In Cancerland, we often employ terms that help us define our situation in dealing with this disease. Such terms gives us a sense of focus, balance, and hope. The most used term is “cancer warrior.” By employing combat/military terminology, we see ourselves as battling a fierce foe - one that is cunning, baffling, powerful.
Of course, we’re not alone in this battle. We have cancer teams composed of oncologists, surgeons, and nurses. And we are provided with weapons to engage the enemy- surgery, chemotherapy, radiation, immunotherapy, and personalized medicine. Another weapon is our spirit - one in which spirituality and/or faith play a central and powerful role. Spirit is, I think, the underlying force of identifying and defining oneself as a cancer warrior. In this sense, our bodies are a battlefield. We go through surgery. We go through treatment. The effects of that battle leave indelible scars on our bodies, and treatment leaves long-lingering after-effects and PTSD. We’ve survived cancer but it’s with a future that is uncertain. As cancer veterans, we live a life in which we are cautiously optimistic. In any battle, the objective is to beat the enemy. But beating the enemy doesn’t necessarily mean annihilation of the enemy. It means eradicating the enemy from the present battlefield. The enemy has retreated but lurks elsewhere. Even after cancer surgery, it’s estimated that over a billion cancer cells continue to circulate in the body. So, the cancer is never really gone. It doesn’t mean that The Beast will come back. But the opportunity is there and cancer is all too often an opportunist. Given the right conditions, cells can gain a foothold on another organ and metastasize into a deadly colony. I have first-hand knowledge of this when rogue cells invaded the left lobe of my liver, thus commencing my second battle with The Beast via recurrence. At this point, it appears that I’ve “won” my second battle with cancer. But the war is far from over. I still have three years on my high-risk surveillance program- three years of semi-annual CT scans with lab/blood work and annual colonoscopies. And that brings me to why I decided to write this article. Quite often when I write something, it’s a response to something I’ve read. Such is the case with “The Problem With The Phrase 'Beat Cancer'” by Brittany Wong. Wong writes about telling her now deceased father, a Stage IV terminal pancreatic cancer patient, that he could beat cancer. Of course, there wasn’t any way her father could beat cancer at that stage of his illness - he was at the end of his journey. In retrospect, Wong writes: “The idea that you can “beat” something as insidious as cancer perpetuates the myth that the patient is wholly responsible for their recovery, not a human caught up in an endless cycle of surgeries, chemotherapy, radiation and relapses. And if they don’t beat it? That’s failure.” Wong’s article is yet another part of a larger conversation regarding the use of combat/military metaphors in Cancerland. In this case, telling a terminal metastatic patient that they can beat cancer implies there is hope in overcoming cancer at a point when it is incurable. At that point, there really isn’t any hope. There is no longer a fight or battle. With Stage IV advanced cancer that is terminal, one cannot conquer death. Stage IV cancer isn’t necessarily an immediate death sentence. Stage IV is defined as advanced or metastatic cancer. Some people may be initially diagnosed with Stage IV cancer. They already have incurable cancer that has spread through their body. Depending on the type of advanced/metastatic cancer, a patient undergoing chemo or radiation may live for several days, months, or even for a few years. Treatment doesn’t cure their disease, rather it extends their survival. Newer therapies like immunotherapy work in combination with chemo and/or radiation to extend life. However, immunotherapy is only available for certain individuals with certain types of cancer. And immunotherapy may or may not work. Some individuals may progress into Stage IV from their previous stage(s) of cancer. In my case, in 2016, I went from Stage I to Stage IV as a result of recurrence to my liver. Fortunately, my recurrence was limited to the left lobe of my liver. Technically, my cancer was oligometastatic meaning a single metastases had occurred to my liver. Oligometastatic is defined as a single or only a few metastases to an organ. My oligometastatic cancer was treated with metastasectomy surgery to the left lobe of my liver where the metastases had occurred. Treatment included neoadjuvant and adjuvant chemo followed by a 5-year high-risk surveillance program. What is unusual about my metastases is it occurred three years after my surgery for Stage I colon cancer. Unusual, yes, unique, no. The 5-year survival rate for Stage I colon cancer is 93%. Which means that 7% of survivors can develop metastases that can, in time, be fatal, or could be potentially curable if the metastases is caught early and treated with a metastasectomy and chemo and/or radiation. At this point, I have been a survivor for 5.8 years with a Stage IV survivorship of 2.7 years. As a 5+ years as a cancer survivor, I’m a realist. Even if I reach the 5-year survival mark that technically makes me cancer “free,” I don’t think I’ll ever say that I beat cancer. There are too many intangibles involved that prevent a total victory in becoming cancer free. I can, however, say that I’ve beat cancer another way. Aside from doctors and medical procedures, the only thing I’m really bringing to this battle is my spirit. And, that’s one thing that cancer will never beat. I realize that ultimately cancer could beat me. But it won’t beat my spirit. And, I think, that’s what beating cancer is about. Certainly, it’s about overcoming the medical obstacles, but it’s also about one’s strength of spirit. Perceiving myself as a cancer warrior and using associated metaphors doesn’t give me a sense of false hope. I know what my odds are. Perhaps more importantly, being a cancer warrior gives hope and courage to others who may, at some point, engage this disease or those who are already engaged with cancer. Being a cancer warrior is about the strength of spirit and soul in facing fierce foe. We are the storm.
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Robert Desjarlait
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