Sunday 30 June 2013

Best Laid Plans

We returned to Melbourne on Thursday so that I could have my pre-operation Ct scan on Friday morning, and also to prepare for Mondays surgery. Late on Friday afternoon a member of the surgical team called to tell me that the surgery had been cancelled as the latest scan had revealed that the enlarged lymph node that was to be removed had shrunk in size from 17mm in diameter to 11mm. This is shrinkage unexpected and good news, however it also raises a number of tricky questions.
At 11mm the lymph node is now classified as 'non specific' i.e. it does not fall into the category of being definitely problematic or definitely benign, and as medicine is a conservative profession by nature the surgical team does not want to undertake a major operation without  there being a definite and specific need to do so, hence the cancellation (it seems that the surgical team made the cancellation without consultation with the oncologist who ordered the surgery, which is inopportune as I think oncologist would have requested that the surgery go ahead due to some complicating factors).
The complicating factor, and the reason the surgical team should have consulted my oncologist prior to cancelling, is the history of my disease over the past few years. This lymph node was first identified as being a potential problem back in 2011 and surgery was raised as a possibility at that time, however the lymph node fell into the 'non specific' category then too. That fact, in combination with the fact that the chemo I had at that time had appeared to be successful, meant that the surgery was deemed unnecessary and I was placed on a monitoring regime instead.
Fast forward 18 months to my latest relapse and it all feels a bit like deja vu, except that I have been through another mountain of crap to get here and I don't want to be sitting here in another couple of years facing the same problem, or worse, I'd rather have the hopefully temporary hassle of major surgery and gain some long term of peace of mind. That may seem weird to some, but I have to bear in mind that treatment options get more limited and more brutal with every relapse, so I want to do everything I possibly can now rather than risk another relapse.
Offset against all this is the possibility that the enlarged lymph node has not actually been the source of my problems over the last few years; that is just one of many question regarding this matter that I will pose to my oncologist when he returns from leave on Monday week. I have a feeling that my oncologist will share my opinion that the surgery is necessary and he will request the surgeons to go ahead irrespective of what the lymph node is doing, on the other hand he may want to wait and do another scan in month or so to see what the lymph node is up to.
All the above adds up to a sense of confusion at the moment.
Cheers, Pete

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