Mr. Ali's Hopeful Story of Colorectal - Rectal Cancer

From now on, we will occasionally present striking cases through glimpses of real patients' lives. In cancer, where hardship and helplessness are frequently discussed and people lose hope, we will show the many successful and hopeful stories under “hopeful stories”. Sharing patients' treatment experiences in their words and my comments aims to increase knowledge and provide memorable cancer education through cases. Here we share the hopeful story of Mr. Ali and his family after he overcame rectal cancer.

Aged 63, Mr. Ali learned in the final week of December 2012 that he had rectal cancer, affecting the large bowel near the anus. This began the story bringing him to us. Let us hear the rest from him.

What Symptoms and Complaints Led to Diagnosis?

Mr. Ali: Initially, there was sometimes very slight blood with stool. My bowel pattern changed for 1 week, with frequent movements. Bleeding increased, then improved somewhat, but recently there was slight bleeding every time. I also felt weak and lost appetite. Eating little made me lose weight. Suspecting hemorrhoids, I visited a general surgeon.

How Did You Learn the Cancer Diagnosis?

Mr. Ali: I saw a surgeon at the hospital where my son worked. He examined me and took a sample using a camera in the large bowel. The tumor was just at the anal entrance. The sample showed cancer.

What Did You Do After Learning You Had Cancer?

Mr. Ali: I wanted immediate surgery to get rid of it. The diagnosing surgeon referred me to his senior surgeon, preparations were made quickly and I underwent surgery on 10 January 2013.

How Was Surgery, and What Preparation Was Done?

Mr. Ali: I had abdominal CT and repeat colonoscopy, then surgery. After removing the diseased area, they temporarily brought the bowel outside, called a colostomy. It remained outside for 8 months. My doctor said to finish chemotherapy before putting it back.

What Treatment Followed Discharge?

Mr. Ali: I received 6 months of chemotherapy and ablation of the liver lesion (metastasis).

How Did You Meet Dr. Mustafa Özdoğan?

Mr. Ali: A friend recommended him, as did my surgeon. Samples were taken from both bowel and liver during surgery. I did not know about the liver problem beforehand; I learned from the sample taken during surgery.

Who First Told You Cancer Had Spread to the Liver, and How Did You Feel?

Mr. Ali: My surgeon first told me, but I did not fully understand. At my first visit, Dr. Mustafa explained in detail. I was shocked and depressed, psychologically distressed. I lost control. Had something been beside me, I might have done something bad. I could not comprehend it. Part of me knew it was not the doctor's fault, but people can want to react that way. It was truly a shock. After 6-7 months, I adjusted and later accepted the illness.

When Did You Begin Escaping These Feelings?

Mr. Ali's wife: At each treatment, the doctor showed us how the disease was progressing and explained everything step by step. This improved my husband's morale.

Mr. Ali: The art and crafts teacher in the chemotherapy unit talked with patients and encouraged us. She advised planting flowers, painting and finding relaxing activities. This comforted me somewhat. The nurse taking blood also asked how I was, cared closely and reassured me. Chemotherapy staff likewise supported me, saying these things would pass and not to dwell on them.

Mr. Ali's wife: We have a tiny garden. My husband plants things and spends time there.

Mr. Ali: I do not socialize very often. I cycle 4-5 km daily and get fresh air.

How Long After Surgery Did Chemotherapy Start?

Mr. Ali: It began 1 month after surgery.

Do You Remember Receiving Chemotherapy Also Called a Targeted Drug?

Mr. Ali: I was given Altuzan and told it was a targeted drug. I also took Xeloda tablets, which later caused diarrhea. I spent 5 days in hospital for it. Intravenous chemotherapy was given every 21 days. I also took oral chemotherapy for 14 days followed by a 1-week break. This continued for 6 months. Then the liver metastasis was burned with radio waves, called radiofrequency ablation.

How Was Disease Assessed During Chemotherapy? What Were the Results?

Mr. Ali: I had 2 PET scans. The first was after surgery, just before chemotherapy, along with liver MRI. I was told there was no spread outside the liver. Midway through treatment, PET and liver MRI were repeated to check progress.

You Responded Well, Though Not Everyone Does. How Did You Feel?

Mr. Ali: When they said the results were good, I felt on top of the world.

There Was Initially a Liver Mass That Shrank with Treatment. Radiofrequency Ablation (RFA) Was Then Applied to the Metastasis. How Did You Feel When Told It Would Be Burned with Radio Waves? What Did You Understand?

Mr. Ali: I was excited and thought it meant burning and destroying the disease there. I even told the doctor, “Burn a little wider so nothing remains.” I was not frightened. In August 2013, 8 months after surgery, the bowel was put back and the colostomy closed. I have had no treatment since. Bowel movements are comfortable. I feel well and live normally. I now attend annual checkups and colonoscopy regularly. Everything is fine. I have had no problems for nearly 3 years. My weight is normal and appetite good, thankfully...

Colorectal cancers are among the commonest, ranking 3. in both women and men in our country. Rectal cancers affect the final 16-18 cm of the large bowel. In the United States, %20 of colorectal cancers are initially diagnosed at stage 4., metastatic to another organ. The proportion is higher in our country because recommended screening after age 50 is not followed. We therefore see more late-stage cases. Patients with metastatic colon cancer are not always as fortunate as ours, particularly with multiple liver and lung metastases, where treatment success is lower. Rectal bleeding or changed bowel habits should prompt early consultation and, if persistent, colonoscopy, examination with an illuminated endoscope. Healthy individuals after age 50 should also have annual stool tumor analysis or colonoscopy every 10 years.

Although our patient had stage 4. disease, appropriate use of highly effective surgery, chemotherapy, targeted drugs and liver ablation at the right time by an experienced team achieved a cure. Follow-up will continue because a small recurrence risk remains over the years. I believe this successful outcome and the patient's account offer lessons for many healthy people and hope and encouragement to our patients.