Genes, Genes, Genes

(Title reference explained below)**

On Monday I was at my endocrinologist’s office. No big news from my meeting with him. Everything’s good. Except he said “it’s good that you’re wearing a hat.” I assumed it was some middle-aged bald guy advice (NB: sunburned scalp is the most disgusting feeling known to humans), but it turns out Lenvima can make you hypersensitive to the sun. As in: a sunburn of any kind is now potentially a second degree burn. This may explain why my prickly heat in Provence was the worst ever (<–also a gross feeling).

On my way out, I ran into my surgeon, whom I hadn’t seen in several years. I almost didn’t talk to him. We exchanged pleasantries, I went to the elevator, I hit the button to go down. Then I had a thought. My current book project contains an anecdote about me waking up during surgery in 2010. He was there. So I went back to ask him about it. He pulls out his notes (he keeps detailed notes on every surgery, which live in his phone), and we compare memories. If you want to know more, you’ll have to wait for the book (or the draft, this chapter is currently kicking my ass and I will need help).

I think I’m ending the conversation by asking him what he’s currently researching. It turns out he’s become an expert on thyroid cancer and genetics. He believes that within a decade:

  1. It won’t be called thyroid cancer anymore because it will be referred to by the specific genetic mutation it displays.
  2. Treatments will be gene specific and there will be cures for many mutations.
  3. There was a brief aside about the worst Star Trek movie, Dr. McCoy’s tricorder and a cure for cancer (look it up).
  4. We agreed that surgery is essentially a shinier version of medieval medicine.

But wait, there’s more. It turns out that deep in the bowels of the Jewish General Hospital, there is a slide with tissue from my thyroid tumour from 2009. In 2009 there was no genetic testing like this. Today, if they’d done the surgery, they would have sent the tumour out for testing as a matter of course. But, they can still do it for mine. The hitch is that it’s off-label testing. It’s probably not covered by my supplemental insurance or the province. And the test is $5000 (Canadian).* And probably, I don’t have a mutation for which a specific genetic treatment has been devised. But the test may yield information that is useful in the future, and there’s a small chance it will be useful now. There’s also a small chance that the cancer in my lungs isn’t the same mutation as in my neck, but it’s so small that the test is still worth doing. Getting the tissue out of my lungs, given the size of my thorax and the placement of the tumours, is risky procedure, so that’s not on the table since the Lenvima seems to be working and I’m not super excited about exploratory lung surgery for curiosity’s sake.

So yes, I am about to spend $5000 on a test whose benefits are probably theoretical. But I’d rather know than not know. I think what my oncologist said to me when I asked him about genetic testing is probably still true: that whatever we find out, my treatment will still be the same.

*Insert joke about “available somewhat later in Canada.”

**The title is a reference to Jeans, Jeans, Jeans, a Montreal store where you go in, they look at you, and pull a bunch of jeans off the shelf that fit you perfectly. Or, if not, they’ll be a size too small so you’re not insulted.