Welcome To The Dignity Of Cancer

“Hello, my name is Jennifer Spratlin. I’m a chemotherapy doctor.”

These are the two sentences I introduce myself with when I walk into a room to do my initial consultation with a new cancer patient. It seems like an appropriate introduction here too.

I choose not to introduce myself as Dr. Spratlin in most instances because I want my patients to know my first name as a starting point to our developing relationship. Cancer is a personal journey; it seems fitting to me that I try to make their first moments in the room together with me a little more personal by calling myself by my first name. I don’t know if that makes a difference to them but it does to me so I’ve just always stuck with it. Based on this introduction, some of my patients decide to call me Jennifer or Jenn while others call me Dr. Spratlin; every once in a while, a patient will meld the two and call me Dr. Jenn. I am happy to be called any of these names, as in the end, I just want my patient and their family members or friends to be comfortable talking to me.

My official title is Medical Oncologist. This is the fancy way of saying that I am a cancer doctor. I prescribe chemotherapy and other drugs to cancer patients in hopes of increasing their cure rate if their cancer is curable or making them feel better and/or live longer if their cancer is not.

I sub-specialize within this already specialized field, typically only seeing those patients with gastro-intestinal cancers or those patients who are coming exclusively to consider an early drug trial for their metastatic cancers.

Gastro-intestinal cancers arise from places in the gut: esophagus, stomach, small intestines or small bowel, large intestines or large bowel, rectum, anus, pancreas, liver, and bile ducts. For all of these cancer locations, a cancer can be curable, usually if it can be cut out by a surgeon, or it might not be curable. If the cancer is not curable, it generally has spread from where it first started. We call this spread of cancer metastatic disease.

The word metastatic is often interchanged with the words “stage four cancer” (also stage IV cancer). These are cancers that have started somewhere, for example the pancreas, and spread to other places in the body, for example the liver or lung. Some people mistakenly think when that happens they have pancreas cancer AND liver and lung cancer; this is not true. Instead, they have a pancreas cancer growing in an organ where pancreas cancer cells should not exist. In this example, if we were to take a piece of the cancer in the liver or lung and compare it to that which we see in the pancreas, they would look the same under a microscope. The pancreas cancer cells got to those other organs by spreading through the blood system or the lymph system. These stage four cancers are generally not curable, except for a few special cases.

The other group of patients that I treat are those patients who have usually exhausted all of their standard treatment options but are still well enough to consider being treated with experimental treatments. Often their only option is to participate in an early drug trial where a new drug or drug combination is being tested. The scientific purposes of these trials is to determine the correct dose of the drug or drug combination in people. Along the way, these trials give us information about what the drug is doing in the body and what the body is doing to the drug, and we additionally try to get an idea of which cancers these drugs might be effective in. All of these patients have cancers that are incurable. These types of trials are called phase 1 trials. Because they are experimental, there is no guarantee they will be effective; there is also no guarantee patients will not experience side effects from these drugs. This is a very specialized field of cancer treatment. Not very many patients will participate in one of these early drug trials, usually because of lack of access or because the person gets too sick too fast to be well enough to consider more treatment.

A cancer diagnosis, no matter the stage, can be terrifying – terrifying for the patient and terrifying for friends and family. The uncertainties that cancer causes is scary. In my experience, there is a lot of fear found with cancer – fear of walking into the cancer centre, of treatments to come, of side effects from treatment, of the cancer “coming back”, of impending death. Some patients however, are remarkably at peace with their diagnosis and whatever lies ahead for them and their families. Why one person reacts one way while the next reacts another way to a cancer diagnosis is a curious thing to me.

Over the years of doing my job I have come to fully embrace the belief that cancer is a journey. Every person who gets diagnosed and every loved one of that person, walks their own path with cancer from start to finish, no matter a happy or sad ending. For as many patients that have gone through a cancer journey, there is an equal number of roads that have been taken to get to the final destination.

So why did I decide to write about my job?

I think the answer to this question is that I believe there are so many positive things about living to be learned from my patients.

I see people during some of the most vulnerable, anxious, and fearful times of their lives. There is such a myriad of emotions faced in any cancer journey. These emotions are real, and they are, most often, beautifully unfiltered.

We so often hear of the pain and suffering that cancer brings, both to the affected and to the friends and family of that individual. And this is true. There can be much pain and much suffering with cancer.

But the human spirit and mind and heart are absolutely remarkable. Despite pain and suffering, cancer can also bring hope and grit. Cancer can find grace. Cancer can partner with peace and love.

My job allows me the opportunity to form intimate relationships with my patients. Through these relationships, I have the priceless privilege of witnessing the dignity of cancer. This is what I hope to share a little of in my posts.

Welcome to The Dignity Of Cancer.