Stepmom (1998): What Cancer Does Jackie Have?

Jackie and Luke Harrison are divorced New Yorkers sharing custody of teenage Anna and young Ben. Luke's much younger girlfriend Isabel is a fashion photographer with no experience of children. She is trying, and largely failing, to be accepted by them, and Jackie treats her with open contempt.

Jackie has already been treated once for cancer. At a follow-up appointment she learns it has come back and spread, and at first she tells nobody. Treatment fails, and Luke proposes to Isabel. Jackie is forced into two handovers at once: telling her children she is dying, and conceding that the woman she despises will be the one raising them.

Spoilers below. This page describes the appointment that opens Jackie's storyline in Stepmom, and the Christmas photograph that closes it.

Jackie is routinely described as having lymphoma. That is worth pulling apart, because the film points somewhere else entirely.

The word "lymphoma" appears nowhere in the screenplay. What the doctor actually describes is this: cells found in Jackie's lymph nodes, in three of them; and before that, about a year earlier, a tiny lump in the breast, treated with radiation, which they had hoped they had cleared. The plan from there is more radiation and then chemotherapy.

Later, when Jackie tells her children, she says only "I have cancer". Her daughter says it is what Grammy Lil died from, and Jackie answers that Grammy had a different kind, and that there are lots of kinds.

So no formal name is ever given. But the picture on screen is a cancer that started somewhere and has reached the nodes. That is not a lymphoma, and the difference is the point of the next section.

NCI defines lymph nodes as small bean-shaped structures that filter lymph fluid and hold white blood cells that help fight infection. There are hundreds of them, connected by lymph vessels, clustered in the neck, armpit, chest, abdomen and groin. NCI notes there are about 20 to 40 in the armpit alone, which puts "in three of them" into scale.

Because that network drains fluid from tissue, nearby nodes are often the first place a cancer reaches when it moves beyond where it started. That is why nodes get checked, and why what is found in them changes the stage.

NCI's TNM system makes it explicit. The T describes the size and extent of the main tumour. The N refers to the number of nearby lymph nodes that have cancer, and the higher the number after the N, the more nodes are involved. The M is whether the cancer has spread to distant parts of the body.

A lymphoma is a different animal. NCI defines it as cancer that begins in the cells of the immune system, split broadly into Hodgkin lymphoma and the large group of non-Hodgkin lymphomas. Carcinoma, sarcoma, leukemia and lymphoma sorts cancers by the kind of cell they started in, and the categories behave differently enough that the distinction is not academic.

So "the nodes are involved" is a statement about how far a cancer has travelled. It is not a new diagnosis, and it is not a lymphoma.

There is a second thing worth taking from Jackie's appointment, because it confuses people constantly.

NCI states that a cancer is always referred to by the stage it was given at diagnosis, even if it later gets worse or spreads. New information gets added to the original stage. The stage does not change, even though the cancer might.

That is why Jackie's earlier treatment and her current news belong to one continuous record rather than two separate illnesses. It is also why the phrase people reach for — "it came back as something worse" — usually means something more specific than it sounds. Asking exactly what the nodes showed, and how many, is a more useful question than asking whether it is now a different cancer.

This is what the film is actually good at, and it has nothing to do with biology.

It catches the impulse to conceal, the calculation about when to tell children, and the difference between how a ten-year-old and a teenager take it. Ben asks whether he can catch it. Annabelle's anger lands on her mother rather than her brother. Jackie answers as if to an adult, and admits she waited because she gets frightened when her own children are ill.

NCI's guidance for parents says the same things in flatter language. Give clear, simple information in words the child understands. Explain that cancer is not contagious. Answer honestly, because children use their imaginations to fill unanswered questions and often fear something worse than the truth. And be aware that untruths cost you the child's trust later.

In one scene Jackie explains her portable infusion pump to her son as the thing making her strong. That is a real caregiving manoeuvre, and it is the kind the film gets right. Talking to children about cancer goes through the rest.

Where the drama takes over is the body. Jackie looks tired rather than treated. The physical costs of radiation and chemotherapy are compressed into a few tasteful moments, and her decline is timed to land on Christmas.

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Stepmom is one of the better films about a household absorbing a death, and one of the worst-labelled. It never names a diagnosis, and the label it has been given is not the one its own dialogue points at. If you take one fact away, make it this: lymph nodes and lymphoma are not two words for the same thing.

• NCI — Cancer Staging
• NCI Dictionary of Cancer Terms — lymph node
• NCI — Sentinel Lymph Node Biopsy
• NCI Dictionary of Cancer Terms — lymphoma
• NCI — Talking with Your Child about Cancer
• IMSDb — Stepmom screenplay

This page discusses Stepmom for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].