Friday, July 3, 2009

3 - Surgery 1

Surgery 1

The surgery is not fun. The area where one would normally sit has been assaulted with sharp objects, needles, sutures, probably cauterizing. Sitting is impossible. Lying down is hard enough. Recovery takes a solid week. Fortunately, there are lots and lots of good drugs to help one through the pain. I can't do anything through the drugs except lie there, slack jawed and drooling, staring at the TV. Or the wall. Two friends supply me with a large number of DVDs to help pass the time. I watch many movies that I cannot remember now. As I said, good drugs.

Back to the surgeon for follow-up. Well, everything looks pretty good, he says. Huh? Wait a minute, wait a minute. That's not the way we read it. The pathology report in my hand says that the underlying muscles and the lymphovascular system are involved. This means lots more treatment. The doctor is skeptical. The path report in his hand doesn't say this. Puzzlement. Turns out that his records contain only the preliminary pathology report, which says good things. The final report, which luckily we got a copy of from the hospital, says bad things. (Lesson: get a copy of absolutely every piece of paper you can, from every doctor, every lab, every hospital, and study them all.)

Lucky, lucky, lucky. Had we proceeded based on the incorrect preliminary path report, the cancer would still have been there and still growing. And I would be dead in two years.

The lymphovascular system, oops, is the highway system that drains extracellular fluids from tissues. This provides a path that permits cells to move, too. In particular, it allows such nasties as cancerous cells to get away to other parts of the body, to metastasize, which one does not want. So now I have to go thru the whole treatment, chemo and radiation. Oh, goodie.

The official classification is T2-N0-M0: muscle layer involved, no lymph nodes visibly involved, no metastases visible.

Where Was it Hiding?

The obvious question is, If we had found it just a few months earlier, would the surgery have been effective? Would the surgery have got all the cancer? Would the excision have had the "clean margins" that I'm told I should want? This was a case of early detection, to be sure, but still earlier would have been better. At some point in the past, it must have been small and well-defined and easy to remove. But, being so small, would it have been possible to detect? These things start as one rogue cell. Then they get out of hand. When did it cross the line from undetectable to detectable? When did it change from operable to inoperable? From well-defined to diffuse? The surgery got most of it but not all. Almost all, but not all. What's left is microscopic, but is microscopically bad. Little lethal seeds floating down lymphatic rivers, looking for fertile new homes. We can't let that happen. And if it's not feasible to pick them off one by one, it's time to get out the nuclear weapons.

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