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For years, Grace Silva had experienced odd episodes with her throat — bouts of swelling and radiating pain that seemed to resolve with antibiotics — but her doctors couldn’t explain what was wrong. Finally, after a flare-up in the summer of 2010, Grace was referred to a specialist, an ear doctor who felt something amiss on the left side of her throat: a lump. The Silva family agreed that it was time to get Grace, then 54, to a thyroid specialist. Grace’s daughter Melanie tracked down the name of one at Brigham and Women’s Hospital, a 90-minute drive from Grace’s brown clapboard split-level near New Bedford, Mass. In September 2010, the specialist delivered the diagnosis: anaplastic thyroid cancer. It was bad, he warned her, and she would need surgery. Grace’s other daughter, Karrie, was marrying in a few weeks. “Can’t it wait?” Grace asked. It could not. “And whatever you do,” the specialist said, “please don’t look it up on the Internet.”
Medical texts describe the prognosis for anaplastic thyroid cancer as “poor,” but that hardly captures it. If every cancer has a personality, this one is notoriously aggressive. Its tendrils of tissue are so invasive that by the time of diagnosis, it is often too late to operate safely. Radiation or chemotherapy rarely buy much time, and even when all traces of the tumor are eliminated, it usually reappears. Anaplastic thyroid tumors are also known for their aberrant firmness, more akin to wood than flesh. As they bloom, the tumors can tighten like a noose, constricting the windpipe and giving their victims a sensation of perpetual drowning. This panicky “air hunger” can be mitigated with escalating doses of morphine, but it’s a miserable, desperate end that, once witnessed, is not easily forgotten. The oncologist Grace was sent to, Dr. Jochen Lorch of the nearby Dana-Farber Cancer Institute, had watched a patient die this way during medical school, and it filled him with such horror, such helplessness, that for years he felt sure he would never pursue a career in cancer treatment.
Click here for the full story by Gareth Cook, New York Times Magazine.