Pathology

This week we waited for the pathology report to come in from the tissue that was removed and sampled during surgery.  I wasn’t worried. In fact, I was more focused on healing from the surgery. The pathology report wouldn’t affect that process.

I started thinking about pathology on Wednesday, a week after the surgery. It seemed to me this could be the moment when they said there is no evidence of disease, NED, and that I am officially in remission. Or they could say that there was a lot of active cancer in the lymph nodes and other areas that hadn’t shown up on the scan, including possible cancer still in the lung lining. So far the surgeon hadn’t mentioned the bowel or the lung. What she had said was that it was a very clean surgery, and that there had been very little disease to find and remove.

I felt hopeful because she said they had taken everything that they could see. Nothing was so attached to tissue or important organs that they had to leave it behind.

On Friday afternoon I met with the surgeon’s assistant, Kelli Daly, who had been in the surgery. She gave me the pathology report.

It showed pink tumors in the omentum (4) and in the 14 sampled lymph nodes (2: 1 right and 1 left, in the pelvic region, none above that area).

Based on the pathology report, she staged my cancer at Stage IIIC.

Not Stage IV.

I was pretty stunned in the exam room. I didn’t know the stage could change. But the reading I’ve done since says that actually staging can’t be formally done until surgery, because the scans don’t tell you enough. I told her I’d been staged at IV and she said: “Why? Because of the fluid in the lungs?”

“Yes, and the scan showed nodules on the lung lining.”

“I was there and the surgeon reached her hand in and felt all around the lung and said it was completely smooth and there was no evidence of nodules or tumors.”

The picture given by the surgery and the pathology reports is that the tumors are larger than stage II and have moved outside the original site (ovaries) but have not penetrated other organs (not formed tumors in the lung or liver). So one of two things has happened: 1) the cancer was not as advanced as we thought at first; or 2) it was not established yet outside the pelvic area and the chemotherapy (and prayers) have knocked it back to stage III level. Which would be partial remission.

There are still those pink tumors on the omentum and the sampled lymph nodes to think about. Because of that, there will be 2-3 more cycles of chemotherapy to try to kill whatever else might be lurking there, microscopic or hidden in lymph nodes.

As you can see, I’m working on what this means.

The only way I can see the move from Stage IV to Stage IIIC is stepping back from a cliff’s edge. The initial diagnosis put me way out there on the cliff’s edge. The way I imagined even remission was maintaining my place on that edge. I’d have to just balance out there and live life on that edge, careful not to go over the cliff. Of course, one day the cliff could crumble beneath my feet.

I didn’t consider the possibility of stepping back. Standing on an ever-so-slightly safe space of cliff. That is how big this feels to me. And having just had a sushi lunch with my friend Kim Butler to celebrate 10 years cancer free with a stage IIIC diagnosis– that is “cured” in the cancer world– certainly helps.

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