After some months of increasing tiredness, loss of appetite, and difficulty eating, I finally saw a GP on the 25th July, 2023, and was referred for futher investigations at the hospital, under the two-week rule. (For those who don’t know, the two-week rule is the target set to for specialists to see patients with a strong possibility that they might have cancer.)
Even though the two-week rule applied to me, I was still pretty sure that my symptoms had a simple explanation: a combination of increasing age and possibly a hiatus hernia.
On Saturday, 5th August, I went for an endoscopy examination to look at my oesophagus (the swallowing tube between mouth and stomach). It was a most unpleasant experience that left me faint and shaky for several hours afterwards. As I recovered, the doctor who had performed the examination explained what he had found, as gently as he could.
I had a severe narrowing of the lowest part of my oesophagus and, from what he could see, I almost certainly had cancer of the oesophagus.
The biopsies he took came back a week later, and confirmed I had indeed got squamous cell carcinoma of the oesophagus. The gruesome photo of the cancer is above – where you can see the white patches.
The diagnosis was a shock. I was a healthy person, and had none of the risk factors for this type of oesophageal cancer (the risk factors include being an elderly man, smoking heavily, and drinking too much alcohol). Apart from liking the odd glass of whisky, a small glass of wine with evening meals, and the occasional cider, I thought my alcohol intake was reasonably low.
Further tests – a CT scan followed by a PET scan – showed the cancer was in the lowest part of my oesophagus and might have spread to a a nearby lymph node. The only good news was that my lungs, liver and bones were clear.
Although there was no distant spread, I knew the outlook for oesophageal cancer was poor, especially for cancer that was moderately advanced like mine. (In fact, as a young doctor, I hadn’t known of any patient with cancer of the oesophagus who had survived longer than 6 months.) I wasn’t scared of death – but I felt cheated and angry. I didn’t feel old, and there were so many trips and projects I had planned. Finishing my coastal walk was one of them.
There are many things you might decide to do in the final few months of life. Of course, I wanted to go walking. Unable to leave Manchester (being a cancer patient turned out to be almost a full-time job!) I walked in my local nature reserve and visited my favourite tree.
I updated my will, tidied up my finances, and completed my 2022/23 tax return. In addition, I added my eldest daughter to my bank account – turning it into a joint account – so that she could manage my affairs if, and when, I became too ill to manage them myself. (This turned out to be surprisingly difficult to organise, as the local bank branch had closed and appointments with a bank manger were very hard to arrange.)
Returning to my home in Anglesey for a few days, I went for one last walk along the beach. It was the summer holidays and the beach was busy. Sitting on my favourite “thinking place” on the rocks, I soaked up the views across the bay. It was almost unbearably sad to think that this was probably the last time I would be able to enjoy this place.
Back in Manchester, the next few weeks were frantically busy with telephone discussions and hospital appointments with a variety of people.
The first specialist I had seen was a surgeon. I attended the appointment with my youngest daughter, who took notes. The surgeon told us there had been a heated debate about my case at the MDT meeting (this is the team meeting where the various specialists discuss cancer patients and decide on the best course of treatment). He had won the argument and advised me to have surgery because I was a very good candidate. He was sure he could remove the tumour completely.
I felt the first flickerings of hope. Perhaps, I really would survive this? But, surgeons are often wildly optimistic about their abilities to treat people. But… maybe… I couldn’t bear to hope for too much. It was best to expect the worst.
Rather flattering he, and everyone else I saw, thought I was 10 years younger than I really was. The hospital system had my date of birth down incorrectly. I had to confess I was really 67 and not 57.
I saw a specialist nurse, a dietician, and I underwent an exercise test to see if I was fit enough for the operation. Apparently I was indeed fit enough to have anything that they might throw at me – but in the meantime I read up on the risks and complications of oesophageal surgery. And, to be honest, they were horrendous. But, I decided if I was going to die, I would rather die while unconscious in the ITU than endure a slow lingering death some time later.
Despite the CT scan not showing any spread, the surgeon organised a laproscopy and “washings” to make certain. It was only a day case, but my abdomen was painful for a week afterwards. While I was recovering from this, the surgeon explained I would need to have a course of chemotherapy before the surgery – this came as a surprise to me – and so I was given an appointment with an oncologist to discuss the next steps.
Meanwhile, life goes on. My grandaughter had her sixth birthday, and we celebrated with a cake she had baked and decorated herself!
There are different types of oesophageal cancer. When I saw the oncologist, she explained that the mainstay of treatment for my type of cancer was radiotherapy, with chemotherapy to help the radiotherapy do its job. The decision to offer me surgery had been controversial (I had guessed this) because there was no evidence that surgery would increase my chances of survival. To be fair, there was no evidence that surgery wouldn’t increase my chances either. Nobody knew for certain.
