Cancer Is Not A Monolith

It's a terrible mosaic

Talking about cancer is difficult for many reasons. But one central difficulty arises because “I have cancer” is often heard as “I am dying a slow and painful death,” or “I am about to walk through the valley of the shadow of death sans divine escort.”

But there is really no such thing as “cancer” the way most people mean it.

There is Hodgkin’s lymphoma.

There is leukemia.

There is brain cancer.

There is squamous cell carcinoma.

The list goes on and on. Whatever body part you can think of, cancer can find.

All of these things might share a broad similarity, that cells are replicating incorrectly, but their differences can pile up quickly after that.

They have different stages of progression, different subtypes, different treatment regimens (chemotherapy, surgery, radiation, and more), different survival rates, different symptoms, different chores (administrative and medical), different treatment side effects, and different social awareness and acceptance.

But most people simply don’t know how to distinguish these things (and really, why would they)—and neither do most cancer patients for that matter, right up until they know all too well.

“Cancer” is a monolith in most people’s minds, and often they conflate all cancers with the very worst cancers, or come close to it. But cancer is not a monolith. If someone says, “I have cancer,” you don’t actually know that much. Not really.

Cancerous legibility

I mentioned that some cancers are more socially acceptable above, and this always invites some pushback. Let me elaborate.

Some cancers are more common, have more foundations and events attached to them, and have a ribbon with a universally recognized color. Breast cancer is like this. You can talk about having breast cancer publicly, despite it being a horrible disease. In some ways, it is a regular bad thing, like a debilitating car crash, simply because it affects so many women.

Now take my own disease, Hodgkin’s lymphoma. Right off the bat it’s confusing, because there’s also non-Hodgkin’s lymphoma. What’s the difference (and isn’t there a good one)? And what is “lymphoma” anyway? What the hell is the lymphatic system? And what color ribbon is that (purple)? There’s confusion around the disease, and I often blurt out a ton of information about it all at once when I disclose it to someone for the first time. “IhaveHodgkinslymphomaitsacancerbutIexpectafullcure.”

The great thing about HL—it is very survivable! Most people can expect a cure.¹

So breast cancer is regular, HL is good (or at least better). It all feels a a bit too uncomfortable to describe, but it’s true. These are examples of cancer that, due to one aspect or another, are easier to bring up socially.

But I didn’t say “easy to bring up socially” above. I said “socially acceptable.” What’s a socially unacceptable cancer?

Anal cancer.

Farrah Fawcett is known for many things: an original one of Charlie’s Angels. Famous actress, on screen and stage. All American beauty.

And in 2009, at the age of 62, she died of anal cancer. Not only is this cancer rare, associated with STIs and anal sex, and more deadly than others, it deprives its host of the social grace many other cancer patients can expect.

Put yourself in this moment:

“I have cancer,” you say.

“I’m so sorry,” your friend gasps. “What kind?”

Stay there, in that moment.

.

.

.

I think you get what I mean. Now imagine needing to tell your place of work, your friends, or your mother. There are, of course, many wonderful people who would take the whole thing in stride. You didn’t choose to get anal cancer, no matter what the risk factors might or might not be. And yet here you are with it.

The body part that has cancer can radically alter a patient’s social experience with it. No one even likes to say “anus” or “anal” when it’s a pure anatomical description, let alone when it’s attached to a medical diagnosis.

I don’t think I would have ever come across Farrah Fawcett’s story if I, myself, didn’t get cancer. I knew who she was, but not how she died. But I feel greatly for her, as I do anyone who must deal with both terrible disease and terrible stigma.

Side quests

Many people understand that a cancer patient will likely encounter chemotherapy, radiation, or surgery (I got the first and third in the course of treatment; hopefully the second remains unneeded). But there are side quests that are less well known, and which vary considerably across cancers!

For example: since my chemotherapy drugs can impact fertility, I froze sperm prior to beginning treatment.

I knew I wanted children, so I didn’t have any moment where I wondered whether I actually wanted to freeze my gametes (some people do). But it was jarring to have to get it done right now. It’s a last chopper out of ‘Nam kind of feeling. And you have to go in that room with the suspicious recliner and ~materials~.

When you get cancer, you’re actually signing up for a whole bunch of new life experiences you weren’t expecting!

Not a monolith, but a horrible mosaic

The sheer number of variables that determine exactly how bad “cancer” is are daunting, and particular to each individual. Even now, despite having a “good cancer,” I wonder about longer term and later-onset side effects of treatment. There is just so much to know. But—and I mean this—it’s worth the price of admission. I made a superb trade-off, and I don’t have any lingering bad “what could have been” feelings.

A poisonous treatment in exchange for life? I’ll take that trade every time. Sign. Me. Up.

Many others have to make different trade-offs, with different levels of certainty.

Ms. Fawcett

1. Leukemia and Lymphoma Society: “The goal of Hodgkin lymphoma treatment is to cure the disease. More than 80 percent of all patients diagnosed with Hodgkin lymphoma can be cured by current treatment approaches. The cure rate is higher, approaching 90 percent, in younger patients and those with early-stage favorable disease. Even if disease recurs, many patients can be cured with further treatment.”