Wednesday, April 27, 2011

My Husband the Medical Oddity

First News – Frédéric is home. He was discharged from the hospital on Sunday. They told him his initial recovery was faster than expected. Alas, further recovery will take some time. When they take all your insides out, put them on your chest, cut more, put them all back, it takes awhile for everything to get back into place. He’s doing alright, just in pain and nauseated and losing weight. Hopefully that will improve with time. He's taking walks around the house to try to jingle everything back into place. The doctor said to plan for 3-4 weeks recovery time.

Second News – Good News and Not So Good News
As expected, the kidney tumor really was from the kidney – not metastasis from the testicular cancer. This is good. They removed a wide margin around the tumor, leaving half the kidney. The pathology report indicated this was sufficient to consider the cancer completely removed. And though he’s now at a slightly (5%) increased risk for kidney cancer in that same kidney, they’ll consider the kidney cancer cured.

The other part of the surgery was the lymph node dissection (RPLND) related to the testicular cancer. TC usually goes into the nodes first, so removing them and evaluating them helps both to potentially remove the cancer and determine if it’s spread. Ideally, if it’s in 2 or less nodes, surgery should be sufficient along with surveillance, so no chemo. Initially 2 nodes had been enlarged, which was the cause for concern. They removed 29 nodes overall. All negative for cancer! Hooray! That’s the good news.

The not so good news – they found cancerous cells in the tissue between the nodes and in the vein. So the nodes are clear of cancer, but the tissue is not. This is strange. Apparently, having only the lymph nodes affected or the lymph nodes + tissue affected is typical. Having only the space in between the nodes affected is not. You oncologists and pathologists may have more info, but in a quick review of the literature I couldn’t find any info on this type of situation and the urologist found it very odd.

What does that mean now? We don’t know yet, but probably chemo. Possibly two rounds instead of the more usual 3-4, and maybe 2 drugs instead of 3. However the standard drug for testicular cancer is Cisplatin, which is toxic to the kidney. Though they managed to save half the kidney, his kidneys are weakened and they are at increased risk for kidney problems. So over the next couple of weeks we’ll be making the round of oncologists locally, and his info has been sent to the testicular cancer experts at Indiana University (incidentally where my sister happens to be on faculty, in a different department). Fortunately his case isn’t severe, just unusual, requiring some thinking outside the box in terms of next steps. They don’t want chemo starting until he’s completely recovered from the surgery and his kidney function is as close to normal as possible. Oh, and it’d help if he could hold down some food so he can put some weight back on…

Thank you all again for your wonderful support, help, thoughts, meditations, and prayers. All are very welcome and appreciated. You’ve all made this experience go much more smoothly.

For you medical types, the exact wording on the final path report is:
"the lymph nodes are negative for tumor, however, in the perinodal lymph-vascular spaces metastatic embryonal carcinoma is identified, 2mm at greatest dimension."

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