Tuesday, August 26, 2008 -- Hope at the end of the tunnel?

Dear Bloggy,

I just had to come here and post an entry because today was the day I had my consultation appt. with Dr. John Yee, Thoracic and Lung Surgeon. I'm actually going to cheat here. I just finished sending an email to my family and rather than type it all over again, I'm just going to copy and paste the relevant information (which is long!) here. Hahaha... and you must excuse my rudimentary art work... I drew a diagram, freehand, which I scanned and am including at the bottom of my babble... and, well, let's just say if Picasso and Michaelangelo were alive today, they would not have to feel in any way threatened .

So, without further ado... here is the latest update:

I had my consultation appointment with Dr. John Yee this morning. Right off the top, I have to say... Dr. Yee and I clicked right from our only visit (last March) to this visit. He recognized me when he came into his receptionist's office and I was there talking to her and he gave me the warmest greeting. It's the weirdest thing, but it's almost as if we were friends and have known each other for years... that's how comfortable I am with him and he is with me.

Anywho... once he was finished with the patient before me, we went to one of the consultation rooms that has a computer. He pulled up my CAT scan that I had done on Thursday. Unfortunately (grrrrr) the CAT scan department has NOT sent him their report and analysis of the scan and it's that report that he needs to make any decisions. Although he could call up the scan, the software they have outside of the CAT scan department is not as detailed as the accurate software the CAT scan department has... hence, he needs their actual report.

But, he could show me that the lesion was still there, deep in the bottom lobe of my right lung. He then brought up my CAT scan image that was taken last March... and, by the naked eye, the lesion looked about the same size. He then used the "ruler" function in the software and measured the March lesion and measured the last week's lesion. He said he had done this three times and each time came up with a slightly different measurement, but suffice it to say, the lesion has grown 2-3 mm(s) in the last 5 months. He says that this is a very slow growing growth which leaves more questions than answers. So he told me the possibilities that this lesion could be:

1) a primary lung cancer, due to my 34 years of smoking in the past. But he doesn't believe that this is the case because if it were lung cancer, the lesion would have grown much faster and would be 2-3 times the size it is showing on the scan.

2) a spread from the colon cancer, which is what we are are sort of suspecting. The oddity here is that if/when colon cancer spreads, it usually spreads to the abdomen/liver before it gets up to the lung, but it is possible to be in the lung and not anywhere else so, who really knows until it's out and pathology has looked at it?

3) a benign growth

4) a fungal lung virus, which if there is anyway of telling, then it could be treated by drugs and we could bypass any surgery.

So, the question is... how can we find out what it is? We start with the CAT scan report (which he is still waiting for). With the more accurate measurements that the CAT scan department can do, they will be able to tell him if the lesion has grown more than he is seeing with his software, as well, will be able to tell him if there are other spots that have popped up. There is one other "cloudy" spot that wasn't there in March, but that could be scarring tissue and could have been there all along. Soooo, we wait for the report to come in which should be here in another couple of days.

IF, from the report he still doesn't know one way or the other whether this growth is cancerous, then he would like to suggest a needle biopsy, like I had done on the adrenal gland when we needed to know if the adrenal growth was cancerous or just a fluke that it lit up the PET scan. Now, the problem with the needle biopsy is that the lesion is actually very deep in the lung, so it's possible that doing a needle biopsy on that area will not be feasible or possible. And there's not a 100% guarantee the needle biopsy would tell us what we want to know. He says, if the results come back inconclusive, then we are back to square one. It may or may not be cancer.

IF, from the report he figures that all pointers lean towards it being cancer, then we would forgo the needle biopsy and go right in for the surgery to take it out.

What I love about Dr. Yee is he is willing to spend a lot of time with me, going over what he knows, what he would like to know and what we will do to find out as much as we can before going in and doing the surgery. The end result being... we could do the surgery and when the lesion is sent to pathology, we may find that it was not cancer so the surgery was done when it didn't need to be... or we may find that it is cancer, in which case, thank goodness we did the surgery. Right now, there are a lot of unknowns, mainly because the lesion has grown, but not as quickly as he would have expected it to.

