I have your results. Again.

It's now two weeks since my life-changing surgery. I'm feeling pretty good for the most part - some minor complaints but honestly nothing that I didn't experience before my major surgery. Life is getting back to normal.

Except, of course, it isn't. There's still the pesky little matter of the pathology studies on the tissue that my surgeon removed. And a few days ago my surgeon called to talk about them.

"I have your results," he said after greeting me on the phone.

I felt like telling him that it was Saturday and he should be out cycling or hiking or sleeping in or whatever gave him joy on a Saturday. But he is dedicated and was already taking the time to call me so I dispensed with the life coaching and focused on my care for a few minutes.

"Okay. What did it show?" I asked him.

"Well, in an odd way it was the best possible result from your surgery," he started out. "There were no cancer cells found in the rectum or associated tissues that we removed. However, one out of the twenty-five lymph nodes I removed was positive for the same type of cancer as your primary tumour."

Odd? Best possible result? What Mark was telling me was that he found more cancer when he took out my rectum; how could that be considered a 'best possible result'?

He went on to explain. If the pathologist had found cancer cells within 2.5cm of the edge of the rectal tissue he removed, Mark would have suggested going back to the operating room to remove a wider segment of my sigmoid colon and/or the remnant of my rectum. Not only would this subject me to another round of major abdominal surgery while I'm still recovering from this round, but it would leave me with even less colon to process my stool. My stellar recovery so far would be set back and I would probably experience even more symptoms of LARS (Lower Anterior Resection Syndrome). Then, of course, if the pathologist found more cancer in the segment removed on the second round of surgery, Mark would suggest even more surgery, but this time for a hemicolectomy (remove the left half of my colon) or even a total colectomy (remove ALL of my colon). The reasoning here is that if there are cancer cells spread widely throughout the colon tissue removed, there is no way to be certain that it would not be everywhere throughout my colon.

Removing half or all of my colon might save my life in that case, but it would definitely alter my lifestyle even more than LARS. A colostomy would be a virtual certainty, and while I would still live my life with one if it meant living an otherwise good and long life, I'd rather not have a colostomy. I could therefore see how not finding any cancer in the rectal tissue was a good thing, but why was it good to find it in one lymph node.

"It proves that you needed the surgery," Mark explained. "Four out of five times I remove someone's rectum in cases like this and nothing comes up on pathology. I've taken out a perfectly healthy organ and put someone through major surgery for no actual benefit. But in your case, we found more cancer so you will definitely benefit from the surgery we did. And this is the lowest possible exposure you could have - just one out of twenty-five lymph nodes."

My type of adenocarcinoma spreads along nerve cells, through blood vessels, and through the lymphatic system. The primary tumour didn't have any nerve tissue associated with it so that removes one vector for spread, but it had two large vessels involved. The unknown - the factor that couldn't be determined until I went through surgery - was whether there was any lymphatic involvement. As it turns out, there is.

The lymphatic system extends throughout the body and in effect contacts virtually every cell that makes up our other tissues. It's almost like a freeway that carries toxins, waste, and spent white blood cells to the spleen to detect whether there are any harmful bacteria or viruses present and produces white blood cells targeted to fight off the infection. The lymphatic fluid along with any not presented to the spleen is carried up to the subclavian veins (under the collarbones) and then gets dumped into the bloodstream and carried to the liver and kidneys for processing. It's a very useful system, but in my case there are cancer cells growing in one of my lymph nodes. Those cancer cells may already have spread throughout my body by using this freeway.

It is undeniably better that only one of the lymph nodes was found to have the same type of cancer as my primary tumour. If over half had been found to have cancer in them then the likelihood that other lymph nodes that were not collected also had cancer would be high. And if the pathologist detected a different type of cancer in any of those lymph nodes, then I was actually seeing two separate cancer diagnoses, not just one. A double whammy of the worst proportions. But it wasn't a different variant of cancer and it wasn't in six or eight or ten lymph nodes. It was in just one, and it was the same cell type that had already been found in my colon two months ago.

I already knew what Mark was going to say next.

"I'm referring you to a medical oncologist at the Cancer Agency. They will review your case and work with you to decide on the next best course of action. You should hear from them within a week. Any questions?"

I had a few questions. They were specific to my surgery and don't contribute to this post though and besides, I had already hopped to a new lilypad.

I am probably going to need chemotherapy.

Chemotherapy is a scary, scary word. It invokes images of sickly-looking patients with IVs running into frail arms, their hair falling out, trying not to vomit. And while that certainly represents some chemotherapy it doesn't fairly represent all cancer chemotherapy. A lot of chemo options either don't have these side effects or there are potent drugs available to counter them if they occur.

Well, all except hair loss. And anyone who knows me will know that I'm not really concerned about losing my hair.

I'm not going to obsess about chemo at this point. That's at least one and probably more than one lilypad away from where I am. Right now I need to get as strong and healthy as I can after my surgery and wait to hear from the newest member of my healthcare team - a medical oncologist. I will make an informed choice about my chemotherapy based on the information they present and not based on my fears about what it might do to me. And there's no point worrying about that choice until I have the information to make it.

Living with cancer is really not that different than living without cancer. I have let myself become obsessed with what-ifs before when I didn't have the information I needed to make a decision. I have let fear and other emotions sway my decision-making far in advance of having to make the decisions I faced. I have let other's experience with facing a decision dictate what my experience would be. Now that my decisions are focused on having cancer and treating it, are things really any different?

No. No they aren't. I guess it's just more obvious to me now that I can't make a decision before I am asked to make it.

Maybe Mark was right. Maybe this was the best possible outcome for me.

Only time will tell, and for now it is a beautiful sunny day outside and my sense of taste and smell are coming back. It's a good day, and that's enough for now.