TYOLD Day 69: Haven’t I Been Here Before?

I didn’t do anything actually different today I just did different versions of things that I feel like I’ve done a billion times already.  I went back to the Roy & Patricia Disney Family Cancer Center but I went to the third floor for the first time.  I sat in yet another waiting room – kinda bland – and filled out more forms.  Have I mentioned how much I hate all of the paperwork associated with cancer?  The good news is that now I’m smart enough to have all of the stuff I need for these kind of forms stored in a file on my phone – my medicine list, emergency contact information, family medical history back to the time my great, great, great, great, great grandfather came over from Bavaria.  I’m making that last one up but not by much.

The old man sitting behind me in the waiting room kept farting.  That was different.  I moved.

And most importantly was the different opinion that Dr. Wile E. Coyote had than what the other oncologist had.

Just in case you are coming to the party late, I had my regular check-ups a few weeks ago with a new oncologist, there were some irregularities in the tests so I did more, they found a spot under my armpit, and the new oncologist wants to wait because it’s too small to do anything about right now.  I ran into my former oncologist in a bathroom at Caesars Palace at 1 in the morning and that’s who I saw today for a second opinion.  Yeah, my life is that weird.

caesars

He is “worried.”  But also not totally worried.  Unlike the new oncologist, Dr. Kangaroo, who called me and said “this is what it is and don’t worry about it and I’ll see you in 3 months,” Dr. Wile E. Coyote showed me the test results, went over it line by line, explained what everything meant and also what it didn’t mean, and then actually examined me.

The short version is that there are actually two spots – one is a 1.1 cm “cyst lymph node” that has grown in size since the last scan (up from .7 cm) and is showing “hypermetabolic activity at a maximum SUV of 6.0.”  In layman’s terms, hypermetabolic means the lymph node is angry about something and SUV (Standardized Uptake Value) is how angry.  Anything above 2 is concerning.  There’s a second, even smaller lymph node that is also angry, but only a little bit with an SUV of 2.1.   Both are deep in my left arm pit.

These are the words you don’t want to see on your PET scan results: “suspicious for metastases.”

Okay, so that’s why Dr. Wile E. Coyote is worried.  But here’s why he’s also not worried: he is fairly dumbfounded that the other doctor said to go ahead and have the PET scan despite the fact that I had shingles when I got it.  Dr. Kangaroo said that wouldn’t matter while Dr. Wile E. Coyote said it could totally matter and could explain the results, especially since I had the shingles on the left side of my body and these lymph nodes are in the left arm pit.

He also explained that esophageal cancer rarely spreads to the lymph nodes in the arm pit without getting into the lymph nodes between the esophagus and the armpit first.  That’s both good and bad news, because if it is more than just anger at the shingles, it is probably something other than metastasized esophageal cancer – it could be some entirely other kind of cancer.  That would be different!

But he is still worried enough to want to do something about it so here’s what’s happening next: I am going to go get an ultrasound and they will try to find the lymph nodes that way and see if they are still angry now that the shingles have subsided.  From here it becomes one of those yes/no decision trees.

Question #1: Do the lymph nodes show up on the ultrasound?

a) If no, then it was most likely the shingles and I go back to my regular 4 month check up cycle.

b) If yes, then go on to question #2.

Question #2: Can a biopsy be taken of the lymph nodes?

a) If no, then I wait a couple of months and see if they grow and then do the biopsy.

b) If yes, they will take the biopsy right there – a needle in my armpit.  Fun!  Then go on to question #3.

Question #3: Is the biopsy malignant?

a) If no, then I wait a couple of months and do it again because there is a chance with something this small that they might not be able to get a good sample.

b) If yes, well then it’s a whole different kettle of particularly stinky fish.  They will type the cancer to see what it is and then decide on a course of action from there. Surgery most likely and chemo possibly.

But that’s a long ways between here and there and I’m fully expecting that at least one of the answers above will be a “no” and I won’t have to deal with it.  Fingers crossed.

They are working on getting the ultrasound approved by the insurance and scheduled so that probably won’t happen until next week.  An ultrasound of my armpit and a needle biopsy – that’ll be different too!  Wow I’m stacking up Differentlies all over the place, aren’t I?  Not exactly the kind I was hoping for but…