Question:
I was experiencing pain on my backside for several months, and went to the Doctor in July. He indicated that he wanted to do a biopsy of the tissue outside of my anus to determine if I had some sort of cancerous growth. The biopsy was about 4 inches long, along the left side of the sphincter muscle, and quite deep in places. He did not stitch the incision, and indicated that the incision would close via granularization over time. I have had other surgeries where I have had an incision dehist, and am familiar with this sort of healing. Leaving the wound open allows any drainage to occur that is needed, as well as to avoid trapping any infection inside.
The biopsy came back positive for squamous cell carcinoma, I believe, and a course of chemo-therapy and radiation was immediately ordered. My surgeon indicated that this treatment was 90% effective, which gave me great hope, and made me anxious to start treatment. Prior to treatment, a CT Scan indicated that the malignancy was limited to the biopsy site, and had not spread to the lymph nodes or any surrounding tissue.
In the middle of August, I had my first chemo treatment. On the same day, I began 6 weeks of daily radiation. For 4 weeks, the radiation was less focused, and resulted in the equivalent of sunburn in an area about 6 inches tall both front and back. Of course, this was expected to some extent, but caused serious discomfort on the penis and scrotum. After time, this healed.
A second Chemo occurred 28 days after the first, and then they began a more focused radiation, that aimed the beam more tightly on the affected area.
Following my last radiation, my radiation oncologist indicated that it would be at least 2 months before my energy level would return to normal. She also indicated that the incision had not healed at all during the radiation, since radiation actually destroys the tissue (good and bad), which causes the healing process to slow. Furthermore, on my 1 month check up, her exam indicated that I was still generating some necrotic tissue from the radiation which was sluffing off during sitz baths, etc. The necrotic tissue generation seemed to stop Mid-November.
Here is where I'm a bit curious as too whether I'm being impatient. (Sorry for the long lead-in, but I figured you would want some background first). My incision is starting to heal, but is still only about 50% closed, and still drains. My oncologist said that he wants to see me in 3 months, and the surgeon wants to see me in March. Does it normally take this long to heal? I have no experience with an incision in this area, so I don't know.
Also, it is still quite painful, and I am on a regimen of 45 mg of MS Contin 2x per day, as well as Percocet for breakthrough pain. It is still quite painful to sit on my rear, and I have been using an inflatable donut to ease the pressure when I do.
I do feel that I am making progress, and I'm sure that the pain is adding to my impatience, but I just need to know if this is inside the norm? I feel that I have dodged a bullet with the cancer, but I also feel that the radiation treatment was pretty horrific. The pain didn't really start until after the 2nd week of the radiation.
Any advice, comments, etc would be greatly appreciated.
Woody
Answer:
Woody,
I was diagnosed over 2 1/2 yr ago with rectal cancer. I believe your cancer is different from mine (you and Farrah F. I believe have the same type of cancer). But I will try to help where I can. I had 6 weeks of radiation prior to my surgery, it bought on ALOT of itchies, and left me with lots of bathroom issues. Yes it can knock the tar out of you. I believe I was 6 weeks following my radiation treatment that I felt normal again. Your radiation treatment is different from mine, so 2 mths recovery seems reasonable to me.
As far as pain, I had no pain prior to diagnoses, nor did I have pain during or following radiation (itchies yes, pain no). Since you had pain prior to your diagnoses, I would assume you would have pain during your radiation treatemnts, radiation will irrate that area, making the pain worse.
I had LOTS of pain following my surgery, felt like my bottom area had been busted and broken. I had to use a donut for 4 mths following my surgery. About a month following my surgery, I could sit only up to 30 mins at a time, spent most of that time, lieing on my stomach or on my feet. After 2 mths I could sit for longer periods of time up to a hr. Around 4 mths, I could sit for extended periods of time, but it would ache, if the seat was not comfortable enought. Today I am fine, haven't used that donut in couple of yrs. I still keep it thought.
As far as healing, I could see where radiation treatments prevented healing from happening. Add chemo to the pot, yeah it will take time.
I'm sorry your in pain, I believe you will get better, but it will take time. For me, it took 6 mth to fully recover from surgery and the pain associated with it. Personally I found Motrin to help me the best for pain. My surgeon was aware that I would not be taking presc. pain med unless I positively had to. While she gave me a script for pain med, told me to fill it and use if needed, she also gave me the go ahead to use Motrin as main pain pill. I like Motrin best, because it reduces swelling the best. When there is no swelling, there usually is less or no pain. Maybe try that rather than a presc. pain pill. Just be sure to eat something prior to taking Motrin.
Hope this helped some. Good luck, hope you get relief soon, I do understand your pain.
Lee
Answer:
Thanks for the info that you provided. From what I have heard from discussion groups like this and from talking to the radiology nurses is that rarely does the radiation treatment start immediately following the surgery, while there is still an open wound. I even remember one of the nurses asking the Doc if my surgical wound was a result of the radiation--"I've never seen anything so horrible" were his exact words.
I think the fact that my radiation treatment began before I was completely healed was what has made this feel longer than "normal" -- whatever normal is. Thanks again for a bit of info on your history. I guess if I start the "healing clock" at the end of the radiation impact, then I'm really only about 2 months into my recovery.
Woody