A diagnosis of sorts, and a prognosis. Rather quickly after my PET scan on Friday, the liaison nurse phoned with a summary of the findings (we said it was OK to talk about it over the phone).
It's ain't good. Although it's still unclear where the cancer started - there's no major primary tumour they can see - it has spread to a number of my chest and neck lymph nodes. To summarise: it's looking strongly like 'CUP' (Cancer of Unknown Primary), which is bad news. It's difficult to target chemotherapy, which works best when the origin tissue is known. And anyway it's already got to the metastasis stage (that is, considerable spread from the original site). We're not talking about a cure, and (as far as can be judged at this stage) the prospect of five-year survival is low. I've been given an appointment with an oncologist on Monday to get a more detailed assessment, and to talk about palliative chemotherapy and radiotherapy.
It's a major blow, but one not unexpected. I knew full well what the lymph node involvement was likely to mean, and the picture has become clear both from the direction the investigations were taking, and what we were being told. Yet I feel physically fine; the "D.O.A." tattoo (which will be safely healed by the time I go for chemo) is as grimly apt as I had suspected it would be.
Irene was very upset at the news; I felt a little tearful, but more about making her unhappy than for myself. Now, a few hours later, I feel settled: not because of being "brave" or unfeeling, but because I've become optimistically stoical over recent years. That is, I'm by no means a cheery person - in fact many people think I'm outright gloomy - but that hides an essential belief that life is not out to get me, and that there are always possibilities and new experiences around the corner.
That world-view is helping me immensely at this pretty awful moment. Irene and I know a number of people whose lives are limited, poisoned even, by the most toxic kind of pessimism that makes tragedies of old good experiences and rejects the prospect of new ones (a kind of "my dog died in 1970, so I never got another one" attitude).
A lot can happen in five years, or even a year if it should come to it.
- James
