Not Exactly Hearts and Flowers
Among cancer tests, colonoscopies are a little odd. I’m not talking about the infamous prep, or even the general indignity involved. I’m talking about the results.
If the doctor finds nothing — no polyps, no ulcers, no funny stuff — then, great. You’re in the clear, come back in ten years, see ya later, have a nice life. If the doc finds polyps, which is often the case, he or she will usually try to remove them completely during the colonoscopy. The ones shaped like little pendulums usually get lassoed by a kind of wire snare that cuts them out, stem and all. The flat ones get excised. If they are larger than usual, with a broad attachment area, they may only be biopsied, and may have to be removed by surgery later. In any case, all these bits of tissue get sent to our friend the pathologist, who analyzes them and pronounces them benign. Or not.
The good thing about all this is that, if the doctor does a good job of removing all the polyps so that they have the ever-popular ‘clear margins,’ then even if they turn out to be cancerous, the treatment — removal — is already done. So, you can freak out a little, or maybe a lot, (YIKES!) and then recover (WHEW!), and then attempt to move on to resigned acceptance, because you’ll probably have to have another colonoscopy in a year or three to make sure they don’t come back. The bad thing is, of course, that you’ve just been told you have Another Stalker.
And that’s the weird part. Once you have a malignant polyp removed, you don’t get to hear that magic phrase No Evidence of Disease. You may — with the assurance of your doc and the pathologist that the entire rat bastard was removed with clear margins — assume for the time being that you are now free of disease. But that’s hardly the same thing. And I doubt if anyone in their right mind would willingly have another colonoscopy a week later just so the doc could officially pronounce their colon as being in that blissful state of NED. At least I wouldn’t. Besides which, my insurance wouldn’t pay for it.
This was my experience a year ago. One of the treacherous little bastards removed last year was found to contain cancer cells, and, for the science geeks, was characterized as “tubular adenoma with high-grade dysplasia.” This characterization doesn’t automatically include cancer cells, but mine did. When I saw the doc himself later last year, he told me in no uncertain terms that I’d had non-invasive, in-situ, Stage 0 colon cancer. Great.
The thing is, though, that the other six polyps were not adenomatous, i.e., the kind we worry about, but merely hyperplastic, the kind we don’t worry about. And generally speaking, colon polyps are slow-growing little buggers. So, I had a reasonable expectation that my next colonoscopy would find none of the little buggers.
So, two days ago, I had my one-year follow-up scope. When I arrived, I got hugged by all my nurse friends in Endoscopy/Day Surgery. I was to be knocked out completely this time by the nice anaesthesiologist who came in to introduce himself beforehand. My GI dude also came in to assure me that he would come and talk to me afterward to tell me if he found anything. After I was wheeled in, IV’d, and hooked up to the appropriate monitors — and found yet another old nurse buddy in the OR who was assisting — I laid there watching the IV tube. As the knockout juice began flowing down the tube, I said cheerfully, “Night, night, everyone! Wake me up when it’s over!” And the best part was that I did wake up when it was over, rather than during, which is what happened last year, an event I do NOT recommend.
This year, along with the usual toast, graham crackers, juice, tea and coffee on the post-procedure menu, the recovery nurse offered oatmeal. Wow! Oatmeal! With milk and sugar! And it was pretty good, too, although probably sawdust would have been fantastic after not having eaten solid food for a day and a half. Then she helped me sit up, took my blood pressure again, and showed me a little diagram drawn by my GI dude. A diagram? Uh-oh…
A little later, my doc confirmed what I already knew, that yes, there was a new crop of polyps. There were more of them than last year, but they were smaller. There was also a teeny ulcer that he thought probably just arose from my having to do two days of prep. But he did biopsy it. He removed the eleven or so new polyps. As usual, they were being sent to the pathologist. As usual, he couldn’t really say from just looking whether they might or might not be malignant. The fact that they were there at all was depressing, and I told him so. I was really hoping for nothing. NED. No Evidence of Disease. “This is not the Valentine I wanted from you,” I said. “How long until the path report is done?”
“Give it a week,” he said. “I’ll call you as soon as I know. I got them all, though, so they’re gone.”
Gone but not Forgotten
So, now, I wait. You all know how much fun that is. I tell myself that ‘gone’ is good. Gone means that, no matter what the traitorous little rat bastards turn out to be, I’m done with them. So, I’m okay, right?
No. I’m not okay. I wanted NED. But I didn’t get him. Now, if I’m really honest with myself, what I want is to cry. I was just starting to feel like I was gluing myself and my life back together after my original Stalker. I don’t want to have to be vigilant about another one. I’m really tired of vigilance.
Welcome to Never Normal. Welcome to this brief, I hope, Pity Party. Welcome to Cancerland. I promise to be more cheerful later. Just not today.