She also told me that she was aiming for curative treament. Curative? I thought she was being rather optimistic.
Psychologically, when you discover you have cancer, the first thing you want is for someone to remove it for you and cut it out! But, I am a great believer in evidence-based medicine. And so, sitting in the room with the oncologist, I decided to go ahead with radiotherapy and chemotherapy and NOT to have the surgery.
It wasn’t a difficult decision to make at the time, but later I did occasionally worry if I had made the right choice.
We were in the middle of the summer holidays, and I had promised my granddaughter a trip out. So I took her to the aquarium at the Trafford Centre – which is a big shopping centre on the periphery of central Manchester. Personally, I hate the place, but she loves it. One of the most enjoyable parts of the trip, for her, was using my phone to take photographs.
Other plans had to be cancelled. It was now the end of August, and I had been planning a once-in-a-lifetime safari with a friend. We were going on safari in Kenya, and I had arranged to visit the places I had lived when I was a child. I was born in Kenya and lived there until I was 9, but had never been back. Of course, this trip had to be cancelled.
To try to compensate for the missed trip. I went to Chester Zoo with my youngest daughter. Ironically, the African section was closed for upgrading – but I did manage to see rhinos, monkeys and, of course, some elephants.
In the meantime, I had been referred to a gym for a pre-hab exercise assessment and program. This is an excellent idea and offered routinely (I think) by Manchester hospitals to cancer patients. I was given a program I could do at home, complete with an elastic band contraption and a very good illustrated booklet.
Maybe there was some mistake, but the programme took 2.5 hours to complete. I was supposed to do the routine every other day, but I couldn’t face 2.5 hours of non-stop solitary exercises at home. So, I compromised and did half of the programme on one day, and the other half the next day.
Life continues. Some months earlier, I had arranged for my bedroom to be re-painted. There seemed no point cancelling the arrangement, because I guessed I would be spending a lot of time in bed and I might as well make my bedroom really lovely. In any case, my painter was a cheerful perfectionist, and it was good to spend time in his company. Despite his initial reservations about the colour – “Pink!? Are you sure?” – he did a great job too.
Now, we were well into September, and I had been very busy with tests and exercises and appointments, but I still hadn’t started any treatment.
My swallowing had gradually got worse and was now a major problem. All I could eat were soups, scrambled eggs, and mashed up vegetables. But, thank goodness, chocolate still slipped down easily. Even with soft foods, I still had to chew everything thoroughly and take my time. Also, my stomach gurgled like a drain in a very embarrassing manner. I avoided eating out. It was too stressful, even with family and close friends in their homes.
The oncologist explained that I needed one further procedure before starting chemotherapy. I needed a RIG tube fitting – a feeding tube that is inserted directly through your abdominal wall and into your stomach, thus bypassing the narrowed section of oesophagus.
I didn’t want this procedure – because it felt like admitting defeat and I could still swallow soft food – but my oncologist explained that radiotherapy treatment would make my swallowing much worse, and I needed to get the tube inserted before I started chemotherapy.
The tube was inserted under light sedation by a group of bored-looking but efficient technicians. It hurt like hell! In fact, I had to postpone my first chemotherapy session – which was due to start the next day – because I could barely stand up and realised there was no way I could get myself into hospital for my treatment.
So, here I was at the beginning of October, and my first chemotherapy infusion was booked for the 4th October. In a funny way, I was looking forward to it. Up until the RIG insertion, I had been doing my exercises every day and was fitter than I had been for years. The previous week I had organised my flu vaccination and a covid booster. And I had my hair cut really, really short, in anticipation of losing it all.
I was as thoroughly prepared as I could be.
[To be continued…]
Ruth's Coastal Walk (UK) 
Wow! Ruth keep us posted.i like your sensible approach to the treatment options. Thinking of you.
So so sorry Ruth, but if you are as brave as you are on your walks you will pull through – I love your honesty ……..all the very very best x
I’ve been following you for years, and am so very saddened by this news. May you have the very best of outcomes. Beth F.
oh my goodness Ruth, I guessed that something rather dire had occurred as your walks were last year, but of course hoped it was nothing like this. Thank you for being so honest and upfront about it all.. no doubt you have been through the mill over the last year, but hopefully through the worst? Will wait to read the next post.
Jill
Dear Ruth , what a shock, what can I say ? you have been so honest and brave ,so I will be the same . Im so sorry that for now all of your plans have to be on the back burner . I truly feel for you . I hope that you know just what you achieved on your coast walk , for yourself ,but so much for others following in your footsteps . I started walking the s/e coast with a male friend but it didnt work out for us so with your help following your guide I was able to carry on , thank you so much. love and prayers Sue .
