WHEN Marian O’Herlihy, now a mother-of-six, was diagnosed with oesophageal cancer in 2010 at the age of 37, the prognosis was not good.
Her symptoms included two episodes of nearly choking on her food. Luckily, her son Kevin, then aged 14, performed the Heimlich manoeuvre on her, which involves abdominal thrusts to dislodge blocked food. Kevin learned the procedure from an episode of The Simpsons, of all things.
Marian had other symptoms including indigestion and hiccoughing. The second time she started to choke on her food, her husband slapped her back which allowed her to swallow her food.
Marian, a mental health nurse, who lives in Berrings, was advised by her sister to go to her GP. She was referred to a gastroenterologist and underwent a scope under local anaesthetic.
“Then I was sent for a biopsy which alerted me,” says Marian. “I said there was something wrong but my husband and sister said I was reading too much into it.”
Marian’s instinct was correct. She was told she had a tumour that was 8cm long in her oesophagus, just below her larynx.
“I was told my best chance was to go to Dublin to Professor John Reynolds at St James’s hospital where I had a pet scan. He told me I had stage 3 oesophagus cancer and that it was inoperable. If operated on, my rib cage would have to be cut. It would have been very intrusive.
“At stage 3, the tumour goes through the lining of the oesophagus and tries to grasp onto other organs around it. I was devastated. My husband and myself spent the whole time crying. My only hope was to have chemotherapy and radiotherapy together.”
Marian was sent to Professor Donal Hollywood, who has since died. He was attached to St Luke’s in Dublin and Marian is full of praise for his care.
“The radiotherapy had to be precise. A mask was fitted that held the top of my shoulders. I had to go into a radiotherapy machine clamped down with the exact radiotherapy points indicated. I was also on chemotherapy through IV. I’d have it for seven or eight days at a time and would then walk with my drip attached, to the place for radiotherapy.”
While the experience was frightening, Marian says it’s getting easier to speak about it. She wants to highlight oesophageal cancer through Lollipop Day (February 23 to 24) which involves thousands of volunteers selling €2 lollipops nationwide to raise funds for the Oesophageal Cancer Fund (OCF). It raises awareness of the disease and funds research into it.
While Marian was shattered when she was diagnosed, she says: “Once I started the treatment, I was very determined. I couldn’t waste any bit of energy on crying. I had to protect myself in every way. I felt I could get through the treatment if I kept looking forward.”
After seven or eight days of chemotherapy, Marian would get a break of two and a half weeks but the radiotherapy was ongoing, from Monday to Friday.
“I’d get home from St Luke’s at weekends. If my white blood cells were under a certain limit, I wouldn’t be left home as there would have been a high risk of infection. I was lucky. My white blood cells stayed above the marker. But my red blood cells and iron levels would get very low so I had to have blood transfusions. After a transfusion, I felt like a new woman.”
Fortunately, the radiotherapy and chemotherapy got rid of the tumour and the lymph nodes.
“In 2011, I was in remission. For the first year, I had to be checked every three months. Then it was six monthly checks and then an annual check in Dublin. I’m being well monitored which is great.”
Marian recalls Professor Hollywood telling her that he knew of one girl with stage 3 oesophageal cancer who was still living five years later.
“I latched onto that. It’s eight years this year since I got my diagnosis.”
In 2012, Marian returned to work in Mallow. She recalls that the after effect of radiotherapy was terrible tiredness.
“When you’re going through it, it would nearly burn the oesophagus off you and your swallow would be poor. I had to eat soft foods. I was very lucky. A lot of people can’t swallow food.”
While Marian’s sense of taste disappeared for a while, it came back.
“The doctor couldn’t believe how lucky I was. Sometimes, your voice box can be badly affected by the radiotherapy. Sometimes I can sound a bit croaky but luckily, my larynx was not affected.”
Gastro-oesophageal reflux disease and obesity are strongly associated with the commonest type (70%) of oesophageal cancer and smoking is the cause of a type of the disease in about 30% of cases. Marian smoked as a student “but I was never a regular smoker and after having my first child at 22, I never smoked since then.”
When Marian got sick, she had four sons. She went on to have two more. Blaise, now aged five, “was a complete surprise”.
“There’s nine and a half years between him and my fourth son. Blaise would have been kind of left on his own so we had Cathal who is aged three. It’s like having two families!”
And it’s a mark of Marian’s and her husband’s optimism and just how far she has come since the horrendous diagnosis.
Ireland has one of the highest rates of oesophageal cancer in Europe. It is difficult to cure as it often presents at an incurable stage.
Also, it’s a type of cancer that can be aggressive. However, cure rates are improving thanks to a combination of early diagnosis and safer treatments. In Ireland, there are approximately 450 new diagnoses of oesophageal cancer annually. Not everyone who has difficulties swallowing will be diagnosed with the disease but it’s a symptom that must always be urgently investigated.
Benign oesophageal strictures from chronic reflux or severe motility (the ability of organisms to move or get around) may be the cause of problems with swallowing.)
Less common presentations include intractable reflux and some patients who are diagnosed early already have a reflux-induced change in the lining of the oesophagus known as Barrett’s oesophagus. This occurs in about 10% of patients with symptomatic heartburn or reflux. For anyone diagnosed with Barrett’s oesophagus, there is a one in 400 risk of developing cancer.
The National Cancer Control Programme has designated four hospitals for the treatment of oesophageal cancer; the Mercy University Hospital in Cork, St James’s Hospital in Dublin (the national centre) Beaumont hospital in Dublin and University Hospital Galway.
The OCF is a voluntary organisation and Ireland’s voice for oesophageal cancer. Established in 2001, the organisation does not receive HSE funding and is wholly reliant on fund-raising efforts. All the trustees and scientific board members work on a voluntary.
OCF Chief Executive, Noelle Ryan says: “We are very fortunate to have an ever-increasing number of dedicated volunteers, all of whom make Lollipop Day possible and a success every year. We never have enough volunteers so if anyone or any group is interested in helping out, please contact us on www.lollipopday.ie.”
Or to volunteer in Cork, call Anne Cantrell on 086 4542713.
Join the Lollipop Day Facebook page https://www.facebook.com/lollipopday