Tuesday, November 5, 2013

Don't know much about pathology

           There are some things that are better left unopened. For example, a manila envelope containing pathology reports.
            I had set up an appointment with a prominent New York City gynecological oncologist for Nov. 6 to talk about my ovarian cyst, and I needed to bring her up to speed on that and everything in between. So I innocently swung by my breast surgeon’s office and picked up a copy of my patient chart.
This is me in Imaginary World, stocking up
on the necessities to make my family wonderful meals
soon after my double mastectomy.
Up until now, I had remarkably scant knowledge of my cancer, except for that one side appeared to be in the very earliest stage while the other one was invasive. That had been fine for me. I could pretend that everything would be rosy after surgery, that everything was neatly contained within the breast and that my cyst was a miracle that had helped me detect this invader super early. I would have my double mastectomy on November 11 and would in no time be baking cookies for my children every day and putting dinner on the table just as my husband walked in the door at night. Ha ha ha! Did I just write that? Actually, what I meant to say was, “I would have my double mastectomy on November 11 and would in no time be preventing my children from burning down the house—at least for one day—and be showered in time to get takeout with the family.”
But curiosity got the better of me and I opened that envelope. As I dug in, my fingers inched their way to the laptop and, ultimately, found themselves Googling a crash course in pathology/histology. I was accustomed to writing health stories for savvy consumer audiences, so this crap went waaaay above my level of expertise.
            “Infiltrating, high grade ductal carcinoma.” Why does the word “infiltrating” sound so much worse than “invasive,” though they mean the same thing? And “high grade?” That was typically a good thing, except in the world of oncology. The report described the mass in the right breast as one of the shittiest grades—grade 3: The breast cells looked nothing like normal breast cells, they were dividing rapidly and were poorly differentiated.
Infiltrating ductal carcinoma-- or a Formica
bathroom countertop from the '90s. Hard to tell.
According the American Cancer Society, “Poorly differentiated carcinomas lack normal features, tend to grow and spread faster, and have a worse prognosis.” Good to know. I tried to look on the bright side: Maybe I did indeed catch this aggressive cancer early and whew! Isn’t that a good thing? On the flip side, maybe my head wasn’t actually my head but a MASSIVE METASTATIC TUMOR!
            “Lymphovascular invasion is present.” Again, I defer to the American Cancer Society: “If cancer cells are seen in small blood (or lymph) vessels under the microscope…cancer is growing in these vessels and there is an increased risk that it has spread outside the breast.” Well, that would explain my head.
Another key component of the reports is hormone receptors, which my surgeon and I did discuss face to face. My masses were estrogen receptor (ER) and progesterone receptor (PR) positive, which I’ve been told is a good thing. It means that some very effective estrogen-blocking therapies would be available to me following surgery, and the overall prognosis is typically better than if these receptors tested negative. The status of another receptor, called Her2, is still undergoing testing because it came back inconclusive the first time. (You want that one to test negative, and my breast surgeon says ER- and PR-positive tumors tend to go hand-in-hand with Her2-negative. I remain cautiously optimistic.)
DCIS. You're S.O.L.
“Ductal carcinoma in situ (DCIS) of high nuclear grade with comedo necrosis and associated microcalcifications.” Say what now? According to BreastCancer.org, this means that my early stage ductal carcinoma in situ is high grade (damn it, there’s that phrase again!), and I have a higher chance of a recurrence of cancer within the first five years after diagnosis. Well, doesn’t that give me something to look forward to!
            So by now I’m totally confused. Some things gooood, other things baaad (as Frankenstein might say). Are some of these factors more important than others? Or, more likely, did they all fit together to help form a more complete picture, some of which was still missing because I hadn’t had surgery and staging yet? Now that I think about it, maybe this is best left up to the folks with the MDs after their names, who will perhaps one day include me in this conversation and stop dumbing things down. 
Maybe I should stop Googling now. Maybe not. Let’s see, “Symptoms of OCD…”


  1. Yes, stop googling cancer. But do cut yourself some slack: Researching stuff is what you do. Not quite OCD, but I'd say it's a pretty natural thing among health writers. The few bright spots in this whole mess are a) Targeted therapies. Today's medical treatments are better at getting to the root of cancer with less toxicity than the old standbys; b) Loving support from family and friends; and c) a really great sense of humor....I will never be able to look at formica the same. Brilliant!

    1. Can I hire you to sit with me, 24/7, and keep my proverbial glass half full?