Since last fall, I’ve been on an every three months regime of getting scanned. Two have been chest and abdomen, other was just my lungs. They are tracking the speed of spots in my lungs, looking for anything to get bigger. The last scan, done at the end of June, showed my largest lesion at about 2cm diameter, and growing a couple mm every 3 months. It showed the other ones “unchanged.” This is too slow to be alarming, but they want to track it, along with a tumor marker in my blood.
One possibility is that they will shoot a beam of radiation at the big lesion if it’s growing faster than everything else. Another is that they’ll do nothing until they see a rapid increase in the pace of growth.
What all this means is that I’ve gone into a kind of cycle: the best parts of the year are between the time my doctor finishing the appointment where he says “we’ll do another scan in 3 months” and getting the scan in three months. Then there’s the waiting part in-between, which is less fun.
After last November and December’s adventures in cancer world, it isn’t surprising that I get a lot of questions about my health and emails wishing me well, often based on incomplete information. Of course since I have incomplete information, that’s no wonder. So here’s some slightly more complete information.
We’re back to watch and wait. Ideally, forever. But maybe not.
When I saw my endocrinologist before I left for India on Jan 9th, he read my situation a little differently than the oncologist, as in he thinks I’m in a different class of patient (and was unworried enough to want to talk about teaching evaluations, which I took as a very good sign).
But both of them are singing the same tune in terms of next steps. In a couple months (give or take) I’ll have a scan that will give us a sense of what’s happened since the “new” baseline set in December, and then we’ll do partial scans throughout the year. What they are looking for is when the cancer starts “trying to grow” at a considerably faster rate than it is right now. When that happens, the slow-growing thyroid cancer is trying to start behaving like a more aggressive cancer, so the drugs start. Once I’m on drugs, I’m probably on drugs forever. At least with the medicine at where it is at today. The thing is that “trying to grow” phase could come soon, or it could come in 10 years or even later. And there are no other experimental treatments to try right now (the lithium/radioactive iodine was their best shot).
So now we pay attention every few months, and otherwise we suspend attention. “Watchful waiting” it’s called, but I like to think of it as blissful denial punctuated by periods of intense ambiguity.
This is the best possible outcome at this stage, so around here we’re considering me lucky.
A day later, I’ve been pointed to some nice writings but scientists and statisticians. See here: http://pb204.blogspot.co.uk/2015/01/science-by-press-release.html
A few things become clear: 1) the coverage is of the press release, not the actual paper but 2) there are still major problems in the assumptions of the paper. The “luck” appears to be mostly an artifact of the press release and the abstract, though the analysis remains flawed. The lack of social and environmental analysis is definitely a property of the paper. And of course most of the journalists reporting it are innumerate to boot.
Statsguy has a wonderful critique of the article, but winds up writing about lifestyle as a cause for cancer, and I’m sorry, without environment and social analysis, that’s just bullshit. Yes, HPV causes cervical cancer and smoking causes cancer, but what causes smoking? And neither of those things are good explanations for breast or thyroid cancer, whose increasing prevalence appear to result from a combination of changes in diagnostic technology and practice and environmental causes.
So it would be wrong to say cancer in general is “behaviourally” caused. Some cancers are behaviourally caused, though even there, how you could say smoking causes cancer and not also look at policies that promote the tobacco industry around the world, I don’t know. Ditto for the HPV vaccine. If HPV causes cervical cancer and the HPV vaccine prevents the cancer, then it suggests to me the important behaviour is vaccination, not sexual activity.
There’s a whole layer of moralizing that goes on top of the behaviour talk–which is typical of American (and I’m assuming some other) medical culture. But that will have to be for another post.
A new Johns Hopkins study finds “luck” as a major cause of cancer.
This is a great example of how medical research turns social conditions into inevitability and writes ideology (the order of things is given and unchangeable) as if it were science.
While there is talk of personal responsibility as a possible cause for cancer (“behaviours”), there is no talk of social responsibility (which might have something to do with changes in the environment over the last few generations). The only known cause of thyroid cancer is radiation. Other cancers are well known to be environmentally caused. So if, as the article says, we know cancer is caused by a combination of “luck, environment and heredity,” and the luck is more important than we thought (duh), then the logical conclusion is that if we are concerned about the spread of cancer, we ought to be thinking about the environment.
Sure, I’m all for fatalism as an explanation for why I have cancer and the person who experienced the same conditions doesn’t. But since we know certain cancers –including mine–are greatly increasing in the population overall (at least in the US and Canada, I don’t know worldwide statistics), we might actually want to go looking for explanations and solutions.