From My Mind to....

But Steps Nevertheless - Pt 2

NOTE: I've decided NOT to require a PassKey to access my Blog posts regarding my cancer journey. My Blog is rated high enough for that. I've removed the PassKey from my previous entry as well. Read at your own comfort level.


My phases as best I can determine (with updates from my Oncology appointment yesterday):

Discovery: I had a pain in my abdomen in mid-December. It lasted several days, long enough for me to schedule a visit to my doctor. My first test was a simple Ultrasound of my abdomen. One test led to another, and to another. An interesting note: After I’d made the appointment with my doctor, the pain went away and never reappeared.

Determination: Over the next 11 weeks I had seven tests ranging from that Ultrasound to a Biopsy of a lymph node attached to my right kidney. I wondered aloud why they would biopsy a lymph node rather than the tumor or even the kidney. My doctor told me the lymph node would provide the required information with less potential complications for accessing those other areas.

The biopsy took about half an hour and was completed through the back under a local anesthetic. At least, I was told it was a local—I didn’t remember any of the procedure.

I had an appointment with Oncology yesterday (8 May), and learned that Pathology determined that the lymph nodes that were removed during my surgery were non-cancerous. Yet the biopsied lymph node WAS cancerous. What happened to that initial lymph node? That’s a question I’ll be addressing with my surgeon this morning.

Diagnosis: That battery of tests coupled with a joint Oncology-Urology Cancer Board meeting resulted in a diagnosis of Papilary Renal Cell Carcinoma. The tumor which was attached to the right kidney was large by their estimate--about 7.5 cms, which earned it a Stage 4 pronouncement. It sounded like the end of the world.

During surgery it was discovered that the tumor was actually 20% larger than the scans originally indicated.

Discussion of options: There were two. Medical, in which I would receive immunotherapy treatments in IV form every six weeks with re-testing every three months. This drug was not Chemo nor radiation, and was designed to shrink my tumor to be more easily removed by surgery.

Obviously, the other option was surgery. In my case, this surgery would be a right robot-assisted laparoscopic radical Nephrectomy—which is the removal of the right kidney, the attached tumor and retroperitoneal lymph node dissection. Immunotherapy treatments would follow to reduce or hopefully eliminate any remaining cancer.

Decision--medical or surgical: To determine the best option, I had a CT Chest scan to determine whether the cancer had spread to my lungs. It had not. Thus, surgery was the best option--removing the right kidney, tumor and cancerous lymph nodes before they spread farther.

The surgery was done on 17 April and took four to five hours. My surgery was done at the University Hospital for several reasons. They were better equipped than the VA Hospital across the street having the robotic surgery equipment available. My surgeon was extremely familiar with that equipment. And they had a pre-eminent Vascular Team available 24/7 should a situation arise in that area, which given the tumor’s location was possible.

Incidentally, my first thought at being wheeled into the robotic surgical operating room was how can I even fit into the room? Ther was SOOO much equipment. And where will the doctors be? It was very crowded. And cold. Not cool … COLD! I had wanted to hit 95 (counting backward from 100). The mask was put on me and I never had the chance to say 100. I never saw the room again. I woke up some six hours later in a Recovery room.

My surgeon told me the reason for using robotic laparoscopy was to reduce the trauma to my abdomen by using four small ¾”  and one larger 3” incisions to conduct the surgery versus opening my entire abdomen. Robotic surgery also lowers the recovery time from half a year to four to five weeks.
The smaller incisions were used to literally blow up the skin like a balloon in the abdominal area for the surgeon to work his magic with the robotic implements. I almost wish I could have watched a video of the surgery. Almost.

I’m afraid the med-speak for how he was going to remove a kidney and the tumor which were larger than the 3” incision went right over my head. But as my surgeon was arguably the best for this type of procedure in the state and had done hundreds of successful operations for this type of cancer, I had no objections.

Therapy:  Yesterday was the first meeting to determine how this phase will develop. I know the basics of how the immunotherapy will work. But I don’t know how it will impact my life over the next six to nine months.

What side effects, if any will I experience? Will I be able to travel? Will the meds interfere with normal day-to-day functioning? And so on ….

Meeting with my Oncologist yesterday, I asked those questions and more. My immunotherapy regimen will begin in mid-June and last for one year with scans every two to three months to determine its efficacy. Each appointment begins with blood tests, then a phone or face to face meeting with my doctor, followed by administering the IV immunotherapy via IV, which takes about an hour.  Looks like my next year is planned out.

Oh yeah, the questions. I will be able to travel in between the appointments. My every day actions should be unimpaired. That’s important as my wife and I are retired and enjoy getting away. The therapy is supposed to have few, if any side effects. I was cautioned that it may take up to six months to recover my full strength. And I have certainly noticed a decided weakness at doing even simple tasks. That’s hard to get used to.

I did get one good piece of news regarding the cancer stage. My Oncologist stated I was not a Stage 4, but Stage 3. From my standpoint, I’m not sure how much better I should feel about that … but I suppose it’s a step in the right direction.

Time to post, and then call my surgeon.