The Battleground Emerges

Today’s conference with my surgeon produced both good news, and then disturbing news which then led to the outline of a battle that I hadn’t quite predicted.

First, the very good news. The cancer appears to have been contained within the uterus. There was no evidence that it had spread to any of the surrounding tissues in the abdomen, it had not gotten into the Fallopian tubes or ovaries, and it was not present in any of the lymph nodes that were removed. Because of that, it was classified as Stage I-C.

Now some of the rest. The type of cancer (undifferentiated uterine sarcoma) is relatively rare—though they did not define exactly what type it is. What it isn’t is one called leiomyosarcoma (that’s for those among you who might recognize what that is). But what it is, is a cancer that can spread aggressively by the lymph or blood system, and if by chance some of it is left behind, would pop up in another part of my body.

There were two additional concerns. The first is that my uterus was apparently only about 6mm thick—about ¼ to 1/3 the usual thickness. The cancer had invaded about 4mm out of that, so 2/3 of the way through. That left only 2mm of uninvolved tissue between the uterus and its surroundings—apparently the minimum that would be seen as reasonably safe. The second concern is that although the surgeon took the normal size sections from the lymph nodes in my abdomen, only 4 nodes turned up for testing. And there were no nodes that could be tested in the aortic samples she took. So that verification is less than certain.

These uncertainties are the reason the Tumor Board recommended followup treatment—most certainly with chemotherapy, to minimize the potential for the cancer to spread, and possibly followed with targeted radiation, to take care of anything that might have been left behind.

And now the battleground. It may be likely that Group Health will be more conservative in what they are willing to support than this group of physicians. At least that's been their experience with people in my kind of circumstances. So the battle is how to get the treatment that they believe I should have, to give me an added margin of safety for nonreoccurance.

And that’s where my focus will be in the next couple of weeks. I’ll be starting on it in the morning. Meantime, I celebrated my overall good fortune by having my first Manhattan in two months!