23 NOVEMBER 2007
SO HAD MY CANCER SPREAD PART 2
Concluding an account of her breast cancer diagnosis, Christa D'Souza describes the agonising moment when a surgeon revealed the results of her biopsy, and how, after seeking a second medical opinion in the US, she had to choose between a harrowing course of treatment or letting nature take its course…
Two weeks ago, I thought I was dreaming when I was diagnosed with breast cancer. I had found a teeny, tiny lump the size of a large grape seed back in July – and done nothing about it until a girlfriend who had been diagnosed with the most severe kind of breast cancer persuaded me to get it checked out.
Off I went, courtesy of my private health insurance, to see consultant surgeon Tena Walters at The London Breast Clinic on Harley Street. She was sorry to have to tell me, she said, that the lumpectomy revealed the tumour was malignant.
So here I am, being wheeled down to the operating theatre for the sentinel lymph node biopsy which will tell me if the cancer has spread.
Mildly euphoric from the pre-med, I feel overwhelmed with gratitude for the care I am getting. Would it have been like this on the NHS?
Would my very nice but rather harried local GP have had me treated as quickly? In the triage scheme of things, wouldn't my teeny, tiny lump, which didn't even register on the mammogram, have been put at the end of the queue?
When I come to, I'm sore, with drains coming out of me and I have "blue tit" (from the biopsy dye), but otherwise I'm OK.
Miss Walters has removed some more breast tissue and four of my lymph nodes to check the cancer hasn't spread. Nick, my boyfriend and the father of my two young children, is at my side when I wake up.
He offers to give away the England v Russia tickets he's got for that evening so that he can stay with me, but I shoo him off.
He may have plenty of chances to forgo football in the future, and besides, I just want to sleep.
Back at home the next day, I am unable to concentrate on anything other than the following Tuesday when we will get the biopsy results. Nick has to go away for work, and because I don't want to be on my own, I decide to go with the kids to my sister's in Somerset.
Poor her. The moment she meets us on the driveway, I realise how much harder it is for others than it is for me. To lighten the atmosphere at dinner, I tell her about the routine Nick and I have got going: every time he so much as asks me to bring in a bag of shopping, I say, "Sorry, can't, got cancer." We've decided I should milk it for all it's worth at home. It sort of works.
Inside, I'm feeling less buoyant. We 21st-century humans think we're invincible and then something like this happens. In a way, being so aware of one's mortality is quite a good thing.
It stops one from living life as a long dress rehearsal; forcing you to do it now in case tomorrow you can't. In another way, it is almost too vivid to bear. I keep hugging my kids and telling them I love them, which I know they are beginning to find slightly annoying, but I can't help it. Thank God it is me and not one of them.
In moments like these, I need to talk to people who have had cancer, and who have come through it with flying colours.
One such person is Jo Malone, the scent tycoon, who was diagnosed with grade-three breast cancer six years ago. Jo's positivity seeps through the mobile as I hear how gruelling her experience was and how she got through it.
She tells me how she wasn't allowed to wear an ice cap to prevent hair loss during chemotherapy (her doctor forbade them because they stop the chemo from reaching the brain where other tumours could potentially form), so she lost it all, but it grew back again, thicker and curlier.
When she was first diagnosed, she was given three months to live – and look at her now.
The other "bosom buddy" I have made is Louise, wife of the jeweller Theo Fennell.
Like Jo, Louise, who is 50, had a bilateral mastectomy and six years after being diagnosed with cancer is absolutely fine.
"Welcome to the club that no one wants to join," she cheerfully said when I first called her, explaining that she is one of a group of glam London women who get together every so often for lunch, to have a laugh and "compare each other's reconstructions".
Listening to these women's stories makes me feel somewhat sheepish about my comparatively minor problem. As Jo reassuringly puts it: "Sounds to me like you've got the good kind of cancer. I bet you'll be fine."
So many people volunteer to go with me to get the results the following Tuesday. I am touched beyond words by their offers to drive hundreds of miles, get on a plane, cancel dropping off the kids at boarding school and so on in order to hold my hand.
But I want to do this by myself. I know it is really hard for Nick, who has to be in China, but I am glad he is away. If the news is bad, I don't want the responsibility of having to deal with anyone's reactions but my own.
Miss Walters is standing behind her desk and smiling. She is delighted to report that it hasn't spread; my lymph nodes are clear and so is the breast tissue. In other words: I did have cancer and now I do not.
The news that it has not spread is so wonderful it is almost disappointing. How can all of this have happened in such a short space of time? It's almost like I need a few days to adjust to my new role of non-cancerous person. I call my mum first.
She has been waiting by the telephone, and the relief in her voice makes me realise again just how much harder this little "adventure" has been for my family.
Two weeks later, and I am eating lunch in a restaurant, having just been injected with another lot of gunk, this time radioactive.
In three hours' time, after the gunk has permeated, I will have a bone scan, one of a battery of tests my fabulous oncologist, Dr Maurice Slevin of the London Oncology Clinic, has recommended – not because he thinks he will find anything, but because he wants a "base line" from which to monitor any further problems.
Using something called the SEER programme (an American database that has been monitoring women with cancer since the 1930s), Dr Slevin calculates that I have just a one per cent chance of that same cancer recurring either in my breast or anywhere else in my body.
I could, he explains, make that a 0.25 per cent chance by taking the oestrogen-blocker Tamoxifen for a couple of years, but the negatives (side-effects include early menopause, weight gain, depression and a tiny chance of uterine cancer) outweigh the positives.
If I were his wife, in other words, he would probably not recommend it. That said, he'd be a little "anxious" if I didn't have some radiotherapy.
