What is the first reaction people get they learn they are diagnosed with cancer?
Run for your lives! It’s the end of the world as we know it.
Or
It’s something we might be able to live with for some time, if it's detected early and managed right.
I’ve gotten first-hand experience with these feelings twice during this year. First, in the early spring, my wife of 40 years got diagnosed with breast cancer. She was lucky, as it was diagnosed as a slow growing type. It was also detected very early, in a routine annual mammogram. Subsequent MRI scanning and biopsy showed the location, extent, and nature of the tumor. It did require surgery, mastectomy, but the results were extremely good. After surgery, pathology analyses of the tumor margins and lymph nodes were all negative. The pathology also showed the initial diagnosis based on the MRI and biopsy was correct – no further tumor types or sites were found. The best news was that no radiation or chemotherapy was needed. The future would bring twice yearly mammograms, but that’s a much easier price to pay than suffering through radiation and chemotherapy treatments.
The lessons we learned were:
- 3D mammograms work well. Would a standard 2D mammogram have detected her tumor as early?
- MRI and ultrasound guided biopsy also work well. They gave the surgeons a clear idea of what they faced. There were two surgeons, a breast cancer surgeon to do the mastectomy, and a plastic surgeon to begin the reconstruction and manage my wife's post-surgery healing.
- Breast cancer surgeons, at least those where I live, seem to know their business quite well. Same goes for the plastic/reconstructive surgeon.
Later this summer, it became my turn. Again, it started with an annual physical exam. My PSA level rose, nearly doubling from about 5½ to 9. This is not necessarily alarming, but I have a family history of prostate cancer. My father died from advanced metastatic prostate cancer in 1989, and his brother (9 years younger) also developed it. Both were diagnosed at age 68, although in hind sight, my father’s disease had clearly began much earlier. By the time he was diagnosed, it had already spread from the primary tumor site. My uncle had radical surgery (with permanent nerve damage) that removed his prostate, and allowed him to live cancer-free until he was 80. I have a vivid memory of a conversation I had with him where he said “you know what you have to do”.
And so, despite initial fears of impending doom, I went to see a urologist. Because I live nearby several medical schools, I went to a urologist at Georgetown University Hospital. My brother Dan (who occasionally posts here) is a radiologist there, and he recommended the urologist to me. That certainly helped a lot. Thanks Dan!!!
In rapid order, I had an MRI scan, which identified two possible tumor sites. This was soon followed by an ultrasound-guided biopsy. Computer technology now allows the digital image from the MRI scan to be placed over the real-time digital image from the ultrasound as the biopsy was done. It allowed directly sampling the two possible tumor sites. The biopsy's pathology report confirmed what the MRI radiologist had suggested, that I had two small malignant tumors in my prostate. My urologist called me with those results, and said I should schedule a visit with him to discuss my options. I asked directly, how soon should this visit be, IS THIS URGENT? He said sometime within August will be fine, suggesting that it was not urgent.
So I made an appointment for the next available time, near the end of August. That seemed quite distant to me. I wondered why. In another two days, I heard from another friend who is an experienced pathologist. Based on the MRI and pathology reports, which I sent him, he thought my tumors posed little danger. He went so far as to say he thought one of my options would be do no therapy now, but keep watching it. He said:
This is nothing to worry about!!
Your lesions by ALL likelihood are confined to prostate and I’ll be very surprised, if it turned out to be different. You wouldn’t need prostatectomy at this time. Active Surveillance is the way to go with annual or every 6 months evaluation of PSA and examination and every 3- 5 years biopsy, perhaps. Having said this, given your family history, it is likely that it won’t go away and there is a chance of becoming more aggressive albeit gradually with adequate time to catch it if it did so.
This disease will not do you serious harm, no worries, don’t lose sleep over this!
So I’m in pretty good spirits… make that elated. I thought you’d like to know
.
Please understand that his comments are those of a distant family member who is an experienced pathologist – he is not one of my physicians. I don’t doubt what he says, but I’ll know more details about treatment only after I see my urologist later in August. This may very well explain why he didn’t think I needed to see him sooner.
In the meantime, I’m feeling PDG.
More lessons learned:
- It ain’t over till the fat lady sings. This includes cancer diagnoses.
- Get your prostate examined every year, unless you don’t have one.
- Don’t waste time worrying, unless it helps. (Hint: It doesn’t.)
- It does help to have some MDs in the family. Thanks to both my radiologist brother and the distantly related pathologist!!
- Maybe I should buy that lottery ticket.
So this long story brings me to my real point.
- In cancer, some things have changed for the better in the last decade or two.
- Cancer diagnosis isn’t always a death sentence. It must be diagnosed early, before it becomes metastatic. With early diagnosis, depending on the type of cancer, there are curative options. My wife is an example. And, now I seem to be an example of the type of cancer that can now be detected early and simply watched in the future without taking drastic action.
My own thoughts go back and forth. Sometimes I think I’ll follow the standard conservative advice and go with continued surveillance. At other times, I want curative therapy right now. In fact, I want multiple types of curative therapy, freezing (cryo-ablation),ultrasound ablation, and radioactive seed implants – all at once. Maybe it’s good that I have to wait until late August before anything gets decided. I’ll be glad to be a bit more sober-minded about this.
Thanks for reading. [/END RANT]
