Radiation Oncologist: Surgical Option Best

I spoke with a radiation oncologist today (telemedicine!). All the doctors agree. The next step should be an operation to remove the tumor.

The consultation was informative in that stereotactic body radiation therapy (SBRT) can be helpful in treating sarcomas – but it is still the second choice after surgery.

Surgical Consultation #2

The meeting with the surgeon Dr. Kai Engstad went well in that he saw no reason not to recommend surgery – his remarks are above. This means that a cancer-free future is still possible.  

Engstad warned the complexity of the operation is higher than before because the tumor is in a region that was recently operated on. Scar tissue, flesh reconstituting after disruption, can make for tricky going. Also, the difficulty of the procedure may be increased depending on what surfaces the tumor has adhered to. There is no way to know these finer points without opening me up.

Although Dr. Shao has said that this type of cancer, synovial sarcoma, can not be treated with radiation, I will consult with a radiation oncologist. This is to understand thoroughly what radiation can do in this case. If there is no significant benefit, Dr. Engstad would prefer to skip radiation as this would create more irregular surfaces in the area to be excised.

My main fear is that these surgical procedures become a game of whack-a-mole. The thought I had 16 years between bouts of cancer makes me optimistic I can have another good run.

Many people have acknowledged the difficulty of this period for me and my family. I am so very grateful to receive words of support and empathy. I am comforted that I am part of a web of significant relationships that have defined and enhanced my life. I hope that by posting the details of my cancer treatment here I can skip recounting them in conversation. I don’t know if I will live a long or short time, but either way I prefer to minimize the black thoughts and try and find a positive headspace. So much is unknowable.

I will have a telemedicine consultation with the radiation oncologist later today. As always, I will post all information here.

Bad News

Last week I had a CT scan which indicated a new spot of cancer. Today I met with Dr. Shao, the oncologist, to understand the path forward.

The new tumor is in a cluster of lymph nodes near to where the last tumor resided, nestled between the lung and the heart. The only permanent treatment for synovial sarcoma is surgical, radiation and chemotherapy will just delay growth or mildly shrink the tumor.

The treatment options are ranked from best downward.

• Excise the tumor with a minimally invasive surgery;
• Excise the tumor by opening the chest to gain access;
• If no surgical option is viable, try and retard growth with radiation.

I am scheduling the surgical consultation and will post any news here.

For those who are interested, here is the analysis of the CT scan.

Three-month Checkup

I had my three-month checkup after the surgery. I had hoped to get a final verification that all was well, but such was not to be.

The scan indicates a blood clot and a nodule. The nodule is new and may be just the result of the surgery. There will be another scan in three months.  

Despite this worrisome news, I have been feeling well lately. My lung has stopped hurting when I inhale and, after recent chiropractic treatments, the ache in my ribs eased. When I do normal activity, I feel like my regular self. I notice the diminished lung capacity when I exercise but this is minor in the scope of things.

For those who want the technical stuff, here it is: 

CLINICAL DATA: History of sarcoma.

COMPARISON STUDY: CT chest, abdomen, and pelvis with contrast 3/12/2021.

TECHNIQUE: Sequential axial images of the chest were obtained following a
helical acquisition and intravenous contrast administration of nonionic
contrast. Radiation dose reduction techniques were used.

FINDINGS:

CHEST WITH CONTRAST:
SUPERIORMOST ABDOMEN: The visualized portions of the superiormost abdominal
visceral organs are unremarkable except for 1.1 cm hypodense spleen lesion,
image 98.
MEDIASTINUM: The heart and great vessels of mediastinum are unremarkable except for thrombus in a posterior branch of the left lower lobe pulmonary artery along the course of the surgical staple line. No other pulmonary artery filling defects are identified. Soft tissue density node or nodule is seen in the left anterior lateral mediastinum abutting the pericardium, 1.2 x 1.5 cm with Hounsfield density units of 32, image 55. Otherwise there is no mediastinal or
hilar adenopathy nor pericardial effusion.

TRACHEA AND CENTRAL BRONCHI: The large airways are clear.

LUNGS: There is mild bilateral apical pleural-parenchymal opacity compatible with scarring. Two tiny nodules are seen in the Right Lower Lobe: 4 mm, image 67 and 3 mm, image 79. A 3 mm nodule seen in the Left Upper Lobe lateral, image 38. There are postsurgical changes partial Left Lower Lobe resection with surgical staple line and associated bandlike opacity in the left inferior posterior medial chest extending to the pleura where there is trace pleural fluid and pleural gas bubble, image 80.
PLEURA AND PLEURAL SPACE: There is no pleural effusion or pneumothorax.
MUSCULOSKELETAL: Unremarkable.

IMPRESSION:
1. Postsurgical changes of partial Left Lower Lobe resection with surgical staple line/bandlike opacity and thrombus within a posterior branch of the Left Lower Lobe pulmonary artery extending to the surgical staple line/bandlike opacity. No other evidence of pulmonary embolus.
2. Left anterior mediastinal node or nodule 1.3 x 1.5 cm, metastatic disease is in the differential, appears new from 3/12/2021, alternatively may be postsurgical change/reactive lymph node. RECOMMEND close interval surveillance with CT of the chest with contrast in three months.
3. Trace left pleural fluid and pleural gas bubble left inferior posterior chest.

No Additional Cancer Detected So Far

The pathology report from tissue taken during the surgery has shown no cancer in the tumor’s margins or in the sampled lymph nodes. Also negative were samples taken from pleuritic fluid.  

This supports the idea that the tumor was the only spot of cancer and no further treatment may be required.

I am happy and relieved. 

Home, Sweet Home

 

I’m happy to report that all went well in the surgery. No surprises, bad reactions, or undetected landmines. The tumor was removed intact with decent margins.

To my delight, I was discharged on the earlier side of the spectrum. Obviously, the wound needed to begin the healing process, but I also credit early release on presenting a compelling vision of recuperation to the medical staff.

I told the doctors that I envisioned sitting on the couch with my wife, under a blanket, watching our favorite news program on television, with the possibility of a cat on top of the blanket. The doctors weren’t cat aficionados but understood, mentioning this concept approvingly several times as I was being discharged.

I’m home feeling optimistic about the future. In several weeks there will be more scans and decisions about treatment. Until I hear otherwise, I will follow the plan, which is believing that all is under control and this bout of cancer will soon fade into the past.

Thank you for your concern and well wishes!

Surgery Today

LBJ showing off the scar from his gall bladder surgery in 1965. 

The above is a reminder that there will be no similar pictures of myself posted here – this is a safe space.

Today is the surgery and I look forward to reporting on the successful operation when I return home in several days.

Portland friends, there is no hospital visitation allowed (besides Robin) due to COVID so I will catch up with you afterwards.

Be well!