Varieties of the black spot

Mum tells me that it comes with age, that signs and portents of the Black Spot will become increasingly frequent.

This week, I received an abnormal smear report, a friend's friend is found incidentally to have a brain tumour and Peter Ballocks is diagnosed with an oesophageal mass.

My abnormal smear is not the black spot- maybe a tiny grey comma, if that. It's a pre- pre-cancer warning that will be treated and go away. That's what the cervical screening program is for. I may write about this later as a health education topic and a warning for the next generation, but it's of no real health concern as long as appts are attended.

The friend's friend had a head MRI scan during participation in a research study as a normal control subject. This showed tissue projecting into his fourth cerebral ventricle, with radiological appearances of a subependymoma. If you had to select your own brain tumour, this is the one you pick- slow-growing, non-infiltrating, excellent prognosis. He'd had a neck MRI 6 years ago, and although not picked up at the time the mass was present then- same size and location, then as now asymptomatic. It's not causing any structural/mechanical problems (e.g. hydrocephalus) so he will probably opt to watch and wait. The 4th ventricle lies between the cerebellum and the brainstem, and sticking a knife in there raises a possibility of damaging the autonomic control centres that regulate heartbeat and breathing. For the moment, his tumour will be a silent companion and symbiot. It's not bothering him, so he won't bother it.

Peter Ballocks' tumour is not a harmless stowaway. It's got so big and greedy to grow that it's stopped him swallowing. When he tries to eat solids it makes him throw up, so he sticks to alcohol and milk. He's lost a lot of weight in the last 3 years. Last year he became so persistently obnoxious (behaviourally) that H-etc. kicked him out, and he moved back down to the Borders.

I've had a working diagnosis of Korsakoff's psychosis for Peter for some years (a B-vitamin deficiency provoked by alcohol, which destroys the brain's mammillary bodies and kills memory), but now I wonder if he has another stowaway in his brain, thrown off from the oesophageal tumour. This Friday, the growth in his gullet is so big the endoscope couldn't get past it. He'll be sent for scans next week to image his stowaway's size and assess the extent and location of metastases.

H-etc doesn't visit here, so it's safe to write what isn't yet said. Oesophageal cancer is not a one you'd pick. By the time symptoms precipitate investigation it's usually too late for the docs to do much. In 80% of cases, surgery, chemo and radiotherapy are not worthwhile, causing more symptoms than they solve and little improvement in life expectancy of any decent quality. Survival rate at 5 years- 5%.

All I can do is let H-etc. (the 'etc.' stands for 'who is very good to me') know that my phone line and door are always open, day and night. I can be the nagging bitch on the Western General Hospital's phone line, who makes sure she and Peter B. have access to specialist oncological services and to Marie Curie when the time comes. I can try to help her talk through the guilt feelings that will probably well up once his prognosis becomes clear. Luckily, I know that Peter Ballocks, for all his charm and once-intelligence, was a fucking nightmare to live with, pre-dating this neoplasm, and she didn't divorce him over nothing. I'm good in a crisis, as long as it's not mine.