Opinion: Column: “Clinical Correlation Suggested”

Opinion: Column: “Clinical Correlation Suggested”

Means what exactly? That was the suggestion written by the pathologist after "non small cell lung cancer" was written in the "diagnosis" section of the pathology report completed after my original surgical biopsy was performed at Holy Cross Hospital in early 2009. I had never seen this document until this past week, finally retrieving it after nearly 12 years, representing a kind of symmetry. Though 2009 is when my life as an officially-diagnosed lung cancer patient began, I am not at all prepared to say that my current life as a lung cancer patient is over. It's just called something else.

Nor am I prepared to say this document gives me much clarity or satisfaction, for that matter. Unfortunately, getting re-diagnosed with papillary thyroid cancer recently doesn't change the past or guarantee the future. It does however, reshape it, potentially – for the better. When it comes to cancers you'd prefer to have and the ones you wouldn't, thyroid cancer, generally speaking, is way more preferable than lung cancer. The survivability gap is all you need to know. The side effects and sacrifices required to live with thyroid cancer pale in comparison to those required of lung cancer patients. In fact, if you don't already know it, lung cancer is the leading cause of death among all cancers, by far. Moreover, more people die from lung cancer as do from the next four cancers combined. Lung cancer is a killer. So being reclassified from lung cancer to thyroid cancer is huge. The fact that I've survived so long already, 12 years post-diagnosis, means I may have used up some of my unexpected life expectancy, however. Still, it beats the alternative.

Originally, I was told my lung cancer was incurable and given a "13 month to two year" prognosis. Presently, as it relates to my current prognosis, it's sort of indefinite. The drug I'm taking is effective for three years. After which, I'm sort of on my own as there are no new drugs in the offing to manage my cancer. In effect, I am once again incurable, as the years of treatment for lung cancer had no effect on the underlying thyroid cancer and did a kind of damage that now means I can be treated but not cured. Quite different than had I been treated for thyroid cancer all along.

Yet, seeing this paperwork from 12 years ago which clearly lists "non small cell lung cancer, primary to the lung" has sort of stopped me in my tracks. So far as I understand/recall, there was no "clinical correlation." I started chemotherapy the following week. Was something neglected? Certainly, I didn't ask for a second opinion, which is on me, but was the oncologist supposed to research further? Was the pathology report sort of damning – me, with a kind of faint praise – uncertainty, if you can extrapolate?

Otherwise, how does the profession account for my still being alive? When we got a second opinion a few months back from a head and neck (to include thyroid) cancer specialist at The Lombardi Cancer Center at Georgetown, she said, if I had lung cancer, I wouldn't still be alive, so it's logical to presume the recent surgical biopsies that indicated thyroid cancer were likely confirming a long-standing cancer, and that quite probably I never had lung cancer, but rather thyroid cancer that had metastasized to the lung. But there was no further investigation in 2009. The diagnosis – without a "clinical correlation" – was non small cell lung cancer/carcinoma.

At the initial meeting with my oncologist, it all sounded so serious and the doctor was so clear in his assessment of my situation, that it seemed irresponsible, foolish even, to wait. We scheduled my first chemotherapy infusion for the following week and the rest is history. Now I'm wondering if it was history that need not have been made.