Wednesday, March 26, 2008 - Not the best of news, not the worst either.

For starters, I'm going to go with the thought that all is going to turn out just fine ... we just have to tackle a few more hurdles/challenges to get to that smooth road. As I had made note in the last update, the PET scan found the growth on the right adrenal gland (which is not new, we have known it was there at least since 2001) and a small spot (just under a 1/2") on my lung. At first, my oncologist (Dr. Gill) was VERY concerned about the adrenal growth, but when I reminded her that it has been there since 2001 and had been considered benign since it hadn't grown from 2001 - end of 2006, she had a pow wow with her assistant oncologists while Jo and I waited in the examining room. They went over the reports from my surgeon (Dr. Brown) at the time of my surgery and sure enough, he had made mention of this growth and that it was thought to be benign. It would be extremely rare for colon cancer to spread to the adrenal glands... colon cancer, if it's going to spread, goes to the liver and/or lungs. So Dr. Gill relaxed her concern and said that we would still go through the tests to see if we can prove it's benign or not.... and at the same time as going through those tests, etc., she would also refer me to a Lung Surgeon, Dr. Yee to decide what our plan of action will be for the spot on the lung.

Ok... so last week I went through a kajillion blood and urinalysis tests, etc. These tests are to check for hormone (cortisol) levels, etc. in preparation for going to see an Endocronoligst. This week, being a short week because of the long weekend, was a busy one for me. On Tuesday, I had to be at VGH at 8am for a minor surgery to have my portacath taken out. OUCH!! Although the froze the area (just under the collarbone), there were definitely some moments of "Oh Oh!". The surgeon was very nice and he said that if I felt anything to make sure I let him know and he would give me more freezing. Hahahaha... can you visualize this?? You are on an operating table, with the lights above and he tells you to look to the left while he's working on the right. Meanwhile, you are getting cut open and the whole time you are wide awake!! I had to tell him a few times that I felt what he was doing and he would give more freezing. I'm not exactly sure how the portacath is set... I know it gets attached to a muscle and the thin tube goes into a major vein... how they do that, I have no idea. Somehow, when taking it out they have to cut you open, unattach you from the muscle and take the tube out of the vein. There are some internal stitches that will dissolve and some external stitches that I will go to my GP (Dr. Sean Fay) next week to have him take them out.

That was yesterday morning. Doug Keller (a childhood friend who lived on the same street as we did while growing up and now lives across the street from me) took me to the hospital at 7:30am. After the little surgery, we went to the cafeteria for a coffee and something to eat. We had a couple of hours to kill before we headed to the Imaging department to have a CAT scan. Well, it seems, two CAT scans. They did a chest scan (this is for the Lung Doctor) that was ordered the day before by the Lung Doctor's office, as well as another, what I thought was an abdominal scan... but in fact, was from below so it was a kidney/adrenal scan. I wasn't sure what that was for... I found out today.

Today I had the appt with Dr. John Yee, the Thoracic/Lung surgeon. I really like him! He is not a stuffy, holier-than-thou surgeon... he was very nice, friendly, and spoke in layman's terms so I actually understood what he was saying. He says that my case is actually very complicated and not straight forward. He also said that he has worked with Dr. Sharlene Gill for some years now and she is the best of the best... which does not surprise me because I think you've all heard me say how much I adore my oncologist. (Turns out, Dr. Yee is the best of the best when it comes to Thoracic Surgeons according to a staff person I was talking to on another floor). But, I digress. We had a good appt. and he spelled it out. The reason my case is complicated is because of this adrenal growth. He was very concerned that IF it is cancerous, then it really complicates things and this becomes very serious. I told him that Dr. Gill was very concerned too and she actually said the same thing that my case is very complicated but when she realized that I have had this grown for some years now... but my CEA levels have only been elevated since December, she was no longer concerned (or as concerned) about the adrenal growth. I explained that the growth was on the CAT scans I had done at St. Paul's hospital back in 2001.

And therein lies one of the glitches with our health care system. Apparently, it's only been in the last couple of years that VGH and St. Paul's medical personnel can actually access each other's computer systems and share information on mutual patients. But they did not have this agreement back that far (2001) so he couldn't actually access the scans. He can order copies from St. Paul's but he doesn't have them at his fingertips (nor did Dr. Gill when she was first concerned). So having heard this, he will get copies.

