A Cornucopia of Carcinoma
After receiving the good news of the clear pathology reports, I still had a few more doctor’s appointments before moving to the next stage…
After receiving the good news of the clear pathology reports, I still had a few more doctor’s appointments before moving to the next stage of treatment. The next stop on my Tour de Ninewells Hospital was a review with my plastic surgeon, whom I like to call “My-My-My-My Fiona,” — though I haven’t yet had the guts to sing this to her in person.
Based on her handiwork that I’m sporting on my own physical person, My Fiona is a very skilled plastic surgeon. She’s not quite as skilled at listening. I’ve now met with her nearly half a dozen different times, and each time she’s seemed to have a clear direction in her own mind of what we’re going to discuss or decide or do.
My Fiona was pleased with how my wounds were healing and how I was feeling. After her examination, I sat while she rifled through the paperwork in my chart. “Your file is kind of a mess — they haven’t been keeping things in order,” she said, more to herself than to me. My Fiona does not seem like the kind of person who enjoys disorder. She decided to put all the paperwork in order while I sat there. (To be fair, I am also easily distracted by messy paperwork and am often consumed by the urge to tidy things.) While My Fiona went all Marie Kondo on my chart, she was talking though the various bits and bobs, more to herself than to me.
“OK, initial test … papillary carcinoma … first lumpectomy … second surgery to remove ductal carcinoma and lobular carcinoma …”
Wait, WHAT?? Lobular carcinoma? THREE different kinds of carcinoma? Apparently I was a veritable cornucopia of cancer cell types.
A few days later, I had another appointment, this time with the oncologist to discuss additional treatment options. The recommended plan was a course of radiotherapy. That should be straightforward — a few weeks of getting zapped and then this would all be wrapped up and over and done with and I could think about planning my days around things other than cancer. But … I wasn’t sure about having radiotherapy. I’m predisposed toward minimal treatment options with the least amount of intervention. The particular kinds of carcinomas that I had aren’t the kind that usually spread. Did I really need to undertake the risks of radiation? But now that I knew that lobular carcinoma had been thrown into the mix, I thought radiotherapy did seem like a reasonable next step.
The oncologist was very gentle and kind. Unlike My Fiona, he was much more inclined toward listening. He explained the potential benefits of radiotherapy: up to a 50 percent reduction in the likelihood of cancer recurrence. He explained the potential risks and side-effects of radiotherapy: damage to the skin, edema in the affected tissue, fatigue, and the possibility of developing sarcoma in the treated area within the next ten years.
Um, sarcoma??
In my studious consultations with Dr. Google about radiotherapy, somehow I had missed that one risk is the possibility of creating a much worse cancer than the type you were treating. So now my decision felt like some kind of weird cancer math: N days of radiation x (% risk of recurrence + N types of carcinoma) = P(A) appearance of sarcoma?
The kind oncologist listened very patiently to all my questions. He said in gentle voice that he felt comfortable recommending me for radiotherapy but it was my choice. He gave me the phone number of his assistant to call if I wanted to discuss it further or if I changed my mind. I left his office still trying to do the impossible, unknowable calculations of whether the robust chance of keeping away carcinoma was worth the minute chance of inviting in sarcoma.
That was a Thursday. On Friday, they called to say there was an opening in the schedule, and I could have my radiotherapy prep appointment on Monday. I suppose it was good that things moved quickly so that I had less time to research every possible medical study I could find about sarcoma rates and complications from edema and all the new “watchful waiting” treatment trials for ductal carcinoma in the U.S. and U.K. that now I don’t qualify for. I could probably marinate indefinitely in a stew of indecision waiting for conclusive evidence that doesn’t exist. There are good reasons why doctors recommend radiotherapy, even with the risk of sarcoma. And the sooner I got started, the sooner I’d get finished.