How He Survives Stage IV (also known as Terminal) Colon Cancer So Far

choi

The article is free.

Joe Faratzis (as told to Julia Ries), I'm a 34-Year-Old With Colorectal Cancer. Here Are the Early Signs I Wish I Hadn't Ignored. Self.com, Mar 11, 2024.
https://www.self.com/story/joe-faratzis-colorectal-cancer-at-34

Note:
(a) The capecitabine has brand name which you need not memorialize.
(i) capecitabine. MedLinePlus (maintained by National Library of Medicine, part of United States HHS), undated
https://medlineplus.gov/druginfo/meds/a699003.html
("pronounced as (ka pe site' a been)")
(ii) capecitabine (etymology: "from ca(rboxylate) +‎ pe(ntyl) +‎ -citabine ('cytarabine or azacytidine derivative')")
https://en.wiktionary.org/wiki/capecitabine
(iii) chemical structure of capecitabine is shown at upper right corner of
https://en.wikipedia.org/wiki/Capecitabine
(A) pentyl group
https://en.wikipedia.org/wiki/Pentyl_group
comes from pentane. The pentyl group is at the 2 o'clock position ("/\/\/CH3") in the Wiki page immediately above.
(B) The carboxylate is what between pentyl group to the right AND nitrogen (N) atom to the left.
(C) cytarabine
https://en.wikipedia.org/wiki/Cytarabine
("also known as cytosine arabinoside (ara-C)")
(D) The arabinoside is the five-member ring in the 7 o'clock of
ttps://en.wikipedia.org/wiki/Capecitabine

With the six-member ring attached above, the arabinoside is a derivative of arabinose  (where 'arab" is "Arab"). See arabinose
https://en.wikipedia.org/wiki/Arabinose
(section 2 Etymology: "Arabinose gets its name from gum arabic, from which it was first isolated")
(iv) The capecitabine is a "prodrug." A profrug is defined as a chemical that is not a drug per se (and have no therapeutic value), which will be turned into a drug after the (human) body metabolizes it (chemical).
(v) fluorouracil
https://en.wikipedia.org/wiki/Fluorouracil
(or more accurately: "5-fluorouracil"/ section 5 Pharmacology, section 5.3 Mechanism of action: )
, where 5 refers to the position of fluoride attached the six-member ring. The six-member ring is the drug which is therapeutic.

The capecitabine is a tablet taken by mouth, but the real drug fluorouracil must be injected into bloodstream (infusion or intravenous drip). Why can't fluorouracil be taken orally?
M Malet-Martino and R Martino, Clinical Studies of Three Oral Prodrugs of 5-Fluorouracil (Capecitabine, UFT, S-1): A Review. The Oncologist, 7: 288 (2002)
https://academic.oup.com/oncolo/article/7/4/288/6386799
("5-FU is a small molecule with a pKA (8.0) that should predict excellent absorption and bioavailability. However, the use of oral 5-FU was abandoned decades ago because of its irregular absorption. Plasma levels of 5-FU are quite unpredictable after oral administration with marked intra- and interindividual differences due to the variable activity of DPD," the acronym of a human enzyme that catabolize -- or destroy fluorouracil)


(b)
(i) FOLFOX
https://en.wikipedia.org/wiki/FOLFOX
(ii) oxaliplatin
https://en.wikipedia.org/wiki/Oxaliplatin
(section 3 Structure and mechanism: "It [the chemical or drug]also features a bidentate oxalate group")

The oxalate group is at the extreme right, with a vertical bar connected to TWO keto group. See keto
https://en.wikipedia.org/wiki/Keto
("may refer to "ketone or keto group, the functional group in the chemical compounds ketones")
(iii) oxalate
https://en.wikipedia.org/wiki/Oxalate
is the anion of oxalic acid when it loses the two hydrogen ions. Oxalic acid
(iv) oxalic acid  草酸
https://en.wikipedia.org/wiki/Oxalic_acid
("Its name comes from the fact that early investigators isolated oxalic acid from flowering plants of the genus Oxalis")


