Deep down I knew I would be posting on Newly Diadnosed

Hi , I have been popping up on the forum mostly in what I hope has been some support for us all. Some of you might know my story. Many years ago I was diagnosed with and optic pathway glioma (brain tumour), treatment back then was a hefty load of steroids, radiotherapy and surgery. The very first imag scan for the head had just become available but my diagnosis was based on x-ray initialy. I had the steroids and radiotheray and was monitored very closely, was lucky enough to be at a specialised hospital in london who had one of the first scanners for my firts scan. It was noted that the tumour had stabilised and not grown further since the radiotherapy. so it was watch and wait for a couple for years. fast forward a few decades (four), I still have annual checks and there has only been marginal growth in the past decade, so still annual checheck and MRI every three years. These tumours tend to grow and invade locally but do not tend to metastesise they are also very slow growers so any changes can be acted on with out too much fear, the tumour is about the same size as my eyeball. I had developed a small lump on my lower left eyelid which I initially thout was a little cholesterol bump or something equally benign. when it started to change rapidly in the spring 2022 I went to see my GP who after examination and google images tried to reassure me that it was nothing to worry about. In my heart I think I knew what it was, it was the same side as the glioma and radiotherapy. Annual review was due in July so I thought I would bring it up then and felt another 8 weeks in the current waiting situation was ok. At my appointment the neuro ophthalmologist looked at this little thing with special lenses and slit lamps and whilst I was sat with her referred me straight to oncology at a specialist eye unitl that deals with the area around the outside of the eye. Was seen a week later by the oncologist, scan same day (no results yet!!) However using dermascope and a range of other lenses she was sure we were looking at basal cell carcinoma, the most common and easily treated skin cancer. During the radiotherapy for the glioma my pituitary gland took a big hit and so the side affects of that started to kick in and later in life became Hypopituitary with severe adrenal insufficiency ( I have to have rescue injections if I have adrenal crisis, a crisis can be fatal). The Oncologist felt that I should be transferred to another big hospital which also has the sister unit to the one I was at so the staff had access to intensive care if needed. Yesterday I was nil by mouth by 7am for a small biopsy with local anaesthetic to subtype the carcinoma ( there are quite a few within the group which I had learned about via this wonderful website) but also to stage it because some forms of bcc can become aggressive and not just spread locally. At my meeting with the surgeon yesterday he decided that we go ahead and remove the whole thing. No time for panic, over thinking etc, maybe a bit of anxiety, some relief that the cancer was going to be cut out. No general anaesthetic, I'm too high risk and even sedation was avoided. so with a large amont of local anaesthetic, a large dose of hydrocortisone on board (lack of adrenalin from the adrenal insufficiency) My emergency injection pack to hand for the surgeon I had my carcinoma removed. I didn't feel anything. They have had to remove a third of my lower eyelid and hope they have a clear margin. The lesion has gon to the lab for subtype etc. results should be back in a couple of weeks. The nurse said this surgeon like to push for the biopsies to be fast tracked incase they have to cut a wider margin. My follow up is in two weeks for post surgical reviw and three weeks for oncologist. The CT results are to see if there is local spread to the eyeball and brain. But I will cross that bridge when I get to it. 

Question : The surgeon has said that I should ask my GP for an urgent referral to a dermatologist specialising in skin cancer because he thinks I have more and his area is eyes. One of the sub groups of BCC is Merkel Cell carcinoma which is a NET neuro endocrine tumour, the glioma belongs to that family and I am under Gastro and endocrine for something that enhanced in an MIBG scan last year with elevated blood markers. I know that my gp surgery will say no urgent referral unless written down by surgeon. has anyone else had luck with pushing for a 2ww withought a back up letter??

Love to you all

HM (Sarah) xxx

  • That sounds like a trying experience.

    I can't understand why the surgeon couldn't refer you himself, unless he thought it would be quicker via the GP as 2ww rules are only triggered by a GP referral.

    On discharge, he should have written to your GP and a copy of that letter should have gone to you. If it hasn't or if his suggestion of a referral isn't included, you could ring his medical secretary and explain your predicament.

     

    Good luck

    Dave

  • Hi and welcome to our special club free to join and help others and have a good rant now and again. 

    Im no help with your uninvited guest (cancer).

    I have what is called Addisons disease (and cancer),Addisons is when the adrenal glands stop working and the body shuts down and a coma soon follows i have to take daily hydrocortisone and fludrocortisone tablets to keep myself alive and things ticking over, also have vials of hydrocortisone in fridge just in case. I've had it over 16 years. 

    Hope others will join you soon but weekend can be quiet especially holiday as you may have noticed. 

    Billy 

  • Hi Sarah,

    I agree with Davek that the surgeon's letter to your GP (which you will receive a copy of) should include the recommendation for a 2week referral to dermatology. However, it takes a while for these letters to be typed up and sent out so I suggest you speak to your GP on Monday. Explain what was said by the surgeon and that it should be included in the letter they receive, but is it possible to refer you now. Tell them that, if you have to wait for the letter, the stress will be unbearable. Hopefully the GP will do it. If not, and you haven't received the copy letter by your next appointment with your surgeon, mention it to them. They won't contact your GP but they may give you permission to tell the GP to give them a ring so they can verbally recommend the referral. Good luck and I hope the results bring good news.

