Third post today, but it’s a big day.
It’s looking like the recommendation will be surveillance, but I could always choose RPLND just to allay fears about what’s in that 6-mm lymph node. In general I lean strongly toward whatever Dr. Nichols recommends, but here’s my personal reasoning after having a few hours to think about the scan results.
From my previous post on the subject, the node’s contents are 45% likely to be dead tissue, 45% likely to be teratoma, and 10% likely to be active cancer. Dead tissue is annoying because it shows up on scans, but it’s otherwise harmless. Teratoma is a “surgery-only” cancer, meaning that you do want to remove it, but it doesn’t carry the same risks of metastasis that other cancers do, so there’s no need for followup chemotherapy. And of course, active cancer is bad.
I don’t think it’s teratoma. My original tumor was pure embryonal carcinoma with no teratoma component, and I’m assuming that it’s unlikely a pure EC tumor would suddenly change components after metastasis. This is a layman’s assumption, but I’ve never read anything to the contrary.
I don’t think it’s active cancer. That is a purely faith-based call, but I have to believe that in the ultimate struggle of BEP vs. EC, BEP wins.
That leaves dead tissue. It could be scar tissue that won’t go away, or it could be more squishy necrotic tissue that my lymph system will slowly dissolve over time. I think that the node contains nothing but dead tissue. If I wait a couple months and it’s gotten smaller, I’ll feel fantastic because it’s almost certainly necrotic tissue that’ll eventually go away completely. If it’s the same size, then I’ll probably discuss laparoscopic RPLND with my doctors. I don’t believe it’ll get bigger, because I believe it’s dead.
Of course, if RPLND were convenient and risk-free, that would tip the scales in its favor. But it’s major surgery that would probably accomplish nothing but telling me that the surgery was unnecessary after all (because the excised tissue was harmless). It seems like surveillance — exactly what Dr. Nichols recommends — is the right choice.
Mike, this is from Art:
My fave cousin: I feel bad that we haven’t talked yet, but since day one of the TC, you’ve been in my prayers and thoughts. You deserve the best. I miss you. Call or email us. We’re with you all the way. Love, Art