The Cancer Chronicles by George Johnson Read Free Book Online Page A

(favorable)
    PROGESTERONE RECEPTORS    
Negative (unfavorable)
    The first line provided a scrap to hang on to. Since the growth of some cancers is driven by estrogen, it might be controlled by bluntingits effect. The abundance of these receptors also helped narrow the diagnosis:
    Comment: The estrogen receptor positivity is consistent with an endometrial or ovarian primary rather than a gastrointestinal primary.
    So it was probably gynecological. Theendometrium—the lining of theuterus—is a tissue of epithelial cells, which are vulnerable to carcinomas. I think Nancy had suspected something like that. About a year earlier she had been told by her doctor that she was experiencing unusually earlymenopause. The sign was irregular menstrual bleeding, and I still wonder why that was not taken as a warning, an occasion for more tests—whether the cancer might have been discovered then and treated before it had been allowed to spread.
    Comment: The tumor has micropapillary architecture suggestive of endometrial, ovarian or
    The rest of the sentence was cut off. Monkeys with typewriters recording your fate. And being sure to include the billing code.
    The surgeon was so supportive, so sympathetic, so sisterly. On a follow-up visit she gave Nancy a hug. I think we both were stunned when her next move was to hand us a pile of paper—yellow, pink, blue—orders for various procedures. We were to take them to local clinics, stand in line, and apply for an appointment. The chain store imaging center across the street would do amammogram, chestx-ray, and aCT scan of the abdomen and pelvis. Thecolonoscopy factory was booked solid, the surgeon said. Rather than insisting that a patient with metastatic cancer be accommodated—most people’s colonoscopies are routine and could easily be rescheduled—she issued an order for abarium enema, an ancient, quicker, less definitive test. We asked about a referral to anoncologist. That would be premature, the surgeon told us, until we knew what kind of cancer this was. She actually said that.
    What is a crisis for the patient is routine for the doctor, but this still seems to me like pure idiocy. We went from lab to lab, returning to pick up the results. The mammogram and chest x-ray were negative. The abdominal scan showed the liver, kidneys, pancreas,bowel, and lower lungs to be normal. So were the adrenal glands. A 1.3 centimeter nodule in the area of the spleen looked “to be asplenule only”—a benign mass that can sometimes be confused with a tumor. In the pelvic scan a cyst on the left ovary appeared “unlikely to be neoplastic” but the uterus and endometrium were “prominent” and there were benignfibroids. There was a “question of [a] small constrictive lesion of sigmoid colon.” It was scary reading language whose nuances we were not attuned to understand. Especially disturbing were the results of a blood test:CA-125, a protein found in higher concentration with some cancers, was elevated. The test was far from conclusive—many other things can cause a high reading—but it hinted at the possibility ofovarian cancer, the kind that had killed our friendVivian.
    As we accumulated information we also made phone calls. I talked to a doctor at theMayo Clinic in Scottsdale where I had splurged for my fiftieth birthday on an executive physical. She suggested the obvious:MD Anderson Cancer Center in Houston orSloan-Kettering in New York. I contacted those places and—more importantly it turned out—found out who had treated Vivian. Her husband spoke highly of her oncologist, and when I called the doctor’s office in Santa Fe, his secretary squeezed us in for an appointment.
    Imagine a tall, thin, aging cross between Jimmy Stewart and John Wayne—I think he was wearing cowboy boots—ambling in and taking charge. He was reassuring in his casualness, someone who had seen it all. He leafed through the test results. “There’s nothing here really.” He said it was unlikely