that having Margaret alive was a massive blessing.  I continued to receive that blessing over the Christmas/ New Year period in December 2021/ January 2022 and in December 2022/ January 2023

I was incorrect in assuming I would never again have to live through such a vile Christmas/ New Year period.  The two remaining Christmas/ New Year periods that we were able to spend together were at least as awful as the 2020/ 2021 period.  Fortunately, back in 2020, neither of us knew what was in store in the future.

It is now nearly Christmas 2024 and my heart aches and aches.  She is no longer with me.

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Special guests at our housewarming in 2001 were Sue Marshall and her husband Chris Reilly.  Sue was a beautiful soul who died on cancer in 2004.  As this photo shows, she had lost her hair because of chemotherapy in late 2001.  Chris Reilly is still alive and despite being a special guest in our home in 2001, he cancelled both Margaret and me shortly after the events described in this blog.  He refused to come near me during Margaret’s funeral.  Sue Marshall died at about 2.30 am and we arrived at 3.00 am to remember and celebrate a wonderful, beautiful friend.  Chris Reilly managed to forget all those decades of friendship when Margaret received her terminal cancer diagnosis.

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