As my childhood friend the Bard said:
All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances,
And one man in his time plays many parts, …
There are many staging systems. Some, such as the TNM staging system, are used for many types of cancer. Others are specific to a particular type of cancer. Most staging systems include information about:
- Where the tumor is located in the body
- The cell type (such as, adenocarcinoma or squamous cell carcinoma)
- The size of the tumor
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to a different part of the body
- Tumor grade, which refers to how abnormal the cancer cells look and how likely the tumor is to grow and spread
One system used is this:
Stage What it means Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer. Stage I, Stage II, and Stage III Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues. Stage IV The cancer has spread to distant parts of the body.
At the first cerberus appointment we were told that I had stage III cancer, but that it was “just” stage III, close to stage II. That was not real reassuring but it was something to hold on to.
After surgery the surgeon said reported that pathology determined there were “clean margins.” What the heck does that mean?
Imagine the yolk is a tumor:
And the doctor is about to cut it out. First he adds some salt and pepper and then starts cutting. The idea is to get the entire tumor and then send what is cut out to pathology. They prefer hot sauce on their eggs, but then, they are pathologists.
In order to be sure the doctor got every bit of the tumor, they will look closely at the area the doctor cut. There should be a layer of white and no yellow showing. Any yellow showing means that the yellow, i.e. tumor, was cut and there are some tumor cells left in the patient.
This is an example where there is not a clean margin on the right of this picture, hence some tumor is still in the rest of the fucking colon and I picked the wrong surgeon. And now I’m hungry.
We had clean margins. I did not say “duh” as he took out about 12 inches of colon and the cancer was more like 3 inches or something like that.
lymph node (limf node) A small bean-shaped structure that is part of the body’s immune system. Lymph nodes filter substances that travel through the lymphatic fluid, and they contain lymphocytes (white blood cells) that help the body fight infection and disease. There are hundreds of lymph nodes found throughout the body. They are connected to one another by lymph vessels. Clusters of lymph nodes are found in the neck, axilla (underarm), chest, abdomen, and groin. For example, there are about 20-40 lymph nodes in the axilla. Also called lymph gland.
The surgeon also removed some of the lymph nodes that are involved with the part of the colon I used to have. I was told that there is more concern when five or more lymph nodes have cancer cells. Four of mine did.
… His acts being seven ages. At first, the infant,
Mewling and puking in the nurse’s arms.
Then the whining schoolboy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths and bearded like the pard,
Jealous in honor, sudden and quick in quarrel,
Seeking the bubble reputation …
And that is all I knew going into chemotherapy, the last of the triad …
chemo-radiation : surgery : chemotherapy
I was at one of my every-two-week appointments to get infused. The protocol is I go in and first they hook up to my port and take blood for testing. I meet the doctor afterwards and if the blood tests are “good” I then got two hours of IV, only to go home for 48 hours with a pump continually infusing me more. Luckily Quinilla (Dr. Pye) was back from her leave and I met with her for the majority of the appointments.
I don’t remember how it came up (keep it clean) but we were talking about my current symptoms and whatever, and then she said it.
The final determination on staging was IIIc.
That is the highest stage short of stage IV (spread to other organs).
So that was a surprise. My head was spinning a bit and somehow, as stupid as it was, we got on the subject of survival rates. Stage III has around a 70% five-year survival rate. Stage IV is around 20%.
Had I waited much longer for my colonoscopy I would be dealing with a 20% survival rate. Definitely a 12 on the what-the-fuck-o-meter.
… Even in the cannon’s mouth. And then the justice,
In fair round belly with good capon lined,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part. The sixth age shifts
Into the lean and slippered pantaloon,
With spectacles on nose and pouch on side;
His youthful hose, well saved, a world too wide
For his shrunk shank, and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
-As You Like It, Act II, Scene VII [All the world’s a stage]
William Shakespeare, aka the Bard