The Language of my Cells

Biphasic Synovial Sarcoma cells

A few years ago, I came across a book entitled The Language of Cells: Life as Seen Under a Microscope, by Canadian pathologist Spencer Nadler. Dr. Nadler wrote this collection of essays after having worked as a surgical pathologist in California for over twenty five years. One day, he crossed the intangible barrier between pathologist and patient and suddenly each histopathology plate became much more than just a landscape of cells. In each essay, he writes about the "language" of the cells under the microscope, and how, in getting to know each patient, he also became acquainted with "the connections between cells to a larger self."

I've thought about this idea many times over the past few months, as I have had cells on the brain a lot lately ... division and mutation ... mixed signals ... chromosomal translocation ... What freakin' language are my cells speaking anyway? Why have they failed on me so many times? Why does any one cell decide to go rogue? Dr. Nadler compares breast cancer cells to hula hoops ... are there any pareidolic (my brother taught me that word yesterday) images in my histopathology plate? It just looks like a psychedelic poster to me. What do my cells say about me? What is their connection to my larger self?

I've concluded that I can obsess over my cells until I am blue in the face, but there's no one answer to any of these questions. None of my oncologists have an answer to my repeated question of "Why did I get cancer?" The unfortunate truth is, no one really knows what causes most cancers. Sure, we can speculate that my grandfather got lung cancer because he smoked a pack a day and worked in a factory. And a woman who has inherited the BRCA1 gene is at a much higher risk of developing breast and / or ovarian cancer. If you eat few vegetables and have a meat-based diet rich in processed foods and saturated fats and you brush your teeth with trans fats -- sure, you're at a much higher risk for developing stomach or colon cancer. And if you live next to a nuclear power plant, well, maybe you should think about moving. But beyond all of these no-brainers, we still do not know what causes cancer. There are approximately zero ideas out there as to what causes my cancer, synovial sarcoma. Molecular genetics are a factor in that synovial sarcoma has a characteristic chromosomal translocation of t(X;18). I am no scientist, and a couple of Italian researchers explain it better than I ever could, in the ESUN Synvial Sarcoma article:

SS are characterized as a group by the presence of a specific translocation t(X;18), that fuses the SYT gene from chromosome 18 with SSX1 (about 2/3 of cases), SSX2 (about 1/3 of cases) or SSX4 (rare cases) gene from X chromosome. As a consequence of the translocation, a fusion transcript is formed at mRNA level, detectable by PCR tecniques. Cases with both SYT/SSX1 and SYT/SSX2 fusion transcripts have been described. SYT/SSX1 is reported significantly associated with biphasic SS. The association between SYT/SSX1 with reduced metastasis-free survival in localized tumors was not confirmed in all series, and the prognostic relevance of the fusion gene typing is still uncertain (Mancuso 2000, Mezzelani 2001).

But while it is clear that cancer is a genetic disease, it is a total fallacy that cancer is, thus, an inherited disease. The chromosomal translocation involved in synovial sarcoma is a diagnostic tool, and not a cause. The reality is, most cancers are completely random, sporadic, unanticipated. That is a scary notion, so no one actually wants to believe this. I think that is why, when I tell people (I mean "people"; not my smart friends) that I had / have cancer, I usually get the following responses:

"Do you smoke?" (Because mets to the lung only seem fathomable if you are a chain-smoker.)
No!

"Oh ... it runs in your family, right?"
No!

"What is your diet like?"
Strictly organic and vegan ... (And in my head: Probably better than yours, jerk!)

And my favourite ...

"So, now that you have cancer, are you going to eat better?"
What. I am going to choke you now.

It's hard to deal with comments like this, but you learn how to keep the sarcastic retorts to a minimum. What's more difficult is just accepting the randomness of this all. I got cancer, and I didn't do anything do deserve it. And there is nothing I can do to change it.

Last month, I spent a good hour and a half talking to my radiation oncologist, Dr. Incredibly Kind Irish Man. Since my treatment plan has switched to chemo, he is no longer my main oncologist, but I ran into him in the waiting room prior to my first round, and he asked if there was anything he could do, and if he could see me, just to see how I was doing with all of this. This man is such a rarity; he's one of the top researchers in this field and incredibly busy, yet he still takes the time to see how I am doing now and then. He has always called me at home to check in. He has been the bearer of bad news many times but he also takes the time to make sure that I am ok. I am not sure that that is part of his job description. But anyway, I asked him the dreaded "Why did I get this?" yet again, and he spent a good hour talking to me about molecular genetics. A lot of it went over my head, but I appreciate it when highly intelligent people mistake me for another highly intelligent person, and talk to me as such. We talked about the 18th chromosome. I asked him about anti-angiogenesis agents (ok, so how I really said it was, "Why can't we figure out some way to block the blood supply ... you know, cos malignant tumours are vascular ... why can't you guys cut them off at the source? Why? Why?"). We talked about my many recurrences and he told me something I have heard many, many times ("Your particular case of synovial is behaving in mysterious ways."). Then he said something that is now really stuck in my brain: "You know ... we often ask why people get cancer. But given how easy it is for one cell to receive a mixed message ... I think the question is why don't more people get cancer?"

Good question. Scary question.

So maybe my cells are simultaneously speaking Zulu and English while most people's are unilingual ... I need to stick something akin to l'Academie on those bastards.