(c)
(i) Thermal ablation uses laser at its tip (of a needle or a wand) to generate heat.
(ii) When I left Taiwan in 1984, Doctors in Taiwan chose to do nothing and let State IV patients die. because we did not think treatment would do anything good to the patients. I introduce this article to you, because I learn today that treatment is still available to those patients!
(d) The "digital rectal exam" means to detect a rectal cancer with a finger, which of course can not detect colon cancer (too deep).

digit (etymology: from Latin noun masculine digitus for finger)
https://www.merriam-webster.com/dictionary/digit
-----------------
I’m a 34-Year-Old With Colorectal Cancer. Here Are the Early Signs I Wish I Hadn’t Ignored
A dull pain that comes and goes periodically is easy to explain away when you’re young and feel invincible.
By Julia Ries
March 11, 2024

Joe Faratzis, 34, was diagnosed with stage IV colorectal cancer when he was 28. Four years later, Faratzis is sharing the early colorectal cancer symptoms he overlooked and what life is like with his condition on his TikTok. Here’s his story, as told to health writer Julia Ries.

This all started in 2019. I started experiencing a faint abdominal pain whenever I bent over—for example, to tie my shoe. It was a dull, mild ache in the bottom right portion of my abdomen that popped up periodically, maybe once or twice a week, and I didn’t think much of it. It’s not like I was persistently in pain, or experiencing the ache every day. It was easy to ignore and forget about.

Still, I scheduled an appointment with my primary care doctor and told him about it. He asked me about my bowel movements, which I thought was an odd question, and ordered a CT scan. I never followed up because I assumed it was unnecessary and most likely way too costly. If I had gotten the CT scan back in 2019, I probably would have saved myself a lot of trouble.

Roughly six months after the abdominal pain began, I noticed that, once or twice a week, there were a couple of bright red spots of blood on the toilet paper after I went to the bathroom. It was never an alarming amount, and it didn’t happen every single day, so I wasn’t too concerned. I figured the blood was due to a benign issue, like a fissure or hemorrhoids (which, to be honest, gave me a false sense of security).

As a 28-year-old man, I thought I was invincible, so I didn’t do anything about it. Plus I didn’t want to just run to the doctor to get a digital rectal exam. That whole situation, where the physician inserts a gloved finger in and around your rectum, seemed uncomfortable and embarrassing. Otherwise, I felt normal, but looking back, blood in my stool was a major red flag. That, combined with the sporadic abdominal pain, were major indicators that something was wrong.

The big catalyst that motivated me to take my symptoms seriously occurred a few months later. I was sitting on the couch and I passed gas, looked down, and saw blood. I went to the bathroom and there was about a half a cup of blood in the toilet. It wasn’t painful, but I was like, Holy fuck—obviously there’s some issue here. I’d never lost that much blood before, so I called my PCP and set up an appointment.

During the appointment, I explained my symptoms and he conducted that digital rectal exam I previously avoided. He didn’t see anything concerning, like a mass, but he did notice a tiny bit of blood in my lower rectum. He said I probably had hemorrhoids and referred me to a gastrointestinal specialist for follow-up testing.

The GI doctor also thought it was probably nothing to be worried about and scheduled a colonoscopy. He said it wasn’t probable I had any tumors, but it also wasn’t out of the question—many younger people were being diagnosed with colon cancer, so it was great I wanted to find answers, he told me. Going into the colonoscopy, he, like my PCP, figured my symptoms were due to hemorrhoids. All of my blood work, including my red and white blood counts, came back normal. (Sometimes a low red blood cell count, which can occur from a bleeding tumor, is one of the earliest signs of colon cancer.)

A month later, I had the colonoscopy. The nurses and doctors were in a great mood when I checked into the clinic. A nurse said, “You’re so young! Why are you here?” and I thought, “Oh my god, she just jinxed me. Now I totally have cancer.” I was sedated for the procedure, and when I woke up, the doctor told me they found a big tumor and had taken a biopsy to determine if it was malignant. I was out of it from the anesthesia but tried to soak it all in. To be honest, I’d had an inkling it might be serious—I even told my coworkers a couple days before my colonoscopy that I thought I had cancer, and they were like, “There’s no way.”

