Loving Dad & Husband - Now has Stage 4 Cancer

I'm Katie Novak, Justin Novak's wife and mother of our 3 children. The last few months have been some of the most trying moments of our lives. It's these moments you hope to never experience that test the true strength of a relationship; and drive home the "For Better or For Worse" vows. In September of this year, Justin's mom, Cindy, was diagnosed with stage 4 Pancreatic Cancer. She attempted Chemotherapy but ultimately decided that it would be too taxing on her body and made the difficult and painful decision to pass on as pain free and quickly as possible. Justin took time away from work to be there for her and deal with his own emotions. We burned through our savings pretty quickly, not expecting the next ball to drop. Cindy's passing happened on November 10th, 2023. Just 5 days earlier, Justin went in for what should have been a routine Colonoscopy and was diagnosed with Colorectal Cancer. The outlook and prospect is good; however, he will need to undergo Chemotherapy/Radiation (likely both) as well as surgery. All of which he will need recovery time for and I will be his caregiver. Last year we made the decision that I would stay at home instead of paying for childcare and he was supporting us financially. As I can find employment, I want to ensure I am there for him as well as my children; not to mention the numerous appointments and upcoming unknowns. We also have yet to find out how much insurance will cover. This is terrifying and it's been almost two weeks of constant crying and mourning; mourning my mother in law and mourning the reality of the future. Our family has been through so much over the last 10 years. We take it one day at a time; but the thought of losing the rock in our family is killing me inside.

UPDATE FROM CARING BRIDGE: 12/15/2023
The appointment yesterday left us with more questions than answers. The surgeon performed a Flexible Sigmoidoscopy which was the first time Justin was able to see the cancer in real time. The Colonoscopy that discovered the cancer originally on Nov 6th, 2023 and CT scan on Nov 8th, 2023 only showed one mass. Yesterday 2 masses were seen and the medical report reads as such:

The digital rectal exam revealed a 3 cm (diameter) firm rectal mass palpated 4 to 5 cm from the anal verge. The mass was non-circumferential and located predominantly at the anterior bowel wall. An ulcerated non-obstructing medium-sized mass was found in the proximal rectum. The mass was non-circumferential. The mass measured six cm in length. In addition, its diameter measured three mm. Oozing was present.


Big most concerning aspect of yesterday was the surgeon's concern regarding imaging from the CT scan regarding Justin's liver. When Rectal Cancer spreads, because of the blood filtering role of the liver it and the lungs tend to be the location this cancer will spread to. Justin's GP didn't stress the concern so this was somewhat of a gut punch yesterday. The CT report regarding the liver reads:

4 mm hypoattenuating liver lesion in hepatic segment 6 on series 3 image 47. Additional 3 mm possible hypoattenuating lesion versus focally dilated bile ducts on series 3 image 36.

As these could be benign, there is cause for concern. 2 additional MRI's are scheduled for this next week, Monday Dec 18th, being the liver scan, and Thursday Dec 21st, being another Pelvic scan.

UPDATE:
Justin got the call from Mayo early on Dec 27th, 2023 to let him know the physicians had all consulted and were able to get him in same day to sit down and discuss the treatment plan and what the upcoming months are going to look like.

Justin is officially Stage 3. This means the tumor has went through all 3 layers of the rectal wall. There are 6 lymph nodes surrounding the tumor they believe to be cancerous as well. We knew that the liver scans were clear and there was no metastasization in any other regions of the body. That is good news.

The treatment that they are recommending comes with great difficulties regarding our ability to work, find childcare etc. Because of the nature of cancer as a whole and how Radiation and Chemo affect the physical body and immune system, the recommendation from the doctors is Justin refrain from working with the general public for concern of his immune system (the fact we have 3 young boys is also a factor there) also there is question as to what his physical ability will be to be on his feet for any extended period of time. Justin has been working full time as a high end server at Hazelwood in Woodbury. We recently made the change to Justin working full time and I stay at home with the kids. We are grateful to grandparents and relatives that have been able to step in last minute to babysit. I will be needing to get him to and from his treatments as well as take care of him and the 3 boys. It's a lot!

We have no idea how Justin will react to the treatments. In speaking with the doctors, it sounds like the first few weeks may be fairly uneventful but the subsequent weeks and months come with a big question mark. Justin is already experiencing extreme fatigue from the loss of blood. They are actively monitoring Justin's hemoglobin level. It has been steadily decreasing with each blood draw. As of Dec 27th, his hemoglobin was at 10, if it gets down to 7, they will need to do a blood transfusion to increase his iron.

Onto the treatment plan:

Justin will start with a Chemotherapy Pill (Xeloda) + Radiation - Every Day M-F for 28 Treatments.
Justin will then have a Port put in and receive FOLFOX Chemotherapy for 4 months (8 cycles)

FOLFOX - Infusion 3 Hrs - Combo Drug
  • Oxaliplatin
  • Leucovorin
  • 5-Fu infusional Pump (Take Home for 2 days)

The hope with this aggressive treatment is that the tumor will shrink to the point it is no longer detected and surgery will not be required. The conversation with the doctors on Dec 27th, really hammered home that the location of this tumor is concerning in how surgery would need to be performed and the likelihood of a permanent colostomy bag is still part of the discussion.

Normally, there is a 6-8 week resting period after these treatments; however, they are going to have Justin immediately return for assessment. (CT, MRI, Bloodwork and Flex Sigmoidoscopy). The results here will determine if we create a surgical plan or if we continue with the "Watch and Wait" approach. If everything looks clear at this point, Justin will have to return every 3 months for the same scans. This will graduate into yearly scans if things continue to look good.

If there are still lingering cancer cells, Justin will need to have surgery. No one knows what that would look like, beyond the concern over the location and the difficulty of complete removal without removing the sphincter.

The doctors have explained that in the past, surgery was the immediate first step. Throughout the years, they've realized that there was a much greater reoccurrence of cancer in those that had surgery first instead of the Chemo/Radiation combo. They have found that their recommended approach has been far more successful looking towards the future and overall survivability.

We're beyond grateful that we have access to the Mayo Clinic and their level of expertise. This is all very terrifying and we don't know how we're going to manage financially. We're taking everything one day at a time.

Most importantly the boys need their Dad. There's so much to unpack there we refuse to even go there emotionally at this point. Justin and I have been through hell and back and can certainly navigate this; but, the thought of losing the rock that pulled me from the depths of hell is soul crushing. That extends beyond death, I don't want to watch my partner and children's father loose parts of himself and subsequently die inside. It's heartbreaking and I think we all feel helpless to some extent. Tears come much easier these days.
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Katie Novak
Organizer
Lake City, MN

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