Sometime during the second last month of my pregnancy, I discovered a neck lump the size of a quail egg on my left neck. The lump was hard, non-mobile and painless. My work experience tells me that this might be something more than an infection. As I was in the final stages of my pregnancy, I refused to speculate further and let my imagination run wild. However, I made it a point to raise this with my gynaecologist when I see him two weeks later.
My gynaecologist held the opinion to adopt a surveillance approach. Honestly, that is the only viable option for me there and then. Even if the lump is malignant, my pregnancy made it impossible for me to undergo any treatment without harming the fetus. I was also given the option to do a biopsy. If the results are negative for malignancy, then hip hip hooray. However if the results are positive, I shudder to think more. Hence, I turned down the biopsy and simply focused on enjoying the last few weeks of my pregnancy.
As soon as I delivered my third son, I was immediately hooked up to an ENT (Ear, Nose and Throat) specialist who saw me in my ward. He did a physical examination for me and discovered 2 more lumps on my left neck. My heart sank for this does not bode well. He ordered a FNA (Fine Needle Aspiration) biopsy, a nasoendoscope and a CT scan of the head and neck and thorax region. I know all these investigations too well. They were the typical diagnostic tests to diagnose nasopharyngeal carcinoma (NPC) or nose cancer.
I was reminded of a patient earlier on in my career. She was pregnant and was diagnosed with NPC. When diagnosed, she was only in the first trimester. To protect both mother and child, she was advised to commence her radiotherapy treatment only in her second trimester when her pregnancy has stabilised. Everyone in the department knew of her story. We felt sorry for her and her unborn child. We did all we could to protect her child from the harmful effects of radiation. The last we heard, she had delivered a healthy baby.
I was eager to know the results of the investigations. I had no family history or any other presenting symptoms of NPC. I was convinced that I was suffering from an infection. You know, sometimes pregnancy does funny things to your body. Even my gynaecologist says so. And didn’t the fortune teller say I will not be inflicted with any major illnesses in this lifetime? And the life line on my palm appears the same length as before albeit it does not look that smooth. But it can’t be cancer, can’t it?
The nasoendoscope revealed no anomaly, except possible sinusitis. Likewise, the CT scan showed no primary disease. My heart skipped with joy. However, the scan revealed enlarged retropharyngeal lymph nodes which is a frequently involved site for NPC. I could see the concerned look on the ENT doctor. As he was interpreting the scan to me, I was fixated onto the CT images on his screen. I could see the radiation oncologist marking out the target volume for my treatment and the dose map that is going to ensue. I wondered which of my colleagues are going to handle my treatment.
I gathered from the ENT specialist that he is highly doubtful that my condition is a simple case of infection. We just needed the biopsy to confirm the histology. Meow and I did not exchange much after hearing the results. He is in the same profession as myself and we are more than familiar what goes on thereafter. All I mentioned to Meow was that I dreaded head and neck cancers the most. Many years ago when I was still a radiotherapy student, I had a pact with the divine one (I am a free thinker) that if I were to be stricken with cancer, please let it not be cancers of the head and neck region. The reason is simple. I want to eat and to savour food. Food gives me joy and enjoying good food with family and friends is my favourite pastime. I cannot imagine being denied of this simple joy in my life.
Surely there is more to life than just eating. What about my husband and children? Honestly, I refused to let myself think along those lines. Before my diagnosis is confirmed, I do not want to think or plan any further. My little one is just a few days old. I have my milk supply issues to think of. I do not have the extra resources to be worrying for myself now.
The next day, I received a call from the ENT specialist. Meow beamed a wide smile at me after he put the phone down. The odds were in my favour. There were no malignant cells detected in the neck lump.
As I am writing this, the lump is still stubbornly residing in my left neck. There are no answers to the cause of the multiple lymph node enlargement. I was asked to consider removing it. I have not met up with the ENT specialist since that call. My hope is that it will resolve by itself.
Right now, all I want to do is to nurse my baby. I am filled with gratitude that I do not have to begin making alternative five year plans. I am just thankful for another chance at life.
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