He said that it is VERY RARE that Colon Cancer would spread to the Adrenal glands. It's not impossible... cancer cells can end up anywhere, but it's very rare. Might my adrenal growth be cancerous? It could be depending on this Lung spot. He is pretty sure the colon cancer would not have spread to the adrenal... and it makes sense that the colon cancer spread to the lung and that's why the spot on the lung. BUT, another scenerio is, even though I quit smoking 6-7 years ago, I did smoke for about 30 years. So this spot on the lung could be a primary cancer and have nothing to do with the colon cancer. If it IS a primary cancer, then it is possible that it has spread from the lung to the adrenal.

Soooo... what happens now?

1) I will be given an MRI scan or a special adrenal CAT scan specifically focused on the adrenal gland/growth. Apparently (I'm not sure if I heard this correctly) but the MRI/Special CAT could tell if the adrenal growth is malignant or not.

2) If they can't tell from that scan then I may have to have a "needle biopsy", where they go in by needle and biopsy the growth. He's trying to avoid that if at all possible because that can be an uncomfortable procedure and where he can, he wants to avoid any kind of discomfort or pain.

3) If the adrenal growth is benign (no cancer), then we just deal with the spot on the lung and that will require surgery.

4) If the adrenal growth IS cancerous... then it is not a good thing. They will probably not do any surgery but try to fight it with more chemo and possible radiation. I don't even want to go there, because this becomes nasty with it officially having spread and being considered "incurable". Yes, I know.. one is wondering... well why not cut out the lung spot AND take out the adrenal gland? Both are serious surgeries and if it is cancerous then they can pretty much guarantee it will pop up elsewhere and the body couldn't take surgery every time it pops up somewhere else... hence they would try to control it with chemo and/or radiation.

Are you confused yet?? Ok... here's a summary of 3 possible scenerios... and we all must focus on the first two would be the best!

Scenerio 1 (The best):

The adrenal gland growth is benign and not malignant. Therefore, we can just leave it and focus on the spot on the lung. Dr. Yee would arrange for surgery and have that one spot cut out. We would be in the hospital (VGH) for 5 days or so and then 4-6 weeks at home for recovery. After that, I would be continued to be monitored like a hawk, but technically, I would be cancer-free.

Scenerio 2 (Second best):

The adrenal gland growth is benign and not malignant. It is recommended that both the spot on the lung AND the right adrenal gland with the growth are removed. Because they are two very different parts of the body, this would require two different surgeries. Chances are, they would do the lung surgery first, make sure I'm totally recovered from that surgery, then follow up with the adrenal surgery.

Scenerio 3 (Worst):

The adrenal gland growth is cancerous. They would probably make the decision not to do any surgery. They would treat it the whole system with chemo and possibly radiation on the adrenal growth... but there is no guarantee that it would get rid of one or both, or what may show up later. It's possible the chemo would do the trick, but it's not the best scenerio.

I'm not panicking at all at this point. I figure that the first scenerio is the one that is going to happen. Since it would be so rare for the adrenal gland to be affected, I don't see why it would be with me. Benign growths on the adrenal gland are sooooo common, just as "fibroids" (benign growths in the uterus) are soooooo common in all females. It's possible that a fibroid could be cancerous, just as it's "possible" that a growth on the adrenal gland could be cancerous. But the chances are very low... so I figure I've just got one of the common adrenal benign growths.

Now, when am I going to know results? Good question! I still need a few more appts. lined up. Dr. Yee's assistant will be arranging the MRI/CAT scan with one of Vancouver's top radiologists. She says there are others we could go with and they are good, but Dr. Yee wants me to see Dr. Mayo.... so that appt. might be a little later. Depending on whether he (Dr. Mayo) decides the MRI or the CAT scan will be best, I may have to have more blood work done before the scan. I will be calling Dr. Gill's office to see when an appt. will be arranged with an endocronologist... or if that is done AFTER the MRI/CAT scan. I will be seeing Dr. Gill in 2 weeks, so by then all the scans and tests should be finished.

So, there you have it. Not the best of news but if it is Scenerio 1 or 2, not the worst news either. Besides, if it IS Scenerio 1, I asked him how long it would be before I could start doing some of my hobbies and activities again. He asked if I was planning on going on a trip? I said, "No... but I plan on volunteering for the whole season down at Theatre Under The Stars... is this something I can continue with?" He said if it is scenerio 1, then he will make a point of having me ready for the summer :)

Onwards we go....

Cheryl