Starting to Get a Grip on Melanoma Cancer   May 6th, 2011

When I was first told I had malignant melanoma, one of the leading questions bouncing around my dazed brain was “why me?” And when questions like that start invading one’s consciousness, the answers are rarely satisfactory, and are, in fact, frequently disturbing.

You feel guilt for having somehow contracted a deadly disease, but can’t figure out how you might have contracted it – was it that sunburn in Costa Rica in September 2008? Or too much time spent at high altitude in airplanes? Maybe something we ate at some point? Or too much wine? Or not enough? Could it be our low carb lifestyle? Or did that actually prevent the melanoma from cropping up earlier?

You wonder what you could have done differently so that the diagnosis had come back clean instead of laden with cancer. You wonder if you could have acted sooner to somehow head it off at the pass. You worry that since you got the disease, your loved ones might be susceptible to a similar diagnosis. And, if you’re a person of faith, you might view your diagnosis as some sort of spiritual test.

And this series of “why me?” and “what if?” questions can drive you crazy, stress you out, and depress you – none of which will help one overcome the disease, and could make it even worse, if the theories of mental attitude affecting physical wellness are to be believed (and I do believe them).

After dwelling on these thoughts for a while, and doing some research, which confirmed that even the really smart medical people really don’t know exactly why some people get melanoma and others don’t, I came to the conclusion that the reason I ended up with cancer boiled down to chaos theory, or, in other words, “shit happens” (with apologies to my kids for using the “s” word).

As I have been learning, cancer is the result of cell mutation, which, in simple terms, results in particular cells growing out of control either because they have mutated in a way that accelerates cellular reproduction (mutated oncogenes) or disables the cellular controls that prevent such rapid reproduction (mutated anti-oncogenes). Dr. Siddhartha Mukherjee, author of “The Emperor of All Maladies: A Biography of Cancer” equates these mutations to the controls of a vehicle: the accelerator pedal being pressed all the way down (the mutated oncogenes) or the brake pedal failing (the mutated anti-oncogenes).

In the case of melanoma, the type of cell that has gone nuts – at least initially – is a melanocyte, a pigmented skin cell, hence the classification of melanoma as a skin cancer and warnings by folks like the World Health Organization warning about sun exposure being the cause of skin cancers including melanoma.

However, according to a friend in the field of cancer treatment research (thanks David S.), the mutation can come from any of a number of causes, including, but not limited to, sun exposure, chemicals, or simply the build up of random errors that occur during normal cell division. So, in other words, we’re back to “shit happens”.

In a way, the idea that my cancer was a random, unpredictable occurrence is a bit of a relief, as it allows me to not have to worry about the past, and instead focus on the future.

And that future involves surgery next Monday, and then some sort of treatment – most likely immunotherapy – starting at some point in June.

The surgery I am having on Monday morning is called a “lymphadenectomy”, and involves the removal of all of the lymph nodes in the area where my sentinel lymph node was removed, namely in the region of my right groin. More specifically, I’m having an inguinal lymphadenectomy, “inguinal” referring to the groin and lowest lateral regions of the abdomen (per Merriam-Webster’s dictionary). The surgery will take between two and three hours, and will result in several incisions ranging from the middle/upper part of my right thigh up to my lower abdomen – probably an area about 12-18 inches high in total.

The reason for the lymphadenectomy is that it is believed to be a way to surgically treat cancer which has spread to the lymph nodes but has not metastasized beyond them. The lymph nodes appear to act as a dam of sorts to the cancer cells, collecting and preventing them from easily spreading in the rest of the body, but at some point they can get overwhelmed and then the cancer cells will spread to invade organs and other parts of the body. So, by removing the affected lymph nodes surgically, the hope is that it will also remove the cancerous cells (see, e.g., WebMD). There will be a biopsy performed on all the lymph nodes removed during the surgery to determine how wide spread (if at all) the cancer was in my lymphatic system.

As a bit of background, the lymphatic system is part of a body’s immune system, including the fighting of bacteria, viruses, and even cancerous cells. The clear fluid carried in the lymphatic system is called “lymph”, and lymph nodes act as a filter against foreign materials. There is a good overview of what the lymphatic system is and does here. A diagram from that link showing the lymphatic system and the lymph nodes can be seen below:

(From http://penile-cancer.ca/pc/lymphadenectomy.htm)

Of course, no externally induced physical changes to a biological organism can be made without some sort of side effects, and for lymphadenectomies, the side effects will likely include swelling from the build-up of lymph, now that the lymphatic system has been disrupted by the removal of all the lymph nodes in a given region. This swelling may or may not be temporary, and is called lymphedema. Dealing with the swelling and lymphedema in a leg would require the use of a pressure stocking. Also, during the recovery period after the lymphadenectomy, until the body has adjusted to the lack of particular lymph nodes, will also require the use of a drain to remove excess fluid build-up. The drain I was shown during my initial appointment to discuss the lymphadenectomy was about the size and shape of a hand grenade.

