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The “Good” Kind of Cancer?

Years ago, on my first rotation as a third-year medical student, I received a dreaded phone call. My father had arrived home late one night after work. As he entered the house, he tumbled down the stairs. His physician, worried that my dad had suffered a mini-stroke, ordered an ultrasound of the carotid arteries in the neck.

By this point in my training, I knew that tests often show incidental results, requiring further tests and other follow-up, and thus providers are loathe to order tests unless absolutely necessary. My father’s ultrasound did not disappoint. The carotid arteries showed no plaques that could have broken off and traveled to the brain. Instead a mass in the thyroid gland was revealed. The biopsy confirmed this mass was cancerous.

Upon hearing the news, I reread the thyroid chapter in my pathology textbook. Thyroid tumors have an excellent prognosis, and thus, it is often said, “If you’re going to get cancer, thyroid cancer is the one to get.” However, middle aged men often have a less favorable prognosis, and my father fell squarely into that category.

I found all this information confusing. Should I be happy? Worried? The word “cancer” as a monolith carries a set of complex emotions and fears deeply entrenched in one’s psyche. It was not until medical school that I began to understand that each cancer type is its own distinct disease.

My father’s physician scheduled him for a thyroidectomy, and I was able to return home at that time. I felt anxious, and shared this with a friend, who happened to be on a surgery rotation. The memory of her reply still freezes me in my tracks. She quipped, “It’s hard for me to worry about a thyroid tumor when I see such horrible disease every day in the operating room.”

Her comment shut our conversation down. I didn’t know how to respond. I felt shame for my worry. I felt uncertain. Shouldn’t my father and I be deserving of comfort rather than chastisement?

Since then I have heard similar confusion from friends diagnosed with cancer. If someone has stage 1 cancer, does that “count” as having cancer? Are they “allowed” to receive the same support as someone with a higher stage cancer? Is there a cancer pecking order?

Such judgments create another layer of worry for people already suffering and stressed.

Pamela Adelstein
Newton Center, Massachusetts

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