Ruth, I have enjoyed your coastal travels so much! Your walking and overall fitness will surely help in your treatment and recovery! All the best to you,
Janet Hinton
Good grief Ruth, I don’t know what to say – you’ve really floored me with this news. It must have taken some guts to write about this with so much straightforward honesty – please keep us posted. I really hope you are doing well and I wish you all the very best xx
Oh Ruth what a shock and a massive challenge to come to terms with. Must make the walk seem a doddle. You sound very pragmatic and sensible in your approach to having cancer. I imagine your years as a GP helped? As you’re writing now in September 2024 there must be some kind of positive outcome I’m glad to guess. Wishing you all the best xx
All the best Ruth. What a shock. Have always enjoyed your posts. Will look forward to hearing about your cancer journey, rather than your coastal one, though Im sure you will get back to that.
Oh Ruth, I’m so so sorry to hear this news. I did think when you were uncharacteristically tired while walking John o’Groats Trail that something might be wrong. You are a brave, resilient woman but I feel for you so deeply. Keep us posted, if you’re able. And I send gentle hugs to help you through. xx
I am so sad that you are facing this cancer and I hope that your treatments are effective and not too horrible. Like so many of your readers, I feel like I know you and therefore that I know you will approach this problem as you have all the others in your life and find a way through.
With very best wishes. Ellen
Ruth, so sorry to hear of this situation, but your honest reporting of it is a massive help to those around you. I underlines how apparently healthy people of our age should not shy from getting tested. Wishing you the very best.
keep going
Dear Ruth – sorry to hear about your dreadful news. If it is any comfort I have had 2 close friends diagnosed with cancer of the oesophagus in recent months. Both are hopefully fully cured. One had surgery (I won’t go into the gruesome details) and one merely had radiotherapy as the cancer was caught early. So there is hope!!! Just try to keep being positive. In time I hope to hear you are back on your walk. In the meantime just remember there are hundreds (thousands?) of people thinking of you and hoping for the best. All best Chris xx
All the best Ruth, try to stay positive through the grotty times. Look back at your amazing journeys and keep planning the next ones.
Keep walking, even little walks, it’s really helped my partner through his cancer treatment over the last 3 years. I’m still planning to return to the Scottish coast, the plans are something to look forward to on dark days.
I keep myself busy in the waiting rooms with OS maps on my phone. It’s a great escape.
Keep us posted with your latest journey x
Alice
Very sorry to hear this and I had no idea the prognosis with that type of cancer was so bleak. I was aware of your diagnosis from Facebook but not the severity. I wish you all the best. You have had a lot of bad luck.
I guess the fact you are still writing your blog means perhaps you will be able to recover and get back on the coast one day. If not, well you can be very proud of how far you got and you did the toughest parts of the coast. Your write ups have certainly been a great help to me.
I’m so sorry. Thinking of you and hoping for the best.
Thinking of you and hoping for the best
That you are posting this a year hence gives hope that there is much happier news to come. I do fervently hope so. Your resilience in previous times has been epic and now you’ve rounded the head it should be all downhill to complete your journey. Everything crossed for you.
oh no
how truly shocking
all I can hope is that the medics work their magic for you
will pray hard for you
I have followed your walking from very early on. You have inspired my walking on a number of long trails. I love your documenting of the walk around Britain.
ShockIng news which you have been brave to share and I’m so glad you have as you have an army of well wishers and supporters wishing you well here.
You show us all bravery and I hope your journey through this difficult diagnosis and treatment is as good as it can be. Hoping for the best.
Wishing you all the best. How scary to go from presuming youre just a bit run down to finding out you have cancer. I’m only new here and to your blog, but I’ve really enjoyed your posts and Im hoping you’re well and truly on the mend and perhaps even have some more walking posts lined up ❤️
You’ve left me speechless. It was a difficult read for me, especially having my son singing the Scooby Doo theme beside me. But that sums up life really, farce blending with the most serious moments.
I have been suffering with a neurological issue for the last four years, with people smarter than me leaning towards MSA. It has robbed me of the joy of long walks, so your blog has been a welcome read.
The long wait in publishing the details of your diagnosis and embarking on your treatment journey has now gripped your audience.
I hope you can embrace the warmth of the many heartfelt comments.
Thank you Peter. I’m so sorry to hear of your own difficulties.
Hi Ruth, Neil Anderson here, Late of Rosegarth Guest House, Ravenglass.
So sorry to read about your cancer, however your attitude and sensible way of dealing with it is very uplifting. A close and longstanding friend had cancer of the oesophagus some ten years ago, he is still with us, hope lives on.
My love and wishes are with you. Keep fighting.
Ooft! That must have been such a blow. I hope treatment went well and I’ll wait impatiently to find out how you are doing now.
