The Tale of a Wee Bit of Cancer

I think this story will not live up to the drama of the title. If you mention the word cancer, you introduce an expectation of a story that…

I think this story will not live up to the drama of the title. If you mention the word cancer, you introduce an expectation of a story that includes heroism and chemical weapons and a fight to the death. I don’t think this tale will include any of those elements. But when you have a story about cancer, that’s probably a good thing, at least if you prefer your stories to be reasonably sure of a happy ending.

My tale begins with my appointment in January to get the pathology report from my biopsy. I’ve had biopsies before. They were no big deal. There’s no history of cancer that I know of in my family, I’m comfortably overweight but not morbidly so, I don’t smoke or drink too much or have other risk factors, and I’m not prone to worry. They insist on delivering the pathology report in person rather than by letter or over the phone, so I dutifully trek to Ninewells Hospital in Dundee.

My appointment was in a consulting room in a lower level warren of wards. It wasn’t part of a clinic, meaning that there was no receptionist desk or sign-in procedure. A small anteroom had some chairs and a literature wall stuffed with brochures about breast cancer. I began to feel concerned. I was pretty sure everything was going to be benign and we’d all chuckle about these annoying lumps and bumps and go on about our day. I preferred not to sit staring at a brochure “Lymphedema After Breast Surgery” or “All About Mastectomy,” considering alternative possibilities for the pathology report.

The diagnosis: I had a papillary carcinoma, an exceedingly rare and easy-to-treat tumor inside a 25mm cyst. They aren’t invasive, they aren’t aggressive, they’re just annoying malignant cells that sit inside this bubble they’ve created for themselves. But the cyst still has to come out. Malignant bubbles can’t be left to their own whims and devices. Treatment: wide local excision (used to be called lumpectomy) and probably radiation afterward just to be safe. It is cancer, but it’s not CANCER cancer. Nobody dies from this. I called it “decaf cancer.”

One challenge with decaf cancer is figuring out how to tell people about it. It doesn’t deserve the same level of dramatic emotional response as a stage 4 colon cancer or pancreatic cancer or lung cancer or stomach cancer. When I was 19 years old I had a gangeon cyst removed from my hand. Having a papillary carcinoma felt about like that gangleon cyst— there’s a growth and it has to be excised and yes it does contain a malignancy but otherwise it’s not that big a deal.

My surgery was scheduled for 10 days later — on David’s birthday. (Sorry, babe! What a terrible present.) In the meantime, my greatest stress was trying to get caught up on work projects since I didn’t know how long my recovery would take from surgery and general anesthesia. I was also waffling about whether to do radiation afterward. Because this type of cancer is so rare, there are no clinical trials that I or my heroic medical research team (Tricia!) have been able to find. There are case studies, which were inconclusive about whether radiation actually makes any difference for long-term prognosis. The general feeling seems to be: It won’t hurt, and it might help, so you should probably do it.

The surgery itself went fine, and recovery went well. There might be more to add to those chapters later, but for now let’s move ahead to the post-op appointment, back in our consulting room in the lower-level warren of wards at Ninewells Hospital. The doctor was pleased at how well the incision has healed. They got all of the cyst with its malignant cells contained inside.

But: They didn’t get a clean margin — they found a different type of malignant cells in the surrounding tissue. I also have the much more common ductal carcinoma. It’s typically noninvasive, and mine is moderately aggressive.

So I’m waiting for my second surgery date. This one will likely be much more extensive with a longer recovery. And the “to radiate or not to radiate?” question has a definite answer: After recovery from the surgery, I’ll have several weeks of radiotherapy. The long-term prognosis is still very good. It’s not exactly decaf cancer, but it’s also not super-scary cancer. It’s annoying, inconvenient cancer.

How are we feeling? That’s usually the first question people ask. David is trying not to be worried. Right now, I’m actually not feeling too worried. I’m not excited about more surgery, but it’s gotta happen so I’m trying to use the intervening time to prepare as much as I can. I‘m annoyed by the inconvenience of it. Trips back and forth to Dundee?? An indeterminate period of time of not being able to do regular activities?? Fatigue?? Ain’t nobody got time for that!

But I also feel immensely grateful. Thankful that my prognosis is still good and my treatment plan seems straightforward (and doesn’t include chemo!). Thankful for my wonderful husband who continues to be fully loving and supportive. Thankful for my friends here who have already helped with food and my kids and my dogs and emotional support and time over coffee and prayers. Thankful for other friends who have been on the journey of cancer diagnosis and treatment and who offered empathy and practical advice. Thankful for my family and friends who love and care and pray for us. Thankful to be in a place with excellent medical care and gifted doctors. There’s more to be thankful for than annoyed about, and if nothing else, this wee bit of cancer has given me a reason to be conscious of that and practice gratitude.