However, the radiotherapist to whom he sends me at The Harley Street Clinic says she'd be happy for me not to have it. Of course, I can have it if I want it, she says, but I should know that, having had implants three years ago, it could cause encapsulation (when they go hard), it could discolour the skin, and there is a minuscule risk it could cause cancer.
I'm inclined to go with this advice. Having the treatment for my tiny tumour that I detected so early seems like a bludgeoning, unnecessary move, akin almost to the 1960s and '70s practice of whipping off breasts the moment cancer was diagnosed. So, for the moment, I decide to do nothing.
Am I being irresponsible? I don't think so. After all, Dr Slevin is always going to keep an eye on me, referring back to my base line. In a way, I feel like one of those extremely rich, lucky people who have their own personal medical teams. The moment the tiniest thing goes wrong, my "team" will be there to catch me.
And yet, there's a little voice inside that says I cannot leave it there. I trust my team implicitly but don't I owe my children a second opinion?
Before taking on an assignment in New York, therefore, I find myself going through the long and expensive rigmarole of registering for an appointment with a doctor at the Memorial Sloan-Kettering Cancer Center in Manhattan ($3,000 [£1,480] up front for a second opinion only, no medical insurance accepted).
I hate the fact that I am going to the States for the last word – it makes me feel like a traitor. But in a way, I am not doing this for me so much as for my family. And as a friend who has been down this route points out, the US does have a better record for cancer treatment: 88.5 per cent of patients survive at least five years, compared to 80 per cent in the UK.
"Why on earth would you want to do that?" asks the New York doctor when I tell him I've decided against radiotherapy. As he is saying this, he is calling a radiotherapist somewhere else in the building who, he says, will reiterate the same sentiments if I don't change my mind.
According to the doctor, from the records he has in front of him, I have a 40 to 50 per cent chance of getting cancer in that breast again without radiotherapy. As for Tamoxifen, he says, if it was his wife, there is no doubt she would take it.
That's as maybe. But I need to weigh a few things up.
I need to ask myself whether I am prepared to have all this medication pumped into my body and experience side effects when I may not actually need to. If the risk of distant metastasis (breast cancer cells cropping up in other parts of the body) occurring is four per cent without Tamoxifen, it is two per cent with.
There is no way of knowing at this point, either way. As my oncologist in London pointed out, we have concrete proof that cancer can exist quite happily in my body.
As for keeping a constant check with MRI scans, the doctor explains that cancer sometimes doesn't show up until it is far too late.
Softening, slightly – for he is very stern – he says I should try it. If the idea of taking Tamoxifen for five years is intolerable, then we can review the situation.
But I have made up my mind. Yes, it's true that the Sloan-Kettering has an aggressive policy towards cancer treatment, and that American medicine is fee-based and therefore more proactive, but as I walk down 57th Street, I think of all those tiny breast cancer cells which could be quietly yet industriously developing in other parts of my body, and I imagine the way I'd feel in five years from now, if I'd known I could do something to halt their progress and hadn't. I contemplate, too, the idea of my children without a mother.
So has my life changed? Well, of course it has. But not in quite the way I thought it might.
Yes, I now use one of those crystal, aluminium-free deodorants instead of a spray-on one. I drink green tea every morning (its antioxidants protect cells from cancer).
I try not to incinerate meat (burnt food contains carcinogens), and I have made a fairly valiant effort to cut down on alcohol (two small glasses of wine a day increase your risk of developing breast cancer by 12 per cent), but that is as far as it goes.
As another former cancer patient put it when I told her I might go on a retreat where they wean you off coffee, alcohol and cooked food: "Don't the words 'stable', 'door' and 'bolted' come to mind?" Besides, when I start taking Tamoxifen, I may not feel like drinking alcohol anyway.
It is psychologically that things have changed most. It is hard not to define oneself by one's cancer, to put it before everything else, to assume that every lump, bump, sniffle or cough has got to be the disease returning.
Take the sinus infection I had last week, the likes of which I haven't had since I was a teenager – could that be a signal?
One person who understands this feeling only too well is Kylie Minogue, whom I happened to interview recently. Having beaten the disease herself, she remembers only too well being up on stage in front of 12,000 people one night with a raging flu bug and having that terrible sinking feeling that it might be coming back.
Meanwhile, having not wanted to tell anyone about it at first, I now find I want to tell everybody – the milkman, the paper boy, the check-out girl – not so much to garner sympathy, as to spread the message, as it were.
My pedicurist, for example, tells me she has found a little lump and has booked a doctor's appointment. I find myself hectoring her in a most unseemly way about not cancelling and then making a mental note to call her to check she went.
Early detection is what saves people and I'll be damned if I'm going to shut my journalist's mouth about that.
Being such a Princess and The Pea about my body, I'm not looking forward to the Tamoxifen. Fat and depressed? Who wants that? I'm not looking forward to the fatigue you're supposed to get after radiotherapy, either.
But fat and depressed and tired and alive is better than the alternative.
Every cancer sufferer will tell you this: the disease definitely has a silver lining. It forces even the most disengaged, forward-planning of us to live in the present; the most arrogant of us to be humbled.
It rams it in good and hard, too, just how precious those around you are, how even though you may have your differences, you need them, and how in the end, it's not about being right anyway, it's about being happy.
Let's not forget its usefulness socially, either. Tonight, for example, we've got a late after-theatre dinner. If I suddenly feel like opting out, well hey, I've got a great excuse, haven't I?
Occasionally, I bore myself with my new happy-clappy, relentlessly chirpy outlook on life, but only very occasionally.
I'm by no means original in thinking this, but cancer is definitely a weird kind of blessing. In many ways, I highly recommend it.