This post is part of my Cancer & Healing journal, an archive of the updates I wrote while going through treatment for Stage III rectal cancer. These entries reflect what I knew and felt at the time.

Well… I guess it’s time for another plot twist. 🤠

On August 18, I’ll be having surgery to officially evict the tiny squatter that apparently didn’t get the memo after radiation and chemotherapy.

The Plan: Low Anterior Resection

The plan is an LAR, or Low Anterior Resection.

My tumor started out ultra low, but thanks to radiation and chemotherapy, it has shrunk enough that, based on my MRI scans, my surgeon believes there’s enough room to get clear margins while staying away from all the important plumbing.

If everything goes according to plan, I’ll have a temporary ileostomy for about two to three months while everything heals.

Then I’ll have another surgery to reverse it.

The Backup Plan: APR

Surgery always comes with a backup plan.

If my surgeon gets in there and decides an LAR can’t be done safely, we’ll switch to an APR, or Abdominoperineal Resection, otherwise known in colorectal cancer circles as Barbie Butt Surgery.

That would mean a permanent colostomy.

Is that what I’m hoping for?

Nope.

But if that’s what it takes to get rid of cancer, then let’s do it.

From Stage IIIc to One Tiny Remaining Area

The crazy part is thinking back to where this all started.

Stage IIIc rectal cancer with aggressive features.

Four or more suspicious lymph nodes.

EMVI, meaning the imaging showed cancer involving blood vessels outside the rectum.

Now, after chemoradiation and FOLFOX, the concerning lymph nodes and EMVI are no longer visible on MRI.

And we’re down to one tiny remaining area.

I’m honestly not scared.

More than anything, I’m excited to get this last little jerk out of me.

The goal is clear margins, a complete pathological response and those three beautiful letters:

NED.

No Evidence of Disease.

The Waiting Has Been Its Own Kind of Hard

People often ask what the hardest part has been.

Treatment was brutal. Don’t get me wrong.

But the waiting…

The scanxiety.

Living three months at a time between labs and scans.

That’s been its own kind of exhausting.

So if you’ll do one thing for me over the next few weeks, I’d appreciate all the prayers, good vibes, crossed fingers, lucky socks and positive thoughts you’ve got.

Let’s help my surgeon have his best day at work. ❤️

Here’s to August 18.

A fresh chapter.

And hopefully closing this one for good.

Looking Back

This one is difficult to read now for a completely different reason than some of the others.

I was so ready to be done.

Not recklessly optimistic.

Not in denial.

I understood there was a chance the LAR wouldn’t work.

I understood I might wake up with a permanent colostomy.

I understood surgery could reveal things the MRI couldn’t.

But everything we could see seemed to be moving in the right direction.

The lymph nodes that had originally looked involved were no longer radiographically concerning.

The EMVI was no longer visible.

The primary tumor had responded dramatically.

There was one small remaining area.

So I went into surgery hoping for the best possible ending:

Remove it.

Clear margins.

Complete pathological response.

NED.

LAR Versus APR Wasn’t a Small Decision

There’s a little humor in the original post about “important plumbing” and Barbie Butt Surgery, because humor is how I have survived a considerable portion of this.

But underneath the jokes was an enormous decision.

My tumor was very low.

Preserving the sphincter meant my surgeon would be operating with very little room.

An LAR offered the possibility of removing the cancer while preserving the anus and eventually reconnecting my bowel. The temporary ileostomy would protect that new connection while it healed.

The alternative was an APR.

No reconnection.

Permanent colostomy.

I had thought about both possibilities for months.

By the time August approached, I’d reached a strange kind of peace with it.

Of course I had a preference.

But I wanted the cancer gone more than I wanted any particular anatomy preserved.

Whatever needed to happen once my surgeon got in there, I was ready.

What Surgery Would Eventually Tell Us

This is where hindsight becomes particularly complicated.

The LAR worked.

My surgeon was able to remove the tumor and preserve my sphincter.

The resection achieved clear margins.

I woke up with the temporary loop ileostomy we’d planned for.

Those were all significant wins.

But I didn’t get the complete pathological response I was hoping for.

Surgery gave us information that scans, scopes and biopsies couldn’t.

There was still viable cancer in the tumor bed.

And despite the lymph nodes looking clear on imaging after treatment, pathology would ultimately find cancer in four of the twelve lymph nodes that were removed.

My final post treatment pathology was ypT3N2a.

That was not the pathology report I had imagined when I wrote this post.

Not even close.

But that’s a story for the entry where I actually received those results.

I don’t want to drag that day backward into July 29.

“Let’s Help My Surgeon Have His Best Day at Work”

This might be my favorite line in the whole post.

Because he did.

He went into an ultra low pelvis after radiation and chemotherapy and was able to perform the operation we’d hoped for.

He achieved clear margins.

He preserved my sphincter.

And whatever else I would eventually learn from pathology, those things remained true.

There are outcomes in cancer that can be both disappointing and successful at the same time.

I understand that much better now.

Hopefully Closing This One for Good

That’s how I ended the original post.

Reading it now, there’s an obvious temptation to add:

Well, that didn’t exactly go according to plan.

But I’m not going to.

July 29 Dawn was allowed to hope surgery would close this chapter for good.

She had endured nearly a year of cancer treatment.

She had done radiation.

She had carried a 5 FU pump.

She had made it through seven rounds of FOLFOX.

She had waited through scans, scopes, biopsies and appointments.

And now there was one tiny visible area standing between her and the possibility of NED.

Of course she wanted August 18 to be the end.

I still love that she walked toward surgery excited rather than terrified.

Not because she knew everything would be okay.

She didn’t.

But because whatever my surgeon found when he got in there, I had reached the point where I could say:

If that’s what it takes to get rid of cancer, then let’s do it.

And I meant it.