For the medical folks


I am going to put on my doctor hat now. We physicians (and other medical professionals) have our own language. I try to avoid medical jargon in my writing, but some of you may want to know the details of my case. Of course, if you are not medical you are still welcome to read this – just know that roughly half of it will sound like nonsense and make your eyes glaze over. Be forewarned.

When I was initially diagnosed with cancer in the fall of 2013, imaging showed several masses in my pelvis, and enlarged lymph nodes throughout my abdomen. The physicians taking care of me did several FNAs of the nodes, which confirmed that I had cancer. The cells were poorly differentiated, and they could not determine what the primary cancer was. I am not familiar with all the specialized stains that pathologists utilize, and all of the tumor markers they look at – but none of the tests provided a firm diagnosis.

Initially my oncologist was going to start me on a regimen for cancer of unknown primary, though I do not remember which drugs they were going to be. A couple nights before starting chemotherapy, she called us and said that one of the pathologists thought that the cancer could be a Ewing’s sarcoma (based on what they described as small round blue cells in my biopsy specimens), and she decided to switch me to a regimen for Ewing’s. The cycles were three weeks apart, alternating courses of vincristine, cyclophosphamide, and doxorubicin with courses of ifosfamide and etoposide. My gynecologic oncologist later described this regimen as “brutal” (I am glad that I didn’t know that while I was going through it). After curbsiding a pediatric oncologist who was an expert on Ewing’s sarcoma, my oncologist sent off FISH studies to confirm whether this was a Ewing’s or not. About a week after I started chemo, the FISH studies came back negative, but at that point I was already improving clinically so we continued on that regimen. My diagnosis throughout this time period was “poorly differentiated neoplasm with sarcomatous features”.

Despite being on such heavy doses of chemo, I experienced very few short-term complications and no long-term ones. I developed atypical pneumonia once, but did not have to delay my chemo regimen for it (I was well enough to receive chemo two days after starting antibiotics). I did receive a blood transfusion at that time for a borderline hemoglobin of 8, but did not require any transfusions aside from that one. I had some peripheral neuropathy in my fingertips and toes toward the end of chemo, but that all resolved once the regimen was completed. I still get tired in the early evening sometimes, but so do a lot of other mothers of young children, so who knows if that is from chemo or not. As I follow the journeys of other cancer patients now, I realize how unusual it was to suffer so few complications in light of how difficult that particular regimen of chemo was. Thank you, Jesus.

About a month after I completed chemotherapy, I started to have lower back pain. A CT scan was clear, but the pain persisted. Concerned for bony metastases, my oncologist ordered an MRI – which showed that my lower back was fine (the pain ended up being musculoskeletal), but there was an abnormal finding in my uterus. An ultrasound showed the same thing. I saw a gynecologic oncologist; after reviewing the MRI and ultrasound results and seeing me in her office, she thought that it was most likely a polyp. She did a hysteroscopy and biopsy; we were all shocked when the biopsy showed cancer. A few days later we found out that it was endometrial cancer. After pathologists from two different medical centers (I had started chemo in Chicago, and so my oncologist was there; my gyn onc was at a different medical center closer to home in Wisconsin) compared the specimens from the first cancer and this one, they all said that these were two separate cancers. I had a PET scan which thankfully only showed uptake in my uterus.

We proceeded with a hysterectomy with BSO. My gyn onc did a thorough lymph node dissection, removing seventeen pelvic lymph nodes and seven para-aortic nodes. Results showed a Stage 1A, Grade 2 endometrial carcinoma that was quite superficial; all the lymph nodes were negative for metastases. There were areas of lymphovascular invasion, but since the cancer was so superficial (<2mm into the myometrium), and the tumor itself was only 8mm in diameter, the tumor board decided that I did not need any further treatment after surgery. We breathed a sigh of relief and hoped to put cancer behind us. I did see a genetic counselor and had some genetic studies done, which thankfully came back negative.

