'Did you ever go clear?' Leonard Cohen
So last week I got the results of a CT scan - my seventh since I was diagnosed with bowel cancer in October 2010
. The tumour was surgically removed, but because it had grown through the bowel wall and invaded a single lymph node by the time symptoms had become become apparent, there was a strong chance (about 60%) that it would appear elsewhere.
As long as bowel and many other cancers are diagnosed early enough, it isn't the original tumour that kills you (and you aren't 'cured' when it's removed - XKCD has a very good explanation
of this). No, it's most often the secondaries, created by metastasis. In the case of bowel cancer, these usually appear in the lungs or liver. Presenting not as lung or liver cancer, but proliferating nodules similary to the primary tumour. The problem is, doctors can't yet detect cancer cells floating free in the blood or lymph. That's why, after surgery, I was treated with chemotherapy: infused every two weeks or so with a carefully calibrated cocktail of chemicals that killed off dividing cells (before every treatment, you're weighed like a prize fighter). It's rather like napalming a jungle to get rid of a few pesky insurgents. You don't know that they're there when you strike; you can't be certain you've killed them afterwards; you cause a lot of collateral damage. Most cells in the human body are eventually replaced by new ones; epithelial cells and cells in the marrow, generating various kinds of blood cells, amongst others, proliferate continuously. Until, that is, they are blasted with cytotoxic chemicals. During my treatment, blood platelet and white blood cell counts plummeted; I developed mouth and tongue ulcers, and various digestive upsets as cells lining my GI tract died and sloughed away. Other side effects included fatigue, memory loss and cognitive disfunction (chemobrain); I've been left with peripheral neuropathy in my feet and fingertips because one of the drugs, a platinum compound, attacked my sensory nerves. I also suffered side effects from the steroids and other drugs pumped into me to counter the side effects of the chemotherapy - although at least I was never stricken by nausea.
Oh, and I can't drink coffee now. So it goes.
Every six months, I was scanned: photocopied by multiple X-rays which were assembled into a 3D image and carefully examined to discover whether or not secondary tumours were growing elsewhere. You quickly get used to the minor ordeal of being infused with contrast dye and fed through a giant white doughnut that sounds alarmingly like a washing machine about to spin itself to fragments; you never get used to scanxiety, a clumsy but highly accurate neologism for the state of mind endured before the scan, and afterwards, while you wait for the results. Kind of like jumping out of a plane, and then waiting a week or so until you know the chute is going to open. Or not.
I've been lucky. Each scan has been clear; the latest is also clear, and hopefully will be my last. After three years, the statistical chance of secondary tumours arising in liver, lungs, or elsewhere is hugely reduced. I'll continue to have blood tests for a tumour marker, but if all goes well I will no longer need to be photocopied.
I'm not cured, of course. That milestone is declared after five years, although it's a notional date; there's still a small chance that the cancer could return after that. And after you've survived cancer you are in a different place. You've been betrayed at a cellular level; you've been rudely and violently confronted with your own mortality; you've undergone several years of anxiety and uncertainty and extremely high vigilance, worrying over small aches and pains that beforehand would have gone unremarked. You've changed. But after a war fought on your behalf, with your body as a battleground, you have survived. You can begin to make long-term plans again. You can take up your new life.
It's a good feeling.