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maandag, 21 september 2015 17:28

Coloncarcinoom

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Al voor de zomervakantie had ik last van kortademigheid, het leek een stressverschijnsel. Maar ook na de zomervakantie was deze kortademigheid er weer. Ook vonden anderen dat ik er bleek uitzag. In samenspraak met de huisarts werd gekozen voor een bloedonderzoek en daaruit bleek inderdaad een forse bloedarmoede: een Hb-gehalte va 4,1 in plaats van 8,5. Volgens de dokter een wonder dat ik nog zo fit op de benen stond.

 

Hemoglobine is een ijzerhoudend eiwit, rood van kleur, dat zit in bloedlichaampjes geeft het rode kleur. Deze stof kan zuurstof binden en zorgt voor het transport van zuurstof naar de cellen. Deze cellen hebben zuurstof nodig om goed te functioneren, zoals bijvoorbeeld het verbranden van voedingstoffen waardoor bouwstenen en energie vrijkomen. Een tekort zorgt dus voor minder aanvoer van zuurstof, waardoor er uiteindelijk te weinig energie vrij komt. Met als gevolg dat men zich moe voelt, erg bleek ziet en vaak ook constant koude handen en voeten heeft. Er is ijzer nodig om hemoglobine aan te maken. Een gebrek aan ijzer (ijzertekort) is meestal de oorzaak van deze vorm van bloedarmoede.

 

Volgens de arts wordt een bloedarmoede in veel gevallen veroorzaakt door problemen in de maag en darmen en dus mocht ik vorige week dinsdag opdraven voor een maag- en darmonderzoek. Omdat ik werkelijk helemaal nergens last van had ging ik uit van iets onschuldigs als een zwakke ader of een poliep die af en toe bloed afgeeft. De schok was dan ook groot toen de onderzoekende arts ons meedeelde dat hij een flinke tumor in de dikke darm had waargenomen. Daarnaast ook nog wat vage plekken in de endeldarm.

 

Links: De dikke darm is bij een volwassene ongeveer 1 tot 1,5 meter lang. Bij mij zit de tumor in het opgaande deel. De ontlasting is op die plek nog maar weinig ingedikt zodat de tumor lang onopgemerkt kan blijven.
Rechts: Dit zal ongeveer het beeld zijn dat de maag-darm-arts te zien heeft gekregen bij de coloscopie. Dit is volgens mij al een behoorlijk grote. Het komt wel voor dat bij mensen een tumor zo groot als een tennisbal verwijderd wordt.

 

 

De volgende morgen afspraken gemaakt voor vervolgonderzoeken. Deze vonden afgelopen maandag plaats: een MRI-scan, een longfoto, een CT-scan en nog een keer bloedprikken. Doel van deze onderzoeken was om vast te stellen of de tumor zich al door de darmwand heeft gewerkt en daarbij voor uitzaaiingen heeft gezorgd. Die uitzaaiingen komen dan doorgaans eerst in de lymfeklieren, vervolgens in de lever en de longen.

 

In stadium 1 en 2 is de tumor nog geheel binnen de darmwand gebleven en dus nog in zekere zin geisoleerd. Bij stadium 3 is er reeds contact met het lymfestelsel, waardoor verspreiding van cellen mogelijk is. In stadium 4 zijn uitzaaiingen (metstasen) mogelijk naar andere organen. Doorgaans zijn dat de longen en de lever.

 

De uitslag van de scans heeft helaas nog niet echt veel duidelijkheid kunnen geven, zo bleek uit het gesprek met de arts afgelopen woensdag. Het heeft er alle schijn van dat de tumor de darmwand wel heeft gepasseerd. Op zich zit de tumor op een relatief gunstige plek, waardoor er volgens de chirurg nog wel enige “marge” is door de aanwezigheid van veel vetweefsel. Echter op de lever is een plekje geconstateerd, waarvan men nu nog niet kan zeggen of het kwaadaardig is. Idem is wat dieper in het lichaam een verdikte lymfeklier gevonden. Het is onwaarschijnlijk dat dit een uitzaaiing van de tumor in de dikke darm is, het zou iets op zich staand kunnen wezen, maar ook hier geen duidelijkheid of het kwaadaardig is. Als laatste de verdikkingen in de endeldarm: het is geen “klassieke” endeldarmtumor, maar wel een verdikking die onder het slijmvlies zit. Is dit ook iets kwaadaardigs of gewoon een vetbult of iets dergelijks? Ook hier geen duidelijkheid.

Om wel duidelijkheid te krijgen moet ik maandag een PET-scan ondergaan. Deze methode is veel meer gevoelig dan de CT-scan en kan uitzaaiingen veel beter zichtbaar maken. Maandagavond wordt ik dan besproken in het deskundigen-overleg en dinsdag krijg ik dan te horen hoe de vlag erbij hangt en wat het behandelschema gaat worden. Het lijkt voor de hand te liggen om eerst met een operatie de tumor te verwijderen, maar er kan soms ook voor gekozen worden eerst chemotherapie of bestraling in te zetten. Alles is afhankelijk van de uitkomsten van de PET-scan.

 

Bij een PET-scan wordt glucose in de bloedbaan gebracht, dat is verbonden aan een radio-actief Fluor-atoom (F-18). Tumorcellen verbruiken veel meer en sneller glucose, zodat daar een opeenhoping van het stralende fluor komt te zitten, hetgeen dus vast te leggen is. Het onderzoek moet snel gebeuren want de F-18 moet uit Amsterdam komen en heeft een halfwaardetijd van 110 minuten (met andere woorden na 110 minuten is er nog maar de helft over). Door de PET- te combineren met een CT-scan is het kwaadaardig weefsel goed te lokaliseren.

 

Lees 8879 keer Laatst aangepast op dinsdag, 22 september 2015 11:23
Marc Stronks

September 2015 werd bij mij een coloncarcinoom, oftwel een darmtumor geconstateerd. Ik deze blog wil ik iedereen zo goed mogelijk op de hoogte houden van de ontwikkelingen. Schrijf rustig een reactie (overigens hoef je bij de spambeveiliging maar één woord of getal in te vullen)

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