I expect to be kept in the hospital for a couple of days – probably getting released on Wednesday, and already have a follow-up appointment scheduled at the end of the month, followed by meetings with the clinical staff at the hospital to determine my adjuvant treatment, which will likely involve immunotherapy. Unlike chemotherapy, which involves using cellular toxins to try and kill cancer cells in the body, immunotherapy tries to boost the body’s immune system to help attack any cancer cells remaining in the body after surgical removal of cancerous bits (lymph nodes in my case).

On a separate note, the skin graft on my wide excision has, for the most part, failed to bond. Blood formed under part of the skin graft and prevented it from grafting properly. The downside to this diagnosis is that it will take longer for the excision to heal, and I will have a noticeable scar on my right thigh, but both of those items are, in my view, not significant in comparison to the greater challenges I face in fighting my cancer.

 

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This entry was posted on Friday, May 6th, 2011 at 20:34 and is filed under Health. You can follow any responses to this entry through the RSS 2.0 feed.Both comments and pings are currently closed.

11 Responses

May 6th, 2011 at 20:57
hannah Says:

I lost my “love muffin”, mudji (Blackgiant’s Chief Mudjekeewis, Spirit of the West Wind and father to Hiawatha), to osteosarcoma on this past Tuesday. He was a newfoundland dog, and not just a dog. He slept with me, and was my constant companion. I got him at 12 weeks, and did all I could to ensure he had a long and healthy life, good food, proper vitamins, exercise. Yet, he developed bone cancer. Don’t know the reason, but it happened. Having an 150 pound newf with bone cancer does not offer many options, especially when they are over nine years old. But, I guess the moral is, there is no real reason why one can get cancer.

Good luck Jake. My thoughts will be with you during your surgery. My hope is that physicians are as caring, compassionate, and wonderful as mudji’s vet was through treatment.

May 6th, 2011 at 20:59
Jake Richter Says:

Hi Hannah,

You have our sympathy and condolence. We know how special he was to you.

With love and hugs,

Jake & Linda

May 6th, 2011 at 22:39
Liz Says:

Jake,

Amazing how similar our processes are, mental that is. In the last week or so, I have been saying “what if” or “what if I didn’t”. You have such a great attitude, and are a sense of support for me. I do see a pattern in when we are experience this. You just prior to your huge surgery and me in the throws of chemo and radiation (PS, the last 2-3 days have been h-e-double toothpicks!- for the kids).

Anyway, I definitely agree that it is now time to concentrate on how, what, when, where and why “s” happened, it is not time to deal with it NOW.

Sorry to have to hear about your graft. I have had 4 permanent tattoos placed on my body for radiation. I consider them my “war tattoos”. When this is all over, I will be able to look at my thigh and say “I remember when I beat that!” I hope you will be able to do the same my friend.

I have the weekend off from radiation (my chemo has a long half life, so it works when its not infusing :( )so I’m going to try and relax a little.

My thoughts, prayers and hopes are with you Linda and the Kids on Monday, and long after.

May 6th, 2011 at 22:41
Liz Says:

paragraph 2 correction “now is NOT the time”

May 6th, 2011 at 22:43
Liz Says:

parapgraph 2 correction “but to deal with it NOW”.

May 7th, 2011 at 10:11
Vince D Says:

Sorry to hear about that skin graft! Best wishes that next week all goes well for you. I guess it’s really one day at a time.

May 7th, 2011 at 10:22
Karen Lear Says:

Chicks love scars, don’t you know that Jake?? Seriously though, stay positive, live and love everyday which it seems like is the norm for your family. I am so glad you are able to process through all of this like you are and you’re sooooo right, shit happens. It’s all part of the journey and this too shall pass. Stay strong, know that so many are praying for you and supporting you! And like Vince D said, it really is about 1 day at a time!

May 8th, 2011 at 15:30
Corky and Sy Says:

Jake, we’ll be sending you those positive thoughts and hugs on Monday and each day afterward. Stay strong and positive.

May 8th, 2011 at 20:33
Cousin Mel Says:

Hi Jake, Well this sucks! At first I thought you should put on some loud rock music and scream at the top of your lungs but since you are probably beyond this stage by now maybe something Zen would be more empowering. Look I’m a terrible writer and I don’t want this to sound like a eulogy. You already know you are not alone. You have a strong, courageous spirit. You are taking this thing head on which is as you always do. You’re going to kick some serious cancer butt! Just like gaming, Jake, you are fully armed and ready, all you got to do is show up!

May 11th, 2011 at 11:04
Greta Says:

Hi Jake – I am a complete stranger to you, but really appreciate your blog. I was just told five days ago that my sentinel lymph nodes had the melanoma they found on the arch of my foot. (hmmm…maybe I stepped in fertilizer too much!) Yes, I have been laughed at for that one.

My husband found your blog. I am undergoing the PET CT scans and Brain MRI this week. I move on to possible (probable) Lymph Node Disection soon.

Peace to you and your family.

May 11th, 2011 at 11:10
Jake Richter Says:

Hi Greta,

I am getting the sense that a lymphadenectomy is a standard protocol for when the cancer has metastasized into ones’ lymph nodes. Don’t be afraid to ask your doctors questions about anything that doesn’t make sense.

Good luck with your procedures and please post an update when you have one.

Jake

P.S. Humor is a wonderful weapon against illness. I love the “fertilizer” comment :-)