Medical Update -- 5/27/09

(Gentle reader, the following information is the best understanding I can get about what's going on with me. Your comments are encouraged.)

My healing from surgery is just about done, so it's time to make a decision about what happens next. I got the news yesterday afternoon that the Pathologist at Johns Hopkins confirmed the analysis by the Chester County Hospital Pathologist that the cancer was a metastatic cancer (that means that it can travel from one place to another) in my parotid salivary gland. And I am informed that this is an aggressive form of cancer. This information helped me reach the conclusion mentioned at the end of this write-up.

As mentioned in the 5/23 posting, there is some disagreement about the best way to proceed among the doctors I'm working with, a discrepancy because of two different facets to the cancer:

On one hand, there may be some residual primary tumor in the salivary gland, and some doctors I've talked with say that you should surgically remove the entire parotid as a first step. This would, however, delay chemotherapy and radiology until the new surgery heals up. (Because radiology can undo the healing process and cause considerable difficulties in the process.) One radiologist tells me that the healing would take from 4 to 6 weeks. Another tells me that 2 to 3 weeks would be sufficient. In either case, cancer cells will continue to spread around my body -- settling almost anywhere -- and begin to grow. Something like 7 of the 30-odd lymph nodes that were removed recently had cancer cells in them, so clearly there is spreading going on even as you read this.

The other approach is to start chemotherapy as soon as possible in an effort to eliminate the cancer cells that have traveled away from the primary site. And to start radiology as soon as possible to deal with any residual primary tumor that may remain in the parotid.

An unidentifiable mass -- roughly 1/4 inch -- showed up on the MRI, which may be tumor or may be an inflamed lymph node. There's no way to tell. I am informed that the radiology should be able to "take care" (my term) of this mass if it is tumor, but I must admit I'm not sure whether "taking care" of this means just stopping it from spreading or actually making it shrink and possibly disappear.

After a month of treatment in this second approach, I would undergo a second MRI to see if the mass is smaller, unchanged, or larger.

So Step 1, you remove the parotid gland to provide some assurance in the local area or you go after the stuff that's spreading all around and then concentrate on whatever may be left in the parotid gland.

And I've chosen this second option. To start radiology and chemo as quickly as possible. The initial bump on my neck was discovered in late January and, to date, nothing has been done to address the potential spread of the disease.

It took a long while for me to understand that there are no right and wrong answers to this dilemma as to how to proceed. Both approaches might yield complete success. Or neither approach might do so. The cancer is unusual enough that no one can give an answer with any assurance.

So the right answer is the one that feels best to me, and that's what I've chosen to do.

I am deeply grateful for your continued prayers and best wishes.