I had a follow-up CT of the chest, abdomen, and pelvis in January 2015 that was negative. My next CT was in April 2015. The radiologist saw a 1.1cm lymph node in the right pulmonary hilum. I had a PET scan, hoping for the best, but the node lit up with an SUV of 13.4. The following week I had an endobronchial ultrasound guided biopsy of the lymph node, which showed metastatic, poorly-differentiated carcinoma. The pathologists compared this to the previous cancers and realized that it was possible that all of these cancers might be one and the same:

Comparison of this specimen is made to the prior hysterectomy specimen for endometrial adenocarcinoma, FIGO grade 2 and the prior case (celiac lymph node FNA with high grade malignant neoplasm). The morphologic characteristics and immunohistochemical profile of the current specimen show similar features as compared to the prior endometrial adenocarcinoma, and is favored to represent a metastasis from that tumor. In addition, in retrospect, there are also morphologic similarities to the outside slides of the celiac lymph node FNA. While that specimen shows somewhat discrepant immunohistochemical findings, it remains a possibility that that specimen also represents a metastasis from the patient’s endometrial carcinoma.

The pathologists at my oncologist’s institution also reviewed everything and agreed. Looking through the lens of the retrospectoscope, it looks like this was all an extremely unusual case of metastatic endometrial cancer. Why a 35 year old with absolutely no risk factors would have endometrial cancer in the first place is a question for the ages.

I am sharing images from my chest CT scans below. The first is from September 2014, just for reference:

september_2014

The second from January 2015. The lymph node is now visible on the scan, but still within the range of normal (<1cm). I was recovering from another bout of pneumonia at the time of the scan, so the node (circled below) did not yet raise any red flags:

january2015

The third is from April 2015, when the lymph node measured 1.1cm. This was the node that was biopsied and found to be positive for cancer:

april_2015

And the fourth is from May 2015. The lymph node here is back to normal:

may_2015

Between April and May I did not undergo any treatments, standard or otherwise. I did not try any alternative therapies, nor did I make any changes to my lifestyle, other than praying with faith in the name of Jesus to heal.

In his book Miracles, Craig Keener laments that though there are many reports worldwide of miracles of healing, few of these have been well-documented medically. One reason is that many of these healings happen in parts of the world where medical documentation is scant (in Nepal, for instance, medical records were on large index cards that the patients kept with them). Another reason is that people sometimes lack access to their medical records, or are simply happy to move on with their lives after being healed and don’t seek to have things documented. Perhaps another reason is that many people who are healed are not medical professionals themselves, and their eyes start to glaze over when they attempt to read medical words, kind of like how mine do whenever I try to decipher an Excel spreadsheet. Though some of the details of my case are somewhat personal (I know I lost some of you non-medical men reading this at the word “uterus”… sorry guys), I know that I am in a unique position as an English-speaking Christian physician who knows how to post things to the internet, and therefore am happy to share the details of my case in a way that most are not able to do.

If you have read this far and still believe that there has to be some other non-supernatural explanation for what happened to me, I can relate to that. Until fairly recently, my immediate response to any miracle claim was skepticism. I will write more about my journey from skepticism to open-mindedness about miracles at another time.


Join the discussion:

2 thoughts on “For the medical folks

  • Clare K. Rothschild

    Hey, Ruth. Craig Keener is a friend. We should talk! Why do you oppose natural and supernatural? God often works through natural circumstances. He invented them? We just don’t fully understand. Why would we think that we do? Still millions of dollars committed to answers: this implies that we KNOW how much we don’t know. Right? So relieved you are well. Stay well. And, solve cancer, chica! XO.

    • Ruth Post author

      Yes, we should talk, Clare! I oppose natural and supernatural because that is what our culture does – particularly the medical/scientific community (including the Christian medical/scientific community!), but not just them. Honestly I wrote that sentence without even thinking about it – but you are right, natural vs. supernatural is a false dichotomy. “Non-miraculous” would have been a better word. What we in this secular culture consider “natural” is all Providence – or as Augustine put it, “Nature is what God does.”