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donderdag, 03 maart 2016 13:31

De aanstaande operatie (2)

Geschreven door

Om vast te stellen waar de NET-tumor in de endeldarm zich bevindt moest ik vrijdag 12 februari weer een endo-echoscopie ondergaan. Ik had de chirurg in Almelo daarvoor nog even kort telefonisch gesproken in verband met het bloedonderzoek naar de CEA-tumormarker (uitslag overigens goed) en daar bleek dat bij de allereerste endoscopie ook al 7 cm (vanaf de anus gerekend) was vastgesteld. Ik had dus weinig hoop op die 15 cm. Bij de endoscopie maakte ik geen gebruik van het roesje, zodat ik zelf op de camera mee kon kijken. En ik had al snel in de gaten dat het ding redelijk aan het begin zat. Uiteindelijk zat hij op 9 cm, zo is met de lineaal vastgesteld. Overigens zag de tumor er inderdaad net zo uit als op de (willekeurige) foto die ik twee blogberichten terug plaatste. Verder bleek dat de grootte van de tumor 15 x 18 mm was.

Dat betekent dus helaas wel een lastiger verhaal qua operatie. In hoofdlijnen is dit de bedoeling:

 

 

 

 

Het plaatje gaat over een "normale" tumor. Er wordt hier zelfs een deel van het sigmoïd deel van de dikke darm verwijderd (het horizontale deel voor de endeldarm) . Of dat in mijn geval ook met een NET-tumor gebeurt weet ik niet. De dikke darm moet dan vervolgens met de overgebleven 5-6 cm van de endeldarm verbonden worden. Omdat de doorbloeding aldaar minder is en het herstel dus langzamer gaat, en omdat de endeldarm grotere druk moet kunnen verdragen is de kans erg groot dat de naad kapot gaat en gaat lekken met alle vervelende gevolgen van dien. Daarom moet het onderste gedeelte rust worden gegund en moet er een tijdelijke stoma worden aangelegd. Dat gebeurt klaarblijkelijk meestal met het uiteinde van de dunne darm, maar omdat daar al een operatie heeft plaatsgevonden wordt er nu een stoma van de dikke darm aangelegd, de zgn. colostoma. De operatie gaat plaatsvinden op maandag 7 maart in het UMC Groningen en wordt uitgevoerd door dr. Hemmer.

 

 

In het dalende deel van de dikke darm (op de plaatjes hierboven aan de rechterkant) wordt een stukje darm a.h.w. naar buiten getrokken, vastgezet op de huid (zodat het niet meer terug het lichaam in kan) en opengesneden. Je houdt dan twee uitgangen over. Het heet dan ook een dubbelloops colostoma. Uit de ene uitgang komt de verwerkte darmmassa, uit de andere komt slijm dat de darm produceert om de binnenkant glad te houden. Beide "vloeistoffen" moeten nu worden opgevangen in een stomazakje. Na 6-8 weken zal er een eerste inspectie zijn tot hoever de genezing is gevorderd. Indien dit voldoende is zal er een maand later een hersteloperatie volgen om de stoma weer op te heffen. De twee uiteindes worden dan weer aan elkaar genaaid en in het lichaam teruggeplaatst.

Je zou dan denken dat we al klaar zijn met het verhaal.... maar dat is dan nog niet helemaal het geval. De endeldarm is natuurlijk veel kleiner geworden en dat betekent dus minder reservoir. Daarnaast is het onderste deel van de darm drie maand stilgelegd, en heeft bv de kringspier zich ook weinig hoeven in te spannen. Dat betekent dus in het begin een veelvuldige en onregelmatige stoelgang. De eerste weken schijn je wel grotendeels in de nabijheid van de wc te moeten doorbrengen.... Na verloop van tijd schijnt het zich te stabiliseren en daarnaast neemt de dikke darm een deel van de functie van de endeldarm over. Na verloop van tijd komt er een meer stabiele situatie waarbij je nog 2-4x per dag naar het toilet moet. Daar valt volgens mensen met gelijke ervaringen goed mee te leven. Maar... het duurt volgens de chirurg ongeveer 6-12 maanden voordat die toestand wordt bereikt.

Na het verwijderen zal de tumor natuurlijk weer pathologisch worden onderzocht. Dat er een lymfeklier is aangetast was wel te zien aan de PET-scan, maar of er ook al sprake is van uitzaaiingen elders in het lichaam is nog de vraag. Mocht er een aanwijzing of vermoeden zijn van uitzaaiingen, dan krijg ik een maandelijkse injectie van Somatuline. Dit is een commerciële naam voor de stof lanreotide, een antigroeihormoon. Het lijkt op het hormoon somatostatine, dat van nature in het lichaam voorkomt. Deze stof heeft twee werkingen: het gaat de werking van overmatige hormonen tegen die door NET-tumorcellen worden afgescheiden én het gaat de groei van tumorcellen afremmen. Soms is het mogelijk de uitzaaiingen a.h.w. te "bevriezen", zodat er een stabiele situatie ontstaat.

Kortom: er staat me weer een intensief half-jaar te wachten. Eerst de operatie, dan het herstel en de omgang met de tijdelijke stoma. Dan de hersteloperatie en een periode van veel naar het toilet moeten. Op de vraag of ik het nieuwe schooljaar weer aan het werk zou kunnen, zei de chirurg dat hij de inschatting had van wel, mits ik continu een toilet ter beschikking heb. Ik hoop dat hij gelijk heeft, want ik wil eigenlijk niets liever dan gewoon weer kunnen functioneren. Maar ik moet me ook realiseren dat er natuurlijk allerlei complicaties mogelijk zijn en dat het traject langer in beslag neemt.

 

Erfelijkheidsonderzoek:

Ondertussen heb ik ook (telefonisch) bericht gekregen van het Radboud UMC en men heeft vastgesteld dat er inderdaad een afwijking zit in het MSH2-gen en dat er dus inderdaad sprake is van het Lynch-syndroom. Ik had gedacht dat ze meer konden vertellen, maar dat is niet zo. Mijn zussen hebben een kans van 50% dat zij ook drager zijn van het gen, dus ook zij moeten een onderzoek naar dit gen laten doen om eventueel preventief te werk te kunnen gaan. Om vast te kunnen stellen of ik het via mijn vader of moeder heb gekregen moet mijn moeder ook worden onderzocht op de bewuste afwijking (daar mijn vader niet meer leeft). Dit is dan interessant voor de rest van de familie.

Een overigens interessant artikel over erfelijke kanker in de familie vind je hier.

 
Lees 109975 keer Laatst aangepast op donderdag, 03 maart 2016 14:45
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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