Three days later, my doctor called: I had adenocarcinoma. I was shocked, even though I suspected something deep down. The next steps were laid out: I needed to make an appointment with a colorectal surgeon and do diagnostic testing—including CT cancer staging and an MRI—to see how advanced the cancer was in order to inform my treatment plan.

Everything started to move quickly. The imaging tests showed that the cancer was localized to my colon and hadn’t spread to other parts of my body. I had stage II colorectal cancer and would have to do chemotherapy, radiation, and get surgery to eliminate all of the cancer from my colon.

There was so much I had to do, and I was totally overwhelmed. My mom encouraged me to take things one step at a time, which helped me stay calm. Instead of looking at all of the drugs, scans, tests, and procedures on my plate, I focused on a single goal, like my upcoming surgery, and simply getting through that.

At the start of 2020, I started oral chemo by taking a drug called capecitabine daily, and I did radiation treatment five days a week for a few months to shrink the size of the tumor before having surgery to remove it. That way, the surgeons wouldn’t have to cut out quite as much colon.

When I completed those treatments in March of that year, I had a low anterior resection, a surgery to remove the portion of my colon containing cancer, and an ileoscopy, a procedure where your small intestine is redirected out through your stomach into a bag. This is a temporary solution after a colon resection—it’s done so poop doesn’t pass through your colon, where there’s a fresh wound that could become infected that way. Instead, the waste is rerouted and released through a colostomy bag attached to the outside of your stomach. That whole experience was a mindfuck, but at the same time I was stoked I got through the big surgery and was in the clear.

Or so I thought. Soon after, I had more imaging tests done, which revealed the cancer had exploded. It was now in my lungs and liver. I was diagnosed with stage IV colorectal cancer. I asked my oncologist if that meant I was going to die. He assured me that wasn’t the case, but that we’d have to stay on top of my health.

I did three months of an intravenous chemotherapy called FOLFOX taken every other week to kill off the lung and liver lesions. It took my body about five months to heal from the resection, at which point, I had another surgery to reattach my small bowel to my colon so I could poop normally again. In the meantime, FOLFOX got rid of the spots in my lungs and shrunk my liver lesions. But because multiple liver lesions were still there, I had a laparoscopic procedure conducted, where a needle heats up the malignant tissue and burns the lesions off (a technique called thermal ablation).

Three months later, the lung lesions returned. My doctors used ablation to successfully burn and freeze them away. This process repeated itself: Throughout 2021 and 2022, we’d find new spots on my lungs or liver and have to zap them. I probably had 9 or 10 lung surgeries that worked, but also led to some not-so-fun complications, like a collapsed lung, along the way.

I was never given a prognosis, or survival rate, for what I’m going through. I learned that, even if you have stage IV cancer, if you’re able to find tumors early and have them removed, there’s a chance you could continue to live for a really long time. This isn’t always the case, but, thankfully, my doctors have been able to surgically remove all the malignant lesions that have popped up so far.

Now, I get my chest, abdomen, and pelvis scanned every three months. It’s a never-ending cycle of getting tested. I’ve had clear scans for the past year—it’s the longest stretch I’ve gone with no lesions, which is awesome. I feel good, I’m hopeful, and I live my life as if there isn’t an issue. I sometimes kick myself thinking back to that first doctor’s appointment, and what I would have, could have, should have done. At this point, it’s a mental game. I try not to worry that tomorrow will be my last day.

Listen to your body. If you think there’s something wrong, it doesn’t hurt to go get it checked out. If I hadn’t waited—if I got the CT scan back in 2019 when I had my earliest colorectal cancer symptoms—I might not have wound up in the position I’m in now. Be your own health care advocate. No one else is going to hold your hand and do it for you.