In July 2020, six days after I was diagnosed, I met Dr. H, who would plan my radiation treatment. I also met my tumor.
Dr. H inserted a thin plastic cable into my nostril, threaded it through my sinuses into the back of my mouth, and finally, into my throat. I flinched as the line snaked through; it was entering where nothing foreign should be. The cable’s tip had a miniature video camera and an LED. Its tail was connected to a monitor. The monitor showed the inside of my throat, a brightly-lit cave in mottled pink. My tumour was a red, rough-surfaced lump on the cave wall.
If the tumor had been spherical, it would have been slightly smaller than a golf ball. However, it was flattened, and when a tumour is visible on surface tissue, it’s like an iceberg, mostly lying beneath the surface, displacing flesh in my neck. So it didn’t look like a ball stuck in my throat. Nevertheless, it was shockingly large. Dr. H commented,
“Ah, that’s why you can’t swallow well. I’m amazed that the air can get around it. Actually, how do you even breathe?”
We laughed. Dr. H was calm, reserved, and courteous; his humor communicated respect -- ‘you can handle this hard truth’ -- not lack of care. It helped prepare me for what he said next,
“If your throat swells from the radiation, you won’t be able to breathe. Maybe we’ll need to do a tracheotomy before we start.”
Is he going to cut open my throat?
Cancer is a horror.
Cancer wastes the body; I have lost 40 pounds between the disease and treatments. Tumors that press on your nerves cause agony, and those that erupt through your skin can be hideously disfiguring. At diagnosis, the cancer had already metastasized to my lymph nodes. These nodes are junctions in a network of tubes that circulate fluid throughout the body. Tumor cells in those nodes can travel to other organs and establish colonies of daughter cells. New tumors grow from those colonies to destroy those organs, and you die as your body systems fail. Cancer can kill you in other ways, including suicide, which is twice as common for patients as members of the general population.
A tumor is a parasite, a pseudo-organ competing for my body’s resources and eating me from within. I want it out, but every surgeon has said, “I can cut you. But the outcome would be even worse.”
Do other cancer patients ask, “Why me?” I’d be surprised; it would be just as fair to ask, “Why not you?” The better question is, “Why does anyone get cancer?”
The body is a consortium: 30 trillion cells, each a living organism. These cells reproduce throughout our lives, replacing dead cells and adapting the body to changing environments. We generate 300 billion new cells daily, and a few of them will have flaws. Occasionally, there will be damage to a daughter cell that allows it to reproduce in an uncontrolled way. The replication of DNA from parent to daughter cell is highly reliable, but there is nevertheless a tiny error rate. The daughter cells of that cell will inherit this mutation, as will their daughters, and so on.
My tumor cells descend from a lineage originating from a cell in the tissue that lines my throat. That first daughter cell was just one hundred-thousandth of a meter across. When it reproduced, it was still tiny. But each generation of reproduction doubles the number of cells, so 20 generations = one million cells, and another 10 generations will get you to something as big as my tumor. There’s much more to the story -- cancer must also evade the immune system -- but this will do.
People blame themselves for getting cancer. Tobacco and alcohol are risk factors for throat and mouth cancers. Still, I am not a smoker or a heavy drinker. My tumor biopsy showed that the human papillomavirus likely damaged the original daughter cell, and HPV is often sexually transmitted. So maybe this is all my fault.
That’s absurd: Four in ten Americans will get diagnosed with cancer sometime in their lives; exposure to sunlight can cause cancer. How am I responsible for that? Why is the body vulnerable to things we encounter every day?
Cancer is built into the heart of multicellular life. Single-celled organisms evolved into multicellular organisms about 1.5 billion years ago; every complex organism derives from this foundational event. Think of multicellular organisms as societies, vast cooperatives of interdependent creatures. The cooperative works if every cell reproduces as much as it should and no more. Cancer occurs when that order breaks down.
If cancer is such a risk, why didn’t evolution -- or God, but that poses other questions -- make cellular reproduction perfect? Evolution is about adaptation, not just reproduction. Species evolve because offspring do not perfectly replicate their parents; the fitter ones proliferate, adapting the species to the environment. We have intelligence because evolution learned how to make us.
Why does anyone get cancer? Because cancer is the price of multicellularity, we pay it in return for a rich, sentient life.
And yet it is still a horror, built into the foundation of the natural world.
Well-written. Thank you! The cellular mutations and all the havoc they wreak on us is all part of the natural order. Mutation gives us, as you have so wisely said, adaptation. It also causes harm and loss. It's not personal and you are so very wise to have come to this. It can't be hoped away or hoped away, but sometimes science can suppress or destroy it. It matters tremendously when it is OUR body that is afflicted, but in the large view, we're just a speck in the giant natural order, which is playing out as it should. You are a wise and brave person!
>The body is a consortium: 30 trillion cells, each a living organism.
From this morning's reading:
Dr. Watts, reflecting- on the innumerable channels through which the blood is conveyed over the whole animal system, breaks out in wonder and astonishment, saying,
"Strange that an harp of thousand strings,
Should keep in tune so long."
-Reflections on death. By William Dodd, M.A. chaplain to the lord's bishop of St. David's, 1763