Keep on fighting, keep on walking, keep on treking, carry on living.
Thinking of you, I’ve been with you for a long time, the Swale if my memory serves me right.
Keep on fighting, keep on walking, keep on treking, carry on living.
Thinking of you Ruth, I’ve been on your journey since the Swale, it’s been a stretch.
Hi Ruth, Having read about your ongoing tiredness and lack of appetite, I must admit to have been very worried about you for some time. Also, for a long spell, a lack of blog posts, which is so uncharacteristic.
Along with everyone else, I was devastated to read your news and so really hope that your gruelling treatment was a total success. Here’s hoping you’re able to plan more walks very soon.
Your blogs have been inspiring and have helped me and so many others on our treks. You’ve achieved so much so far and I sincerely hope you’re able return to your adventures very soon. (Or maybe you already have) 🤞
Wishing you a full recovery and many more happy walking days ahead. Take good care of yourself.
Rita
Hi Ruth – You have spades of bravery and determination as we all know, so I wish you all the best and am thinking of you.
The boring bit here is, if you have not already done so you should look up the Office of the Public Guardian on line and look at setting up Lasting Power of Attorney for your immediate family. This can be done for Health and Finance and will greatly help your immediate family in managing your affairs if they need to.
In any case to borrow from Dave Allen – May your God go with you xx
I hope that you will have been strengthened by the admiration and love above. It is more than a year since you lived this and I truly hope it is a good sign that you are posting this now rather than continuing to prepare for something less pleasant. Best wishes. John
I’d just like to add my thanks & admiration Ruth, for all that you have shared on your walking adventure. It’s always a joy to read each stage & see your beautiful photos along the way.
Really hope your road to recovery is progressing well & that you will soon be able to continue your walking challenge!
Angela xx
You are very much in our thoughts.
What rotten luck. I was saddened to read your post this morning but hertened to know that as far as you have described it is from around a year ago, so I hope there has been a more favourable outcome. I can’t remember when I first “discovered” you but I had been following you for some time when you offered hospitality for me when I was walking the Macmillan Cross Britain Way in May 2015, but unfortunately our paths were not destined to cross that time:
From conradwalks.blogspot.com – 23rd. May 2015.
“Dr. Ruth Livingstone, my fellow blogger Coastal Walker. Ruth had invited me to pop in whilst in Stamford but she has gone back to Wales to continue her journey round the coast. Having set off from Norfolk she is now somewhere in the Gower (clockwise) so she is doing jolly well.”
We did eventually meet for an enjoyable lunch when you passed through Arnside later and I have followed you with MUCH RESPECT AND ADMIRATION ever since. I send my very best wishes.
Conrad.
Oh poor you. 🤞🏼🤞🏼🤞🏼🤞🏼
Ruth,I had no idea you’d had this horrib
I first came across your blog by chance when looking for walks along the Cornish coast path. I have loved it ever since and find your writing concise and interesting. So sorry you are going through this but I pray you will be victorious and continue to walk and be an inspiration to so many of us.
What an awful shock for you. Hope the treatment went well and you are now as good as new x
Ruth, I only just found your blog, searching for something to do with the Cornwall coastal path near my home. I just want to wish you a full and speedy recovery. All good wishes, Chris
Ruth, I was so sad and shocked to hear this news! I’m keeping you in my prayers for sure! I hope you’re getting stronger and getting back on your wonderful adventures. Keeping you in my thoughts. X
Really sorry to read this, and do hope it can be beaten. Just keep thinking that you’ve got the pleasures of the John o’Groats Trail straight in front of you – all the way down to Dornoch, often with a narrow trod between a barbed wire fence and sea-bird-rich cliffs. It’s a route and a half. Good luck getting back to it.
David Livermore
It was a shock to read a post with this news. You will be in my prayers as I continue my journey around a coastline you clearly love too.
Jeepers, how awful. Awful but you are now one year ahead. I wish you the very best of luck. I have such admiration for you
Jeepers. I have such admiration for you Ruth. Sending lots of good wishes from Cornwall. I went to school in Llanfairfechan. I got into big trouble running from our crocodile parade and jumping into the sea in my blue Sunday dress and straw hat. Beats Theresa May running thro a field of wheat at least (I think).
Dear Ruth, I am shocked and saddened to read of your diagnosis – and sorry that I have only just read this post. I am a long way behind but jumped ahead to read this. I hope that your fitness levels will have helped you in coping with the treatment and subsequent recovery. Keeping you in my prayers.
I have followed your blog for many years (7 or 8, I think!) and always find a gentle comfort in finding one of your posts in my inbox. I read each one to the end 🙂 I was shocked and sad to read of your diagnosis, and am sending strength and best wishes.
you are a hero x
I don’t feel like one, but thank you!