Confusion

My doc’s office faxed the cytology report to me this morning, but rather than illumination, I have received confusion.

Literally all the report says is:
Right thyroid nodule (fine needle aspiration)
--Hypercellular aspirate fluid composed of blood with scant colloid and cytologically atypical follicle cells
--Excision of this lesion is recommended

Note: Four smears are reviewed

It is my understanding (from the famous literature) that the “hypercellular aspirate [. . .] with scant colloid” is typical of follicular neoplasms, while “cytologically atypical follicle cells” is of no help whatsoever. “Atypical” how exactly? Okay so “not normal” but there are oh-so-many ways for a cell to be “not normal.” And are there scant cytologically atypical follicle cells, or is it scant colloid. . .AND THEN ALSO cytologically atypical follicle cells? If there are lots of cells (hypercellularity) but scant cytologically atypical follicle cells, then shouldn’t this be re-biopsied rather than sent straight in for surgery?

Well, but this paper suggests that my risk of cancer is now hovering around 25%, so not as bad as I thought, but still worse than a 1% chance.

Suspicions

I had my FNA biopsy last Friday—finally. Research is what I do, so I had read a couple of books, numerous articles, and several reputable web-sites (and some disreputable web-sites, if we come down to it). All of which is to say that I knew what to expect, and had actually read that the FNA could be “favorably compared to a blood draw.” Nor yet am I a squeamish person. I was a phlebotomist for a couple of years before I began graduate school, so I am not scared or nervous of needles. I went in as relaxed as a person probably can be to a biopsy. I feel I have a fairly high tolerance for pain. But, I do NOT favorably compare the FNA to a blood draw. It wasn’t the worst thing I’ve ever had done to me in a doctor’s examination room, but it wasn’t the best thing, either.

For some, it seems to be almost painless, but for me, it felt as if the doc was sticking a small pipe into a muscle in my neck, then moving it all around for good measure. Amazingly, I didn’t really bruise, but I had a scratchy throat and small cough for about 24 hours afterward, and I had trouble swallowing for about 12 hours. I am still a little swollen and sore a week later. Unless it’s just my imagination? I don’t remember the nodule being this big—or having any discomfort—before the FNA.

Well, but the biopsy was nothing, NOTHING, compared to the waiting. Arrrrgh! The waiting. The doc and the nurse both told me I should have my results by Monday, Tuesday at the latest. I called every day until I finally got my results Thursday afternoon: “suspicious” for cancer. Although, all I could get out of the doctor was that the pathologist could not make a definitive diagnosis of cancer, but my sample contained “atypical” cells. Doc wouldn’t explain exactly what that meant. Could be that I have cells indicating a follicular neoplasm, which, I understand from the literature, could be either a follicular adenoma (which is okay) or a follicular carcinoma (which is bad). Or, could be that I have truly “atypical” cells, which have strange appearing nuclei and chromatin, etc, which could indicate pre-cancerous cells. I need to get my hands on that cytopathology report.

But now the only way to tell if it’s cancer or not is to have that lobe of my thyroid out and have a pathologist look at it. I’m scheduled to meet with a surgeon this coming Friday. We’ll see if he’ll be a bit more explicit about what the pathology report says. All I can say is, “Fuck!” My understanding from the literature is that my chance of having cancer is now getting on 50%. Fuck!

I have no history of cancer in my family, no history of thyroid problems. Oh, we’ve got all kinds of other problems, alcoholism, heart disease, even mental illness, but cancer? Not so much. I think I had a great aunt who died of lymphoma, but that’s the only person I know of. Wow. I may have the dubious honor of breaking another barrier in the family: first to go to college, first to get cancer. What the fuck?!

Okay, enough of the pity party.

On a more positive note, my baby cousin is turning 2 on September 6, and I am knitting her a tiger cub bag. She’s a huge fan of tigers AND bags. Apparently, she’s also into shoes. Ah, a girl after my own heart. Whoever said that women were EITHER shoe ladies or bag ladies didn’t know from squat. I’m both. Oh, and a pen/pencil freak, too. There are worse/more expensive things to be compulsive about.