The Pathology Report
I am sitting on a railroad track. I have never been here before. I have never felt the grit of this dirt beneath me, but I recognize the faces in the crowd— I see my sisters, afraid and angry; my mom and stepdad, urgent, diligent; my father; aunts and uncles; cousins; friends, both old and new all crowd among faces I’ve never met. In the distance, a speeding train races towards me. The sound of metal against metal squeals in my ears and the hiss of the engine grows louder. If I turn my head to watch, I will see the front of the train—the face of a silver bullet called Death.
I know there is no conductor, no passengers, no robot to pull an emergency brake. Still, I sit, cross-legged on the rails—defiant, reluctant, yet at peace. On-lookers scream and urge me to move. Get off the track! They yell from the safety of the platform, You’re crazy! You’re going to get yourself killed! I look at them mobbed in front of me. I listen to their shouts and I know they might be right. Still, as if buckled in place, I sit.
“The train will stop,” I tell them. I take a deep breath, keep my heart steady, “I am going to live.”
Over the course of days since my diagnosis, I often felt strapped to a railroad track. I did not come here by choice, nor without fear, but I stayed grounded by a conviction I often didn’t understand, and with a knowledge I couldn’t explain. Like when you meet the one you are going to marry, some things you just know. Through the course of my treatment decisions, I often said to others, “I feel as though I am being led by something larger than myself,” and I clung to that inner voice like a safety net. When fear threatened to steal my peace, I sought that voice. I listened to doctors who told me chemotherapy would save my life. I listened when they said, “If you don’t do chemo, you’ll be dead in less than five years.” And every time, a silent, booming voice that was not my own, but only I could hear resounded within me: You’re wrong.
It’s difficult for onlookers understand what they cannot see and cannot feel, particularly when it seems illogical and goes against social conditioning. Logic said, listen to the recommendations and warnings from doctors; listen the pleadings from my friends and family. But I had no other choice but to listen to the voice within. And now I know now that had I not, I might not be writing these words right now.
Instead, for three months I meticulously followed a fresh juice and raw, plant-based diet— something I grew to hate because it required so much time. Still, it’s worth noting that the nutrition and alternative therapies I underwent prior to my surgery did play at least a part in either keeping my cancer from spreading, or possibly even helping improve its invasiveness. I know this because in February, three months after my initial diagnosis when I officially switched my care from Piedmont hospital to Emory, I underwent re-staging—meaning doctors took new scans of my tumor to assess if the cancer had worsened or spread.
I had new scans and images taken at a different hospital with a different set of doctors because the doctors I initially saw at Piedmont had denied my request for up-front surgery, and also refused my request for genetic testing prior to starting treatment. The denial was no fault of the doctors, however. The standard of care for stage III rectal cancer does not order genetic testing prior to treatment, nor does it typically recommend genetic testing for cancer patients who are not in a metastatic state—meaning the cancer had not spread to distant organs or formed secondary tumors. The reasons behind not performing up-front genetic testing on non-metastatic cancer patients are bureaucratic, but if you ever find yourself amidst a cancer diagnosis, do yourself a favor and get genetic testing, regardless of your stage, and even if you have to pay for it yourself. It isn’t cheap; my test cost $6000, but it could save your life.
After being re-staged, I learned that the nutritive treatment, meditation, acupuncture, supplements (I was taking DOZENS), and everything else I did for the 90 days between my initial diagnosis and my go-ahead for surgery in March had in fact made a difference. While the dimensions of my tumor did not actually improve, the invasiveness of it did. At least according to the surgeon who ultimately agreed to put me under the knife, and he had reviewed both my initial scans from December, and the new ones taken in February. When I met with him for my pre-surgery consultation, I asked, “What changed?”
He said, “Your tumor improved.” He explained that the initial images from December showed my tumor had penetrated through the fatty tissue and into the muscle beneath the rectum, which meant he would not be able to safely remove the cancer without first shrinking the tumor. The new images showed that the tumor had not penetrated the muscle (or no longer penetrated the muscle), which made him confident he could safely perform the surgery. He further detailed that he only needed “millimeters” of improvement, and in his opinion, that’s exactly what had happened. The underside of the tumor improved enough so that the millimeters my surgeon needed were now available.
However, the four doctors on the review board that discussed my case were in disagreement. Two of them agreed that the tumor had improved, while two of them believed nothing had changed. Bear in mind that the different sets of scans were performed at different facilities on different equipment, and technology is not infallible. I mention this because illness and cancer are scary and serious, and this is only my experience with it. I am by no means a doctor, nor am I qualified to issue medical advice. God forbid you ever find yourself faced with chronic illness, but if you are, your doctors will know better than I do. It is important that you listen to your instinct, your doctors, and do what is right for you in your unique situation. Nothing I share here is meant to substitute for medical advice. But it is important to know that you do have options, and you do have a right to chose your treatment. So, listen to your heart, do your research, and know exactly what you are faced with before deciding what the best course of action may be for your specific situation.
I should note that it is not typical protocol for patients with rectal cancer to go straight to surgery. Though colon cancer and rectal cancer often get lumped into the category of “colorectal” cancers, they are not the same. The rectum, unlike the colon, is surrounded and held in place by muscle, while the colon floats free. And as such, rectal tumor treatment calls for shrinking a tumor via radiation and chemotherapy prior to surgical removal in order to ensure an easier operation. Colon cancer patients, on the other hand, typically go to surgery first and undergo chemotherapy after. Furthermore, recent studies suggest preoperative therapy may also reduce the chance of recurrence. Thus, the initial denial of my request came as no surprise, particularly given the large size and invasiveness of my tumor. However, had I not researched chemotherapy and learned about a genetic mutation that can cause complications with it, I would not have known to ask for the genetic testing, and likely would have moved forward the doctors’ recommendations. At the time, I had no way of knowing whether or not I had those particular mutations, but due to the severity and side effects associated with chemo, I was willing to risk of putting off treatment in order to find out.
My preoperative diagnosis labeled my condition as a T3 N1 M0 adenocarcinoma of the rectum. In Laymen’s terms, the tumor (T3) had grown into the outermost layers of the rectum and invaded at least one lymph node (N1). The lymphatic system, a network that helps rid the body of waste and toxins, also acts as a mechanism for transporting disease from one part of the body to another. And as such, once cancer is detected in the lymph nodes, it receives a stage three classification—regardless of the number of lymph nodes involved—due to the unpredictable imminence of metastasis. Luckily, the CT scans taken of my chest and abdomen had come back negative for metastasis (M0), meaning secondary tumors were not detectable in my liver and lungs, where colorectal cancers usually spread first.
Upon removal, the cancerous mass measured approximately 8.6 centimeters at greatest length, approximately 5 centimeters at greatest diameter, and encompassed about 70% of the rectal canal. It was as if I’d swallowed and entire orange and it engorged itself in the lowest bowels of my body. My team of surgeons submitted the tumor to the pathologist for dissection and appraisal. The pathology report, a ten-page document which they gave to me a few weeks after my release from the hospital, detailed exactly what procedures I had undergone in the operating room and what the pathologist had learned about my specific tumor. And what I read brought me to my knees in tears.