    Angie (Stage 3 melanoma patient since 2009)

  • I agree with everything others have said. But, also if you have new visible lesions anywhere – hence the eye doctor's suspicion – then, given the GP was slow to diagnose the eye lesion (in light of your cancer history and what the specialist consultant has determined), I think you have even stronger grounds to push for a 2WW referral before the specialist letter arrives. So, do have a good physical check of your body to see if there are new or changing lesions before the call. Also, do explain the link as you have done here re glioma family, endocrinology and possible NET.

    I feel there is a possibility your GP may actually do two referrals – one to dermatology and another to endocrinology for review.

    My own GP really surprised me recently in making a second referral (because she felt I had linked conditions). It wasn't something I asked for even. Just got a call back later that day saying I'd been referred and GP hoped that was okay by me. (I was delighted!) The extra clinic I'm now going to is a multidisciplinary one, so I've been told to expect to see numerous different members of the team and that I will have to undergo lots of different tests all on one day. Hope all works out getting the referrals you need too.

    Do please let us know how you get on.xx

  • Hi Dave, the nusre only gave me my new appointment letter and wound care instructions, she said his report would go straight to GP. I will however ask for a copy anyway for my own file, they can print off a copy at the surgery. I think you are right because he did say the quick referral would be through gp.

    best wishes

    Sarah

  • Hi Billygoat a fellow Addison mate, yup Hydrocortison sick day rules injections and a cool bag with my injections in that goes everywhere with me. The addisons unit I go to was the same hospital where they did my surgery yesterday so a lot of close liasing with the endo team prior to the procedure and injection ready in theatre if it was needed. Mine is secondary due to inactive pituitary from previous radiotherapy. the addisons forum has been a great source of help

     

    best wishes 

    Sarah

  • Hi Angie thank you for your wise words, I have a review at the asthma clinic in my surgery on Tuesday and its a good long slot so i will talk it through with the nurse, she might be able to pre book me an appoinmtment to talk to a gp rather than the frantic phone early in the morning after a bank holiday when everyone else is also trying to get through. My follow up with the surgeon is two weeks away, face to face because he wants to check the wound heeling, I can talk it through with him if I have no progress with the GP

    best wishes 

    Sarah

  • Thank you rose Star Blue, more wise words. I will actually write down what you have said as bullet points. I had an issue during covid where I lost the feeling in the bottom of bothe of my feet (the soles), spoke to a different gp at the practice and told no hope of getting a neuro appointment NHS could I go private. thankfully my credit card was clear, a week later saw a spinal neuro who referred me to a colegue who arrange nerve conduction tests, upshot is large fibre neuropathy bothe legs with loss of knee and ankle reflexes. Idiopathic because they don't know why it has happened. This time as things are very slowly easing after covid I feel I should stand my guns. If I had my own private medical insurance then it would be a no brainer but I don't. I will keep you posted.

    best wishes

    Sarah xx

  • Yes, there are a lot of delays in the system! Strangely enough, I too lost all sensation in part of one of my heels rather than my soles. After a physical exam, GP decided it was definitely nerve-related so did lots of blood tests (to exclude anything treatable) then, as it wasn't spreading but had stabilised, decided there was no need to refer me. She warned me the loss could be permanent. (Think she's right about that unfortunately.) My other referrals are to a specialist airways clinic run by a respiratory Consultant who specialises in immunotherapy and other respiratory interventions, while the other is to immunology. One of the clinics has been a long wait and I did debate going private, but the other has come through a lot quicker. I really hope you are able to get the appointment(s) you need on the NHS following your recent surgery without adding to your anxiety (which could exacerbate your asthma). Hope all goes well at the asthma review on Tuesday. It sounds like you have an awful lot to deal with health wise. Sending you a virtual hug. Love Rose xx

  • Thank you Rose, I have had so many issues for so long they refer to me as complex. But I can compartmentalise until i need to yhink about it (probably a sort of denial) my anxiety is internal. Private wuld be wonderful just thinking you can get an appointment in a week. I have looked at our nearset private hospital for dermatologists with an interest in skin cancer etc and two of them work at my local NHS hospital so I will write down their names and ask my gP to refer to one of them on a 2ww. will see what happens, over the last two and a half years I have had to get stronger mentally so I can advocate for myself and try and get things sorted out. In july 2020 whilst having my adrenal function tested a very high marker was found that indicated a paraganlioma or secreting NET somewhere in my body, i had a nulear MIBG scan which showed intense uptake in the ilium of the small bowel. they tried to visualise it via colonoscopy last month but failed so my gastric consultant is talking with other colegues about the next steps. I have her direct email so at least I can chase once the eye settles down.

    Take care Rose and sending a virtual hug back

    Sarah xx