My phone rings whilst I am mid-Zoom conversation. A withheld number.
It is early Monday morning, less than a week since I had that fateful phone conversation with my GP, just a weekend since I had the whole body CT scan on Friday to look for cancer spread. I am waiting for the results. I am imagining they will take a while, then there will be an oncology doctor conversation and maybe more biopsies to confirm what kind of cancer I have. I imagine weeks will pass before any definitive treatment plan. I have only spoken to my GP on the phone so far, no-one else. I have been alone, locked down in my flat – since my slight fever and then the surprise cancer diagnosis – for nearly two weeks. I have only been able to speak to my loved ones via a screen.
It is a man, a stranger. Confident, direct, surgeon.
We have just discussed your case in the Melanoma team meeting and I would like to operate tomorrow.
What? What? Tomorrow? But, but…
I try and juggle the two conversations, Zoom and phone, and fail. The surgeon agrees to video call me in 10 minutes whilst I wrap up the Zoom.
After the usual technical mishaps, and a wait of 40 minutes, we manage to speak on the phone. I have questions.
How do you know the type of cancer is melanoma? It’s not been confirmed? I’ve only had the one biopsy that said ‘most likely’ melanoma…
We are happy that it is melanoma. I would like to offer you a groin dissection operation tomorrow.
But, but – the CT? Has it been reported?
I know if it has spread then doing a major operation might be a wasted effort.
Oh no! he says casually. No, your CT was clear. Just spread as far as the lymph nodes in your groin. I want to operate tomorrow and take them out…
He starts to describe the operation. What we need to do is….
I can’t keep up. The CT results – wow, such a huge, brilliant thing – and now surgery. I am glad. I am worried.
But we haven’t even found the primary melanoma yet, I say. We don’t know where this has come from. Are you sure you’ve got this right?
All skin cancers start with a primary lesion or tumour. In the case of melanoma, it is usually a mole that is (or becomes) cancerous. It then starts invading the local tissue before spreading to the nearest lymphatic vessels, then the local lymph nodes and from there – if left unchecked – it’s an easy hoppity skip highway to spread round the body.
In my case, though, there has been no such mole; my only symptom was this increasing, intense pain down my leg.
(I later discover this was caused by the swollen, cancerous lymph node pressing on a nerve).
Ah, yes, he says. Well. You will need a skin check to look for a cancerous mole that you might not’ve spotted, but it could be one appeared and disappeared without you realising – melanoma can do that – but left some cells behind. And these cells have now started multiplying and spreading. That said – what happened when you were a child?
When I was 9 a large, ugly mole grew on my left thigh. It was scabby and bled and I became very self-conscious about it. It was removed in a 5 minute operation under local anaesthetic when I was 10, just because it was ugly and ‘best taken off’, not because my doctor was particularly worried about it. Children don’t get malignant melanoma after all.
A week later, Mum got a call whilst she was driving (back in the days when you could talk and drive at the same time!). I’m terribly sorry, the histopathology shows it’s a malignant melanoma, the surgeon said in her ear. I need to operate again, but this time I need to remove a lot more so she will need to have a general anaesthetic. We would like to operate this week.
I had a large chunk of my 10 year old leg removed, an impressive scar and no further complications or treatment. There was no sign of spread.
However, some six years later the Royal Marsden, curious about melanoma in such a young patient (very rare), took a look at the tissue…and summarily declared it had not been a melanoma at all, just an unusual-looking, benign mole. Some (ahem) discussion happened between eminent histopathologists and it ended with two of them feeling it was a melanoma and two who did not, and that on balance we could be cautiously optimistic. As everything was well, the matter was left.
Fast forward exactly 29 years from that surgery and I began to have slight pain and swelling at the top of the same leg.
Melanoma is well known for being one of the sneakiest of cancers. It only needs a few microscopic cells left behind, quite capable of staying dormant for decades, until one day some inexplicable switch gets turned on (or some cellular brakes get turned off) and it begins to evade the immune system and grow again. It would appear that this is what happened with me.
And so, to surgery. I am spinning, my first conversation with a specialist and it is that he wants to operate immediately. There will be time, in future, to talk to oncology, to do a skin check for cancerous moles, to hold my hand, but for now it’s all go go go as he wants to (tomorrow!) take out all of the lymph nodes in my upper leg, groin and left pelvis in the hope of removing all the cancer. He runs through the risks and possible complications.
I ask – or maybe it just comes up, it’s such a blur – why tomorrow? Why not next week, when I would have time to organise my life, to organise support, to organise my thoughts.
Covid again. Apparently they might be cancelling his future operating lists and he therefore wants to get me done and sorted as soon as possible. He is kindly crowbarring me on to the end of his (already fairly full) operating list, to make sure I get my urgent surgery.
And, just like that, I am having major cancer surgery within 24 hours.