The Good, The Bad, and The Ugly

(Guest-starring Lee Van Cleef as The Man Made of Scalpels.)

I still haven’t received an actual tangible version of the biopsy results — I will apparently have to send a fax requesting them, and will likewise receive a fax in response. This feels oddly archaic, especially in a day and age where I was handed my imaging results on a CD-R the day after they were taken, but never mind that.

I do know, roughly speaking, what they say, having had a chance to discuss them with my surgeon a little over a week back. They’re a bit of a mixed bag in some respects, but overall, things could be a lot worse. Here, then, is a summary of what we know, albeit not in the order promised by the title.

First, the bad: it’s an astrocytoma, rather than an oligodendroglioma. This means that it lacks the chromosomal deletions that would maximize the effectiveness of currently-available chemotherapy. So it goes.

Next, the good: it’s a low-grade astrocytoma — Grade II on a scale where Grade III is ominous and Grade IV is serious stuff indeed — and it is, as far as we know, not malignant.

This brings us to the ugly, of which there are actually a few separate bits.

  1. When it comes to brain tumors, “benign” is a bit of a misnomer. A red herring, even. Nearly all other areas of the body feature membranes to keep things tidy and compartmentalized. This serves to contain, for instance, a benign skin tumor. The brain lacks any such membranes, so while a benign tumor won’t send out little metastatic seedlets to colonize other parts of the brain, it won’t be confined, either. Given enough time, it will grow and crowd healthy tissues — hence the need to control it.

  2. The odds of completely removing and/or killing the astrocytoma are somewhere between slim and none. The best that can be done is to remove as much of it as possible without affecting the function of healthy tissue, and then attacking what’s left with chemotherapy and possibly radiation.

  3. One of the obnoxious habits exhibited by astrocytomas is a tendency to eventually go malignant, even if they didn’t start out that way. It seems to happen to pretty much all of them eventually. (When you start out with a somatic mutation in p53, the gene that’s responsible for keeping other mutations in check, most anything goes after that.)

  4. With all of the preceding is said and done, median survival time for patients with astrocytomas is eight years and change. For those of you whose statistics are rusty, this means that half of those surveyed live longer, and half, well… don’t.

    This may sound grim, but I have every intention of being on the very far side of the bell curve. I have a first-rate medical team, a pathologist father who I trust will keep me from doing anything clinically stupid, and an incredibly warm and supportive group of friends and family who are stumbling over each other to offer their assistance in any way they can. (More on this last point in an upcoming post.)

    Lastly, the science on this stuff is moving quickly. The current arsenal of chemotherapy drugs is quite recent, and if I’m not mistaken, the weapon of choice against oligodendroglioma only appeared on the field something like six years ago. So there’s some basis for hope that the longevity curve will stretch out before me as I walk it.

Upshot: I’m totally banking on being ahead of the lot of you when they start rolling out the military-grade neural interface packages. I’ll have an easily-reopened hole in my head and a little cavity where they can stash the hardware-wetware bridge. You’ll envy me, suckers.

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