Yesterday I traveled to San Antonio for a visit with my gynecologic oncologist for a follow-up to my hysterectomy that occurred July 1. The original intent of that surgery was to remove my “lady parts”, including a problematic left ovary, but quickly became an all-out hunt for cancer.
When I arrived at the doctor’s office yesterday morning, I obtained a copy of the pathology report documenting what was discovered during surgery, and the results of studies that were conducted on tissue samples harvested during the surgery. Some of what the report contained, I already knew: the cancer was Stage IIa, and all tissue samples, including lymph nodes, were negative for malignancy. No surprises there.
G3 & LVI
As I sat in the waiting room, reading the report, there were two findings it contained that I wasn’t expecting: the tumor was Grade 3 (G3), and I learned a new phrase – “lymph-vascular invasion”.
On the surface of it, “G3” can be bad news. Depending on the kind of tumor, it can mean that the cancer is of a molecular structure that is fast-growing. Reading that in the waiting room, with no one there to ask for clarification, I got pretty rattled, especially after I looked up on my iPhone what was meant by Grade 3. I’ve got to put that rubber band on my wrist and snap it every time I head to the Internet to look up medical stuff!!
When I got in with the doctor, I asked him what I should’ve waited to ask in the first place: What does Grade 3 mean for me? If I HAD waited, I would’ve found out that the grading of tumors in ovarian cancer isn’t nearly as much of an indicator of prognosis as staging is, and the stage of my cancer, at IIa, is good. He said the grade is useful for formulating the chemotherapy I will receive, and that’s about it. Now I know there is not only a stage of cancer, but also a grade.
As for “lymph-vascular invasion”, which was reported in my case as being “present”, he again said not to worry about that. I was confused, because the report stated that there was no cancer found in any of the many lymph samples that were submitted, yet there is “lymph-vascular invasion”. I have arrived at an understanding that LVI means cells are present in the blood stream and lymph system; however, in ovarian cancer that apparently isn’t a real big concern, and chemotherapy should take care of it. In uterine or cervical cancer, it is a big deal, but not ovarian. This may or may not be something I choose to learn more about; for now, since I was advised not to worry about it, I won’t worry about it.
So, we know what the outcome of the surgery was; the experience of having undergone the surgery, and my understanding of what happened during that time, is remarkable to me in many ways.
WHEN MAN PLANS, GOD LAUGHS
The original surgery was planned as a conventional hysterectomy. The procedure was to be laparoscopic and robotic, and last about an hour. Things changed when, in the course of that procedure, cancerous tissue was discovered. At that moment, the whole protocol of the operation shifted – from laparoscopic/robotic to conventional surgery, including a real incision. Suddenly, there was much more work to do.
With the discovery of cancer, the emphasis of the surgery changed from removing the female apparatus to ridding the area not just of cancerous organs, but conducting an almost microscopic scrutiny of every square inch of my entire abdominal region. Indeed, the surgeon launched into a rigorous search for any more cancer, and focused on obtaining more than 20 tissue samples for biopsy, to detect any spreading of the disease.
True to the surgeon’s mandated protocol, everything that could deliver a tissue sample for testing was clipped – every lymph node, the bladder, the abdominal wall; everything left inside was examined, inch by inch, bit by bit. There was a peritoneal wash that was analyzed for cancer cells. The surgeon paid an astounding degree of attention to every last molecule of my abdominal area and all of its contents. As a result of all of that scrutiny, it was clear that the visible cancer was limited to parts that were removed, namely, one ovary and related fallopian tube. As I would learn from the detailed 14-page report, everything else came back negative for malignancy.
As a side note, my surgeon is a type of specialist I’d never heard of before – a “gynecologic oncologist”. I recently read a piece in the NY Times which said that because many women go to traditional gynecologists for their “female” surgery, when cancer is discovered they may not get the thorough removal and sampling for biopsies from which I benefited. I feel confident that, had my surgeon not been trained to recognize the cancer and know what to do when he did find it, I might have a very different path ahead of me.
BACK TO THE FUTURE
As I look forward to my time with the good people at MD Anderson next week, I also look back. I have been through a lot over the last two months; my life has been changed forever. I am so deeply and humbly aware of how much love for me there is, and with that my heart is full and my spirit is peaceful. I am right where I am supposed to be.