Sunday, August 12, 2007

August 12, 2007 - Explaining Watch-and-Wait

This morning in the worship service, I preach about the Christian symbolism in Harry Potter and the Deathly Hallows (a topic I’ve briefly mentioned in this blog, on July 27th).

After the sermon, as I read aloud the list of names for intercessory prayer, I include my own name at the end of the list: briefly explaining that I’ve had my consultation up at Memorial Sloan-Kettering, that my cancer is back but is slow-moving, and that the consensus of the doctors is to watch and wait.

Afterwards, I have to explain to a number of people what I meant by that, because it sounds so counter-intuitive.

“You mean you’re not getting treated?”

“No, I am getting treated. Watch-and-wait is my treatment for now. The doctor’s going to monitor me carefully, and as soon as my swollen lymph nodes get big enough, or I develop symptoms – whichever comes first – we’ll start treatment. Sooner, later – it doesn’t much matter when. The treatment will be no more effective later than it would be if we started tomorrow.”


Lymphoma is significantly different from many other forms of cancer. With most cancers, there’s great anxiety about the tumors metastasizing – spreading to other parts of the body. With other cancers, the lymphatic system is often the highway by which malignant cells make their dangerous journey. If a woman has breast cancer, for example, the oncologist keeps a close watch on “sentinel lymph nodes” nearby, and calls on a surgeon to remove any that appear cancerous. Once that kind of cancer gets into the lymphatic system – whose network of nodes and vessels functions as a sort of superhighway within the body – it can take any one of a number of exit ramps, establishing residence in other bodily organs.


With lymphoma, there’s not much concern about the cancer jumping to other parts of the body. Lymphoma doesn’t metastasize to the lungs or the brain, for example. It could move into the bone marrow (in which case my lymphoma would be labeled stage IV, rather than stage III), but – according to my understanding, anyway – that’s about as far as it can go. It can spread more extensively within the lymphatic system, creating more and more enlarged lymph nodes – not to mention bulky tumors, which are clusters of cancerous lymph nodes. Depending on where they’re located, such tumors can create ill effects by physically pressing on nerves, blood vessels, or organs. Yet, lymphoma’s not likely to show up in the form of lung cancer, nor brain cancer, nor any of other scary varieties you may care to mention.

The sort of watching and waiting my doctors and I are now practicing is not a sort of passive resignation. Nor is it an abdication of responsibility. It’s just what we have to do right now, and for the foreseeable future.