In which my tumors are ready for their closeups

Meet Blob Loblaw up close and personal: Invasive Lobular Carcinoma

 It's good to have friends in high places. And low places. And pathology labs.

At some point in the midst of this shitstorm, I told my friend Emyli that I had cancer. She works in pathology at the hospital where I was being treated. She generally wouldn't see my tissues (she works with clinical studies) but I didn't know that when I first let her know what was going on...partly I wanted to tell her and partly I didn't want my boob to randomly end up on her tray and her be blindsided by that.

And what a fortuitous thing this was. 

Emyli read through the blog and immediately texted me asking if I wanted my titanium tumor clips back. UM YES I DO. I can add to my "Weird Shit that's Been In My Body" collection (see: gallstones, botfly). [side note, I had to also ask my surgeon to requisition them which she did, because she is awesome, but I am pretty sure she was like I'm sorry, you want me to do WHAT exactly?]

But it didn't stop there. Here is where I learned a lot more. She asked what else I wanted. I have had to make a lot of decisions over the last few months, but this is one that I was not expecting. Wanted? What were the options? What did this even mean?

She said I could get the tissue back, should I wish to bury it. And she was kind of pulling for this because as my friend, it didn't sit well with her that a part of me would be incinerated. That is, she was pulling for the booby funeral until I pointed out that we don't have a great burial ground and we DO have a lot of neighborhood scavenger animals. Em and I are neighbors so the suggestion that she might find my boob on the sidewalk was enough to agree that incineration was perhaps not the worst choice.

Then we talked about other options. A note on process is probably warranted (warning, SCIENCE! If you glaze over at science, skip down to SCIENCE LESSON OVER.). When the tumor is removed, they do a few things to preserve the tissue. First they "fix" it, often in formaldehyde. Formaldehyde serves to crosslink the tissue, making it stiffer, among other things, but think of it partly as the first anti-rot stage. Once it's been in formaldehyde for a day or so, they begin the embedding procedure. the tissue is packed into a little cassette and then put into a series of baths of alcohol of increasing concentrations. This is a terrible analogy because  the concentrations are wrong, and lab-grade alcohol should NEVER be drunk, but it starts in something with an alcohol content of, say, Aperol and then ends up in Everclear. If we started in Everclear, that would cause the tissue to just shrivel up (much like a human after a night with Everclear) so the process is gradual. The purpose of this step is to dehydrate, or remove water. This is the second anti-rot step. Water allows all sorts of gross things to grow, so we want water out. And then the tissue is put into paraffin (yes, like candle wax). This is multiple steps too, though as far as I know there isn't a single protocol for this, but here is an example. Once the tissue is embedded, it looks like this:

My actual tumor! Asshole.

Once the tissue is paraffin embedded, it's shelf stable. I had boxes and boxes of some tissues I had embedded from some experiments! (And I am just now realizing I have no idea what happened to them...)

When I worked with tissue in my postdoc and later in my own lab, we used a different method (we froze the tissue at -80 which led to all sorts of other issues), so I'll just say that the above is the end of my knowledge of paraffin embedding.

Embedding is all well and good but that doesn't mean you can see anything; tissues are embedded in these globs, and your standard light microscope needs a much tinier piece to look at, so the next step is to take it to an instrument called a microtome to cut REALLLLLLY thin sections. And then, since tissue naturally doesn't have a ton of color that helps you see what you need to see, you still need to stain the tissue. 

There are a lot of different staining options and what you use depends on what you're trying to look at, but a lab standard is H&E or hematoxylin & eosin. If you have ever seen pictures like the two here that look pink and purple, you've seen H&E staining. It's easy, fast, and cheap, but most importantly, it stains for really useful things. Also, wear gloves when you do it, or you will never, ever get this shit off your skin.

This is what DCIS looks like

 With H&E, the H (purple) stains cell nuclei, which for cancer  purposes, is useful since cancer is just a load of cells (with nuclei) growing out of control (Pink stains a bunch of stuff that is more sciency).

SCIENCE LESSON OVER

Emyli offered to get me sections of the tumors. Of course I said yes to this too. And then she asked me if I wanted them in a pretty box. I wasn't sure what she meant.

"We'll keep a whole range of blocks [of my tumors]. I can cut one of each and we have nice wooden slide boxes. Like Dexter."

This is undoubtedly why we are friends.

I turned down the box of slides but asked for a slide of each tumor, with some photos. I anticipate framing these (and my tumor clips).

I may get all of this back next week, which is exciting, though she has to slate all of this into her work day so whenever it works out, it works out. 

I made sure to ask her permission before writing this post, to make sure that she would not get in trouble (not that anyone beyond my immediate circle reads this blog), but she said very specifically that I have a legal right to all of these things. I had no idea about this, and only learned it because I happened to have a friend in pathology. I am probably an outlier here in wanting it back, you know, just putting it out there.