A Bump in the Road

I haven’t posted much of late about my experiences learning about and responding to cancer. The primary reason for the drop in output is the decline in my certainty about what I’m dealing with. The certainty…uncertainty…certainty…uncertainty cycles have been torturing my sense of confidence that I know what the hell going on with my body.

Initially, I was sure the problem was relatively minor. I decided it deserved little in the way of detailed explanations. And I was confident my cancer was far less serious than the cancer the majority of people experience. And, then, over the course of several days, I came to realize mine was more serious than I thought. Again, though, I convinced myself it was serious, but not too serious. After my surgery, my surgeon’s quick comment (that all the margins were clear and there were no obvious signs the cancer has spread) was reason to celebrate. A couple of days ago, though, my cause for celebration declined somewhat. My oncologist said there was evidence that cancer had invaded the margins in one area. For that reason, she said, she was inclined to think radiation treatment, in addition to chemotherapy, was in order. Chemo was to be primary, but radiation should  be part of the regimen. By the way, she said, the tumor was considerably larger than the PET scan indicated. Instead of 6.5 cm, the tumor was 7.4 cm. That fact, alone, changed the stage classification of the cancer: it is now classified as a Stage IIIa cancer, versus a State IIb cancer. The day after my appointment with the oncologist, I had my follow-up appointment with the surgeon.

Indeed, he said, he has seen no evidence whatsoever of cancer in the margins. But lab analysis indicated there was cancer in the cells between the lower right lobe—the one removed—and the middle right lobe. He explained that the transition areas in my lobes were clear; typically, he said, the tissues in those areas would be somewhat murky and opaque if cancer cells were present. But the lab analysis showed evidence of cancer, even though the tissues in those areas were clear and virtually transparent. He said he felt certain he could go back in and remove any areas in which there might be cancer, but I had already been through major surgery and doing it again was probably not a wise move. And, he said, the felt confident the radiation could quickly eradicate any remaining cancer. He showed me some still images of the devices used to separate the lobes and which were used to “get rid of” the cancer cells. It made perfectly good sense. The bottom line, he said, was this: if the chemo and radiation didn’t get rid of the cancer, he could go back in later and remove it. But doing it now would present a risk, let alone considerable pain again (not that it’s gone yet). So, the good news is still “pretty good,” but not extremely good. And it’s the sort of news that has effectively hit me in jaw like a cast-iron skillet.

As things stand at this moment, I’ll go back to see the oncologist in about two weeks for various tests, etc. Then, two weeks later, I’ll return (appointment scheduled for December 31) for my first chemo treatment. But I’m apt to change that. I leaning toward rescheduling my first chemo treatment for the week after the first of the year.

I asked the surgeon what the chances were that, even after his surgery, there might be cancer in my body (even assuming nothing went awry with the surgery). The rationale for my question: if the chances were slim, I would think additional treatment would be unnecessary. He said the likelihood is almost certain to be 100%. There is some cancer circulating in my bloodstream, he said. I have to kill it or it will kill me. So declining chemo is out of the question at the moment. That would be madness.

I’ve bounced back and forth so much I can’t believe I haven’t short-circuited my brain. My moods have spun from gleeful to terrified to thrilled to frightened and back again, all in the span of fifteen minutes. And I’ve been conscious of the fact that I absolutely had to keep my emotions in check or I would melt down in the exam room and be unable to recover. I wish I could go out for a long, lonely drive…maybe a several-day diversion in a back-woods cabin somewhere my screams would not alert the police. But I can’t even drive for a while, so that’s out of the question.

The surgeon seems pleased with the results, except that he’s very unhappy that he did not see that cancer cells had spread outside the tumor he removed. And he was surprised at how large the tumor was. I remembered what he had said earlier about what he believed was a 6.5 cm tumor; a tumor that large almost always has spread into the lymph nodes and, frequently, beyond. But the lab results from my surgery showed no evidence that cancer had invaded my lymph nodes. So, on the one hand, I’m very happy that “all the evidence” that’s currently available, suggests the cancer has not spread (except maybe to my middle lobe). On the other hand, I am disappointed to have to go through radiation treatment in addition to the chemo. But maybe I should be grateful that I’ve been presented with the opportunity to fight the bastard that invaded my chest and, if I work hard, win the fight. I’m working on developing that sense of gratitude. I know my circumstances could be far worse. My mood, on the other hand, could be far better. Perhaps my most immediate goal should be to improve the stability of that emotional seesaw.

If I were half smart, I’d look at my most recent information update as merely a bump in the road that needs smoothing. The bump may be a what in Mexico is called a tope (speed bump) or it may be a pothole that needs to be filled. Whatever it is, it won’t get fixed if all I do is bitch about it. Corrective action is on the horizon. Now, what, exactly, does it look like?