I was six months pregnant when I got a message from my doctor saying he needed to see me right away. I soon found myself in his office, tapping my foot. Finally, the nurse ushered me in. My doctor asked politely about the family and then got to the point: I had cancer. Well, a little bit of cancer. My annual pap smear had revealed pre-cancerous cells on my cervix, probably caused by HPV (human papilloma virus), a common virus that in most people causes no symptoms, but in some can lead to my predicament. I was scared – without medical intervention I might be looking at cervical cancer down the road.
My doctor assured me I would be fine; but I had to have a colposcopy (see “Know the Facts,” opposite) and then a cauterization procedure called a LEEP, or Loop Electrosurgical Excision Procedure. I remember wondering if I should be upset, since it was a relatively small procedure and the abnormal cells had been caught early. Since I was six months pregnant, I went with “upset.” When I called my common-law partner, I was in tears.
Cancer is a word that terrifies; even just a little bit of it. But the truth is, there are hundreds of forms of cancer and not all of them are lethal. Some of us will die of unrelated causes in old age carrying cancer somewhere in our bodies without ever knowing it. In this sense, “cancer” refers more to the behaviour of certain cells than it does to the bigger picture of disease.
It’s important to make these distinctions, says Dr. Jay Easaw, an oncologist with Calgary’s Tom Baker Cancer Centre, not just for doctors but patients. Dr. Easaw treats people with potentially lethal brain and gastrointestinal cancers. “The distinction is important,” he says, “Because once it becomes invasive it can kill people. These are the things we want to get on top of and treat, because down the road they are much more aggressive.”
Oncologists now talk of in situ cancers, which people are more likely to die with, than die of. Doctors are more often calling some types of prostate, thyroid and breast cancers “high-grade dysplasia.” Ductal carcinoma in situ, or DCIS, for example, accounts for one fifth of breast cancer cases. But it has been removed from the official list of cancers by the medical establishment, because it is an accumulation of abnormal-looking cells in the milk ducts. It does not appear as a lump, but as a collection of weird cells in an x-ray. DCIS can be treated with surgery and radiation therapy, but some experts say that these treatments may be unnecessary.
When they hear the dreaded C-word many people want to get rid of the deadly passenger. Another name for what I had is “cervical dysplasia,” which – to me – sounds a lot nicer than “pre-cancerous cells.” The latter sounds like it was time to start writing a bucket list. “Dysplasia,” on the other hand, sounds like my cervix went for a stroll without a map – all it needed was a nice old lady to bring it back home.
I sometimes wonder: should my doctor have told a pregnant woman with a collection of abnormal-looking cells that she cancer? Yes, says Dr. Easaw. “The terminology is important because it’s more accurate,” he says. “We need to know these things because they tell us what the risk is. High-grade dysplasia, if untreated, has an increased risk of becoming an invasive disease. It’s necessary for the patient to know that treating it is important.”
And it’s important to remember how we can make these distinctions at all – because of innovations and advances in cancer diagnosis and treatment. Dr. Easaw says he personally has witnessed an explosion of new treatments in recent years. “The field is pushing forward so fast,” he says. “We have surgeons who are able to give previously deemed incurable patients a chance. Rules about who could and could not be saved aren’t rules anymore.”
There have been advances in treatments, too, such as drugs that work in conjunction with chemotherapy to thwart the growth of the blood vessels that supply the tumour with nutrients and allow it to grow. A physician may be more likely to follow than treat some types of prostate cancer. Some agencies that monitor cancer now exclude 74,100 non-melanoma skin cancers because they’re localized, non-life-threatening abnormalities.
I wouldn’t say I’m a cancer survivor. That would be disrespectful to people who’ve had to quit work and suffer months of painful treatment in order to save their lives. There was some courage involved in my own experience – I had to wait until my baby was born before I could undergo treatment – and the LEEP procedure was, personally, a very emotional experience. But ultimately I spent one morning in the hospital, and then I was cancer-free, with no expectations of a recurrence, by that afternoon.
“It’s good you got the LEEP procedure,” says Dr. Easaw. “My own belief is that the more people who are aware of these possibilities, the better off we are. In your case you had a chance at a cure – a great thing. The best way to cope with cancer is to never have it.”
Know the facts
DCIS, or ductal carcinoma in situ is cancer that starts inside the milk ducts of the breast.
In situ means “in its original place.”
A colposcopy is a procedure that a gynecologist can do in her office. She puts acetic acid (vinegar) on the cervix and looks at the cervix through a machine called a colposcope. The acetic acid makes the abnormal cells on the cervix look white and the doctor takes samples of the whitest areas to send them to the lab.
Cervical dysplasia is abnormal growth of cells on the surface of the cervix. Doctors classify it as low-grade or high-grade. Low-grade cervical dysplasia progresses slowly, often resolving by itself. Without treatment, between 30 and 50 percent of cases of high-grade cervical dysplasia progress to invasive cancer.
HPV and cervical cancer: Many people have a common infection called HPV. For unknown reasons, a few women infected with HPV will develop cervical dysplasia. See page 38 for more information about HPV.