With all the blood tests, dental check-ups, optician examinations, ct/mri/pet scans and various consultations complete, the surgeon showed me the results of my MRI Scan whereby he explained the size of my tumor (cancerous tissue growth) had already spread too wide across and too deep into my head regions (nose, eye, cheek, forehead and throat) to perform any kind of useful surgery.
The surgeon concluded by saying words along the lines of "Surgery would need to be done on a huge scale", "It would be very risky and complex" and "Not worth the complications it would entail". In short, he could do nothing for me. At that point, together with the news that I had such a rare cancer, I thought I would only have a few months to live.
The problem at this point is that I was taking in too much information. Plus the fact the surgeon was only completing his part of the story in terms of what he and his team could and could not do for me. Hence why I thought he was concluding my life story. Fortunately he went onto to say he had referred me to an Oncologist (Dr Mary Lei) for Chemotherapy and Radiotherapy treatments. Without that added piece of information things were looking a little final.
Luckily, I was able to have a short consultation with the Oncologist straight after seeing the surgeon. She began by asking me detailed questions about my health history and current medications before showing me, and explaining in more detail, the results of my MRI Scan. When showing me the various slides from the MRI Scan, she explained my tumor was unusually huge; to the point she said she very rarely used the word Huge.
My tumor (cancerous tissue growth), around the right nostril area of my face, is huge.
She went onto to say the tumor was very aggressive and had started eating bone structure towards my brain - You have your skull bone, then a brain membrane protecting the brain (called the Dura) and then the brain itself. Well in my case the tumor seems to of pierced a slight space in the skull bone, enough to breach my membrane (dura).
With all said and done: She concluded by saying that 5-6 Cycles of Chemotherapy would be needed, with each cycle taking 21 Days - 1 Day of Chemotherapy at the hospital, 2 Days of Chemotherapy Tablets and 8 other days consisting of various medications - instead of the standard 3-4 cycles. She then suggested that 6 Weeks of Radiotherapy may need to start during (in combination with) Cycles #4 and #5 of my chemotherapy instead of starting it much later.
Furthermore, she said more chemotherapy may be needed afterwards, as a kind of booster, but many specialists told me months later that not many people are strong enough for more chemotherapy; especially having already had months of chemotherapy and radiotherapy in combination.
Interesting, she also stated that Chemotherapy alone would not completely kill off the tumor. The idea behind the chemotherapy is to shrink the tumor enough to identify where the root or roots of it began. By identifying the root locations Radiotherapy can then be used to try and kill off (destroy/break the DNA sequences), or at least dramatically shrink, the tumor so that it is either completely dead or at least classed as undetectable.
The wordings below are taken directly from certain sections of my official diagnosis papers, as concluded by the various specialists who have been involved in my case (the surgeon, oncologist and their teams).
Official Diagnosis: T4bN2c High Grade NeuroEndocrine Carcinoma of Ethmoid Sinus
Laterally, there is an erosion of the papyracea with deep extension into the extraconal orbital tissues. There is secondary anterolateral displacement of the globe (resulting in proptosis and sight moulding) as well as anterosuperior displacement of the medial rectus. There is no direct invasion of the intraconal tissues or globe. More inferiorly, there is lobulated extension into the maxillary antrum, via large erosions of the medial wall.
Posteriorly, the lesion abuts the orbital/optic canal and anterior genu of internal cartoid artery (with minor bony attenution bnoted on CT), but the calibre of the ICA flow void is preserved. More inferiorly, the lesion invades the sphenoid sinus, pterygopalatine fossa and pterygoid process of the sphenoid bone, with invagination into the attachment of the medial pterygoid. There is also minor posteromedial extension into the nasopharynx.
Posteriorly, the lesion effaces the posterior nasal septum and traverses in the midline at the level of the posterior ethmoidal air cells and sphenoid sinus, to erode into the posteromedial aspect of the left maxillary antrum.
Anteriorly, there is extension into the deep epicanthic/nasolacrimal tiisues and there is tracking along the anterior superior aspect of the nasal cavity, with minor erosion of the low T2 signal of the overlying bone.
Superiorly, there is tumor abutting the anterior skull base over a broad base and extending to the inferior right frontal sinus. There is some minor attenuation of the low signal complex (bone/periosteum) and some minimal focal dural thickening. There is no evidence of intradural extension.
Further tumoral deposits are seen within the posteroinferior aspect of the right maxillary antrum and right infraorbital region (interrupting the fibres of the obicularis oculi muscle and abuting the inferior tarsal plate); the nodules measure 9 mm and 14 mm respectively.
There is a bilateral cervical lymphadenopathy, involving levels IB to V on the right and IIA to V on the left. The largest right level IB node measures 19 mm. The level II nodes are slightly heterogeneous may be partially necrotic; they measure up to 18 mm on the right and 17 mm on the left. Enlarged pharyngeal nodes are seen bilaterally, measuring up to 8 mm on the left and 5 mm on the right.
CONCLUSION - Extensive, destructive sinonasal mass centred on the right ethmoid, with extra conal orbital extension, minor breach in the anterior skull base with the CT of the CT shows and minor nasopharyngeal extension (consistent with T4b disease). The nodal status is N2c.
Fine needle aspiration right cheek nodule, right neck level 4 and left neck level 3 lymph nodes: The morphological features and immunoprofile are consistent with metastatic high grade neuroendocrine carcinoma.
I have explained to Mr Cairns that he has been diagnosed with an aggressive, rapidly progressive rare cancer of the head and neck region. It is concerning that he has multiple lymph nodes involved on both sides of the neck and also that the dura (lining around brain) is slightly thickened in places.
The chance of cure is unfortunately uncertain due to the extent and aggressive nature of the disease but I have discussed treatment with curative intent to consist of induction chemotherapy followed by chemoradiation. I have discussed induction chemotherapy with cisplatin and etoposide and Mr Cairns has provided his informed consent.