Thursday, May 18, 2017

Danger, Will Robinson! Danger!

If you've been following along, welcome back. If you're new, I urge you to head backward and start from post 1. They're not long, but it'll catch you up to the story thus far. As I said before, my husband had been going for scans monthly, and his oncologist had been keeping an eye on his tumor markers. We now go into

December 2016 - the month everything went to hell in a handbasket

So, my husband's tumor markers never returned to zero after the operation. They dropped significantly, but this is one reason the doc was keeping such a close eye. Each month, they were doubling.

In December, they rose to a much higher level. Wanna know the kicker? Nothing was showing up on the CT scans. Nothing. Nada. Zero.

So, he was scheduled for a PET. Turns out, there's a 3cm tumor on his abdominal lymph nodes.

We asked the oncologist what that meant, and he informs us that means my husband will have to undergo chemotherapy (BEP - 3 rounds). You've never seen a more wretched couple of people.

Being the information/education seekers we are, our searches began. What we came across scared the crap out of us.

We asked for time to seek a second opinion and sent files and e-mails to one of the top TC oncologists here in Atlanta. First appointment availability was in January. We took it.

Now, my personal suggestion is to seek/find all the information you can from reputable sources if you're at this stage of the process. If you go looking at things from survivors or those suffering through this, you'll only end up crying in a corner with a box of tissues. Facebook also has some excellent resources via groups and pages. Lots of support to be found there.

Let's move on to

January 2017

Second opinion doctor says he also recommends BEP chemo. But, he tells us something we hadn't heard: If the tumor is teratoma, the chemo won't do anything to it. Looking at the path report (if you're new, you can find it on this post), that doesn't look as likely. Teratoma only made up a small portion of the original tumor.

I ask if it might be better to get a biopsy to be sure before going through the crazy that's chemo. That option isn't a good one because it can cause the cancer to "seed" or spread by being opened up.

Basically, worst-case will be if the tumor is entirely teratoma. If that turns out to be the case, the chemo will do nothing to it, and we'll still be looking at surgery.

Let me take a moment here and give you an aside/some education on what kind of surgery this is.

It's called an RPLND. Defined:

Retroperitoneal lymph node dissection (RPLND) is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type. It is usually performed using an incision that extends from the sternum to several inches below the navel.

If you look at the human lymphatic system, you'll see exactly where these nodes are spread through the body. Here's a photo because I'm a visual person:



Let's zoom in to where it matters (abdomen) and get anatomical:


As you can see, these particular nodes are wrapped around major blood vessels. These are the nodes into which the testes drain.

Back to the matter at hand.

Now, from what we've been able to glean from research and speaking with doctors (lots and lots of them), teratoma doesn't make tumor markers rise.

We make a (well informed) decision to go ahead with the BEP (or PEB): bleomycin, etoposide, and cisplatin chemo. It started February 20th.

BEP (three cycles) goes like this:
  • Week 1: 5 days (M-F) - etoposide and cisplatin daily with bleomycin also given on Tuesday
  • Week 2: bleomycin on Tuesday
  • Week 3: bleomycin on Tuesday
  • Week 4: 5 days (M-F) - etoposide and cisplatin daily with bleomycin also given on Tuesday
  • Week 5: bleomycin on Tuesday
  • Week 6: bleomycin on Tuesday
  • Week 7: 5 days (M-F) - etoposide and cisplatin daily with bleomycin also given on Tuesday
  • Week 8: bleomycin on Tuesday
  • Week 9: bleomycin on Tuesday
I'll tell you the tale of February 2017 tomorrow and go into all the other things infused with these drugs.

Until then!

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