As I write this, I’m sitting in our rental car heading south from New Hampshire to Chelsea, Massachusetts. My ever patient and supportive wife Linda is driving as the skin graft on my thigh is still too delicate to allow me to use the gas pedal and brake adequately.

Our destination this morning is the Massachusetts General Hospital imaging facility, where I am schedule to get a brain MRI scan, and a chest and pelvic CT scan – one right after the other. The purpose of these scans is to determine whether the cancer that was found in the lymph node that was removed a couple of weeks ago has metastatisized. In plain language, the scans might help determine whether there is detectable cancer in any of my organs.

Sign on the 9th floor of the Massachusetts General Hospital Yawkey Center - 9E is the place for me

Sign on the 9th floor of the Massachusetts General Hospital Yawkey Center - 9E is the place for me

 

The oncological surgeon we met with a couple of days ago explained that these sorts of scans have pros and cons. The pro being, of course, that it could detect cancer in a non-invasive manner. I thought a con might have been the radiation or electro-magnetic effects, but as he indicated, the cons are mostly human in nature. Statistically (and in cancer detection and care, statistics are the guiding principal as I’m learning), he said, only 3% of scans actually turn up cancer in the scans, but in around a third of scans the radiologist might see something questionable. That in turn can cause anxiety in the cancer patients when the doctor reports back that he or she thinks the scans are okay, but is not entirely sure. It then becomes an issue of trust between the patient and the medical care givers of whether some possible anamoly detected in the scans needs to be investigated further or not. However, that 3% positive detection rate is still worth it, and as it was pointed out to us, the scans are a standard diagnostic after the next surgery I’m scheduled to have in order to help determine what adjuvant (additional) treatment I would be started on (with the best guess being a long regimen of interferon).

The surgery I’m schedule for on May 9th is called a lymphadenectomy, and its purpose is to remove all the lymph nodes in the vicinity of my right groin, where the cancer-containing lymph node was removed during my biopsy. This is a surgical attempt to eradicate the cancer before it has a chance to spread, as it is believed that the lymph nodes act as a temporary road block against cancer getting into the rest of the body. At the same time all of the removed lymph nodes are biopsied as well, and according to the doctor, there is a 7-22% chance, statisically, given my biopsy results, that more cancer will be found in some of the removed lymph nodes. Either way the surgery would be followed by the adjuvant treatment I mentioned above, as an additional safety measure to attempt to help my body eradicate any cancer still in my body.

However, that might also all be moot if the scans I am getting today do detect metastasis. In the unlikely event that happens, then my surgery might well be cancelled, as removing all the lymph nodes in my right groin would no longer be necessary to prevent the spread of cancer, and another treatment path would need to be determined.

I have been learning over the last couple of weeks that cancer detection and treatment is still a very hit-or-miss sort of thing. There appears to be great understanding what cancer is (basically, cells that for some reason start replicating in an uncontrolled fashion), but beyond that, things get a bit foggy. There are apparently a number of different cancers which in turn respond (or don’t) to various treatments. My form of cancer, melanoma, is one of the ones for which the treatment options are pretty limited. I’ve been told that chemotherapy, which is a treatment that many people associate with more common forms of cancer, is not particularly effective with melanoma. Needless to say, I am slowly ramping up to start my own research into melanoma so I can be better prepared to understand my options at the crucial points in my treatment.

The lack of complete understanding of how to eliminate cancer, or even detect it, is part of what makes cancer such a terrifying disease. We expect doctors to have all the answers, but in the case of cancer what they really contribute is more knowledge and experience, and thus provide the best statistical chance for survival. It then becomes a matter of trust, and a matter of hope that your trust is well placed. That said, Linda and I feel very good about our medical team so far, but blind trust and faith is not our way, so we will be working to improve our knowledge as much as possible so that I can be a fully informed patient.

One of the two barium sulfate containers I need to drink before my CT scan

One of the two barium sulfate containers I need to drink before my CT scan

As I submit this post, I have just completed my brain MRI – 45 minutes in a claustrophobic tube where I was not allowed to move my head at all, but given time to occasionally clear my throat. I’m now downing two containers of a barium sulfate tracer solution that will assist in analyzing my upcoming chest and pelvic CT scan.

 

The scan test results, or, more accurately, the analysis of the scans, should be completed no later than Monday. Until then it’s a matter of waiting anxiously.

Adding to the anxiety is that we found a nice short-term rental apartment just minutes from Massachusetts General Hospital, but are now waiting for our rental application to be approved. We should know about that by Monday as well. Having the apartment is important because if things go as planned, I will have regular appointments at the hospital starting at the surgical date going forward, and if I am put on interferon, I will be needing daily intravenous applications for the first month of treatments followed by self-injections three times a week for a long time thereafter.

Wish us luck.