Vocabulary Lesson, Part 2

Building on my earlier Vocabulary Lesson post, I have some more advanced vocabulary here. It’s a little technical, but it helps to spread some knowledge around that better reflects the state of what cancer patients go through today.

Prognosis – this is the third rail of conversation with cancer patients. Conversationally, prognosis means what physicians predict what is going to happen to the patient, and when. However, physicians know that they are terrible at this, and good doctors will refuse to give prognoses all the time. I have heard a lot of cancer patients complaining that when (probably well-meaning) people ask about their prognosis, they feel like they are looking for the “expiration date” that must be stamped on them somewhere. You know, like the perfectly nice person I see in the grocery store who brightly says, “But your prognosis is good, right?” Or the hairstylist who says, after I explain why I lost all my hair, “But everything’s good now, right?” Or the other hairstylist … what is it with hairstylists?  Maybe I’ll write a whole other piece about this one, but the bottom line is that no one can predict what your prognosis is because surprise is always part of the picture. I can tell you what the median survival time is for patients with Stage IV breast cancer, but that won’t tell you much about my case.  I offer this as the only topic to be avoided with cancer patients.

First Line/Second Line Treatment – this was a new one to me, but it’s extremely important. The First Line Treatment in chemo is whatever your oncologist puts you on first, usually according to whatever the clinical guidelines tell him/her to do. When that appears to be not working anymore, because cancer finds a way around most treatments, s/he puts you on the second line treatment. In Ontario, the government funds two lines of treatment, so the decision to switch from one to the next takes on a lot of clinical significance.  If I’m reading the NCCN guidelines correctly, the largescale data says that there’s no additional benefit to treatment beyond 2 lines of therapy, so this is Ontario’s reasoning.  It also takes on emotional significance for the patient, who may be known to say things like, “I failed Ibrance after 8 months”! But never, “Ibrance failed me.” Discuss amongst yourselves.

Targeted Therapy – not all treatments are chemotherapy. Increasingly, cancer patients on targeted therapies that aim to interrupt specific traits in cancers, such as proteins or hormones, rather than attacking all cells, as chemotherapy (cytotoxic) drugs do. For example, for HER2-positive patients like me, who are between 15-20% of breast cancer patients, we are likely to get Herceptin and Perjeta, which are HER2-targeted drugs, at some point. These drugs are considered very good and have dramatically increased the prognosis of patients like me.

Second Opinion – this is also a funny one. A second opinion is when you go to another professional to find out how they see your case. I learned from experience that second opinions are often verboten in Canada because why would you imply that you weren’t already getting the best possible treatment in our amazing OHIP system? The tricky part is that I am American, and my family still resides in the U.S., where second opinions are basically required of everyone and if you don’t get one you might as well announce to anyone who will listen that you don’t care about your own health or the quality of your care. This is one of the many subtle differences between Canada and the U.S. that are very easy to overlook until you bump right up against them. Yeah, more on this one later, for sure.

Back in December, there was a lot riding on my laparoscopic surgery.  You see, I had this growth that was showing up in my pelvis, and no one could say for sure what it was unless we got a sample to the pathology lab. Was it cancer, showing that something new and dangerous was growing in my torso? Or was it just one of those things that grows in your pelvis? An attempt at an ultrasound-guided biopsy did not work out, but if it proved to be cancer, then we would have to move from a first-line treatment to a second-line treatment. So I had my ovaries removed — as one does — and learned that the growth was actually just regular benign fibroids, so I get to stay on my first-line targeted therapy, for now.  Woo-hoo.