Anyone living along a coastal area knows about the cone of uncertainty. These are widely ranging swaths of land that lie in the projected path of a hurricane or typhoon. The cone starts small, at the point of landfall, then widens exponentially to include every blade of grass or bird that could possibly be impacted by the storm event.
At one point prior to Hurricane Ike the weathermap showed IKE sucking up heat as it moved across the entire Gulf of Mexico, then striking the Houston Ship Channel and barreling up a narrow corridor until it landed directly on my house. I was sure of that. This was not a happy moment. I crawled into the bathtub with the dog and ate almonds and chocolate while the storm ripped all the leaves off the trees for miles around and anniliated large sections of beach and homes in Galeston, which suffered the most devastating damage.
Hurricane Ike's Cone of Uncertainty
This came back to me again because I've been living in a cone of uncertainty for the last month or so. My thoughts darkened. I felt like I was sheltering in place, treading water, as I waiting for results from tests and as importantly, learning what those tests meant in the context of my life, my health. This is especiallly important in cancer, where an errant fact might look bad yet fit in a cohesive narrative on an indivual level. From what I knew? I could be in trouble. Or not. And I wouldn't know the answer for a number of weeks.
At the end of October metastatic breast cancer was found in the lining of my stomach. My oncologist had ordered an endoscopy to check out my gut's workings when I continued to lose weight and suffer from bouts of nausea and vomiting without rhyme or reason. None of these episodes could be related say, to a batch of minor food poisoning or a 24-hour virus running through the community.
Metastatic lobular breast cancer, this little darling of a breast cancer I have (only comprising from 10-15 percent of all breast cancers) can weasel its way anywhere, sneaking along through the lymph system and even wedging between the lining of the stomach and the muscle. When my oncologist explained this yesterday, drawing a decent stomach, esophagus and upper intestine, he penciled in how the cells line up between the two layers. From there it was a mental skip and a jump to grasp what is described medically as a "plastic-type" presentation. As the cells accumulate the stomach itself becomes more rigid and and lead to the symptoms I've been experiencing.
But the stomach mets did not represent progression. No progression. In cancer land there's no better music to one's ears. The stomach mets were mostly likely present when I was diagnosed with metastatic disease in April. These would not have become apparent on CT until they formed tumors and given the symptoms I've already had, I shiver to imagine how ill I would have been by then.
So the good news definitely is no progression. The obvious news is learning to live with a stomach that's been damaged by cancer. Some, but not all, of the damage will ease as Femara continues its work. An aromastase inhibitor, which works by blocking the enyme that allows androgen to convert to estrogen, Femara has done remarkable work in my system in six months, nearly knocking out the extensive lymph node involvement I presented with. This is like removing the tree trunk from all the limbs. The more we continue to shut down the feeding system, the fewer malignancies -- like these monsters creeping along in my stomach -- will be there to find.
In the meantime my disease falls back into the manageable, chronic category. If I continue to take the daily medicine I could be fine for many, many months. I'll have scans again in eight weeks. But no one is a fool, either. There are some indescriminate lesions we want to remain boringly, indescriminate. We want them to stay as boring as they are now.
I'll watch, yes, I'll be mindful, but I certainly am not qoing to stick around and wait for trouble. No one can say when the next inevitable progression or drug resistance will occur, when the cone of uncertainly will hover again. All of us know that cancer can change its mind in a moment, fake out your immune system, and even recruit a few buddies to help its do its dirty work. We do what we can. Stay rested, eat well, exercise. Don't give the creeps an inch.
I felt hope growing yesterday, small, but true, and deep.
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