Saturday, February 20, 2010

Talking Big C with Dr. C

In the event you really want to know what happened at the oncologist’s office yesterday…

1. Office staff at first tried to foist off a nurse practitioner on me. We wouldn’t have it. After a few minutes Dr. C arrived, and patiently answered my questions.

2. The surgery previously scheduled for Thursday is still on. A single metastasis in my right hip will be removed in a wide local excision. It’s an office procedure that will be done with local anesthetic. Ellen will be with me so I don’t have to drive home perched on one side of my butt.

3. The “crop of bumps” I’ve experienced in the last few weeks—three, to be precise—might pass with no further recurrences for now. Metastatic melanoma is notoriously unpredictable, however, and anything is possible. It could recur at any time.

4. Surgery remains the treatment option of choice, so long as the mets don’t come again in bunches. Should they spread internally, surgery obviously becomes more problematic.

5. There is no guarantee the mets will stay centered in tissues under the skin. Dr. C used a “seed and soil” metaphor, in which he described a person’s melanoma as having a certain preference for where it grows. Mets found in the skin are clearly not as serious as, say, in the liver.

6. Over time, melanoma cells often develop additional mutations, which increase the likelihood that the melanoma will migrate to other, internal tissues. The “seeds” develop a liking for other “soils.” My prognosis is better so long as any future mets are found in the skin only.

7. My immune system is working furiously to contain the melanoma. Unfortunately, it’s currently on overload, which is why my melanoma is now metastatic (as opposed to local).

8. Surgery is therapeutic to the extent that the “tumor burden” in the body is reduced each time a nodule is removed. You don’t want to leave a nodule unattended any longer than you have to, as they have a doubling time of about two months. (Should everything you’ve learned about cancer come from Woody Allen, let me assure you that suppressed anger is not a risk factor. It was in the movie "Manhattan," that Allen whined, “ I can't express anger. That's my problem. I internalize everything. I just grow a tumor instead.”)

9. We also talked to Dr. C about cancer vaccines, immunotherapy, chemo, targeted therapy and other dastardly ways of combating further advancement of my melanoma. The science that underlies the treatment options is fascinating, albeit not very effective. We don’t have to go there for now, thank God.

10. In the ongoing speculation over the amazing disappearing leg nodule (see below), Dr. C thinks it was in fact a melanoma and that he can’t explain why it resolved. The indicator on the Miracle-O-Meter tilts back toward “true.”

11. Dr. C granted me a patronizing smile when I said prayer might have had something to do with the vanishing nodule. If you’re so inclined, you might want to fire off a prayer this week that the nodule in my hip also self-destructs. I'd love to crimp the business of these oncologic surgeons.

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