Ok... onto the surgery if we have to do it. I have included a very rudimentary drawing (hey, I am many things, but I can't claim to be an artist by any stretch of the imagination!) to help explain what the procedure will be. As you can see, both lungs basically consist of 3 lobes. Another analogy would be the lungs have three branches with a leaf (lobe) at the end of each branch.

I have marked in the bottom right lobe (Lobe 3) approx. where the lesion can be found. Dr. Yee would start the surgery, sort of like Laprascopic surgery, with incisions where one incision is used for a camera. Alas, the lesion is deep in the 3rd lobe, so the camera is not about to pick up anything on the outside of the 3rd lobe. So, prior to surgery, I would be taken to the CAT scan department and a tiny dot of plutanium (?) would be inserted into the lesion. I would then be wheeled to Surgery where Dr. Yee and team would be waiting for me and I would be put under anesthetic. The camera would be inserted into a small incision and now the camera will be able to pick up the plutanium dot and know exactly where the lesion was deep in the lung.

Notice on my drawing, the dotted lines? That would be the smaller area of Lobe 3 that they would take out... that includes the lesion. While I'm still on the table and under anesthetic, they would have removed the lesion and surrounding tissue (the dotted line area) and would send it down to pathology who would analyze it right then and there while I'm still on the operating table. IF the results proved that the lesion was benign, then that is it, they would sew me up and then it's a matter of recovering from the surgery with a big chunk of Lobe #3 having been removed.

IF the results prove that it in fact is cancer, whether it is colon cancer because it had spread or a primary lung cancer, I would then be opened up further and they would remove all of Lobe 3 from the right lung. The reason? Notice in the diagram I have 3 arrows pointing from the lesion passed the dotted line. If this is cancer, then it would start spreading from the lesion in that direction (not upwards or downwards). So they would have to remove the complete Lobe 3. That decision can't be made until they know what they are dealing with... which would be after the results came back from pathology.

Of course, if the CAT scan report comes back indicating that this lesion is cancerous, then we would be bypassing the needle-biopsy and the surgery to remove part of the lobe and go directly into removing Lobe 3.

So, it's not as cut and dry as say, tonsils. They are inflamed, out they come... no decisions need to be made. This has a lot more variables. After Dr. Yee finished explaining all of this to me, I told him that if we exhaust every possibility we can of finding out whether this lesion is cancer or not and we still come up with inconclusive results, then I would rather we went through with the surgery, rather than not do anything and just hope that it is benign.

Having said that, there is no immediate hurry to get into surgery. We have time to do some testings and hopefully find out what we are dealing with. It still looks like we may be looking at October for any surgery. The one glitch, Dr. Yee is off to Bangladesh for 2 weeks in October. Every year, he goes where the need is and volunteers his services as an expert in Thoracic Surgery (which makes me respect him even more! A man after my own heart when it comes to volunteering one's expertise, no matter what that is). He said that if he was gone that he would definitely get one of his colleagues to do my surgery if need be. I asked him if I waited until he came back, would I be putting my health at even the remotest risk? He said that no, there would be no risk and he would only be gone 2 weeks. I told him then the decision is a no brainer for me... I want HIM to do the surgery, even though I'm sure his colleagues are fabulous too... I just happen to know I have the best and would like to keep it that way :)

Sooooo.... ends my very long babble on this appointment I had with Dr. Yee. I am soooo excited that I have such a wonderful surgeon, and someone I feel totally comfortable communicating with. His explanations made perfect sense to me. I am not going to get my hopes up too high, but could you imagine if it turns out that this lesion is benign?? Even if we go through with the surgery... it would mean the cancer is in check as we speak!!!



Sooooo, even if the surgery is a go, keep sending those wonderful, positive thoughts!! Heck, if this IS benign and we have the surgery because we don't know for sure, well , all the more reason to have one big old party afterwards!!! That is still in the planning stages so get out those party frocks!!! :D

Huggggggs,

Cheryl