This changes everything

After a many year hiatus, I've decided to reactivate my blog to talk about a life-changing event in my life and my new forced perspective. Here is the email message I sent out to my family to announce my news:

I had an endoscopy a couple weeks ago to look an acid reflux problem I was having and as part of that, they do a biopsy. The biopsy revealed some cancer cells on my esophagus. So they did a CT/PET scan and I just got the results a couple of days ago. The cancer has already progressed to stage 3 and possibly stage 4. That was not the news we wanted to hear! The good news is that this more advanced stage rules out surgery. Just the idea of that fairly radical surgery was giving me a lot of anxiety. So I'll be making my stand with chemotherapy and radiation. I have my youth and vigor working for me and cancer science is improving all the time so there is lots of hope. But it is definitely a WTF moment. Physically, I feel perfectly normal. Emotionally, I'm pretty shaken up as you might imagine. It kind of changes everything.

On Friday morning I'll know more as we are meeting with a panel of experts to explain the nature of the cancer and determine which course we take. Esophagus cancer has a reputation for being pretty aggressive and we are determined be equally aggressive in getting to a good outcome.

Friday morning came and I brought Mary and my sister Betsy to meet the medical players in my drama. First there was Coralyn, an RN who coordinates all my care. She was terrific and made me feel like I was in good hands. Then we met Dr. Scott, an Internal Medicine specialist who would coordinate chemotherapy. He did a brief examination and answered some basic questions. The most difficult was the question of "staging". The PET scan had revealed that the esophagus cancer had spread into the adjacent lymph glands (stage 3) and it also showed "hot spots" both on the liver and in lymph nodes in mediastinum (the chamber near the entrance to my lungs). If these hot spots proved to be cancer, then my cancer would be considered stage 4.

This was a pretty big deal because stage 4 is considered untreatable and terminal and stage 3 had considerably more hope. The next doctor, a Surgical Oncologist, Dr. McCahill explained to us that if it had spread to other organs, surgery would no longer be an option and surgery was the key to getting rid of the cancer. He went on to explain that the hot spots presented like cancer but they could be other things. In my favor, he remarked that it was unusual that a tumor as small as the one in my esophagus could spread so far without me feeling more of the symptoms. If I was in stage 4, I should be dragging my ass around in exhaustion. This gave us some hope! If it had only progressed only to the local lymph nodes, then surgery would still be an option. It is major surgery but the survival percentage rate is in double digits.

Dr. McCahill went on to explain that my next step would be to biopsy the hot spots to rule out (or in) stage 4 and thus map out my treatment. Since the mediastinum is hard to get to and requires a thoracic surgeon, we would do the liver biopsy first. If the pathology report showed cancer, that would be it. I'm stage 4. No surgery or radiation. On to Chemotherapy to try and slow the growth of cancer cells in a systemic approach. If the pathology report was negative for cancer, we would proceed to schedule the thoracic surgeon to biopsy the nodes in my chest.

I briefly met the Radiation Oncologist, Dr. Padula, who mentioned that radiation was only a possibility if the liver biopsy was negative and he would talk to me later if this was the case.

I then had consultations with a Dietician (Amy) and a Cancer Resource Specialist, (Alina) who coordinates non-medical cancer issues for me.

A liver biopsy appointment was set up.

The morning of the liver biopsy did not start well. We arrived at 6:30am and discovered I was not on the list. We waited for nearly an hour and listened to a substitute receptionist make multiple calls to try and figure out where I was supposed to go. They finally tucked me into an examination room, started an IV and a new chart for me. Eventually word came up from radiology to bring me down for a ultrasound-assisted liver biopsy.

Here is the message I sent out at the end of the day:

First of all, the liver biopsy was pretty grueling. It took much longer because the spot they were going after was small and just under my ribs. Instead of getting to sleep through it, I had to stay awake and hold a deep breath over and over so my lungs would push my liver into an accessible position. It took much longer than expected and they didn't get it on the first try.

After 4 hours of recovery, I met with my thoracic surgeon, Dr. Bruce Shabahang to discuss the chest spots that showed up in the PET Scan earlier. It was a great meeting. He had spoken to someone who had a preliminary look at the liver biopsy who said he doubted it was cancer. Dr. Shabahang said he was 90% sure it was not cancer. We won't know for sure until maybe Friday.

He then talked about the infected lymph nodes in my chest. He said it was somewhat unlikely that the cancer from the small tumor on my esophagus could travel all the way over there without infecting any of the lymph nodes along the way. It could be a 2nd kind of cancer but he said it was a good possibility that it was a benign fungal infection. That would explain my otherwise excellent health.

The only way to know for sure is to biopsy them. The standard way to do that would be to go through between the ribs and it is a very invasive procedure and they cut little pieces without having a good look at them in context to the body. But fortunately, he is a nationally recognized expert on the da Vinci robot surgery method. They cut 3 holes in the torso; two for robot arms and one for a camera. They deflate a lung and he has a clear shot at cutting out the infected lymph nodes by remote control, much like plucking grapes. He re-inflates the lung and then, viola! 2 days in the hospital and then I can go home.

If the nodes are cancer, I'm back to being stage 4 which has very low odds of survival over 5 years. But if they are not, I will be downgraded to stage 3 and they will start me on chemo and radiation and I'll be a candidate for the surgery which has much better odds for survival and even a complete cure! That surgery is pretty major- if you read about it you'll wonder why I am so excited about it- but that is a topic for another time. For now I am on cloud 9! I'm back in the game!!

So yesterday I got the pathology report from the liver biopsy and as expected, it came back negative for cancer. My robot surgery is scheduled for 8:00am on Monday morning at St. Mary's Hospital. I'm told I'll stay for two nights after that. I'm pretty optimistic that the biopsy results for that one will be negative as well.