Possible Lung Thingy

[Vinny]

Hi folks, long time no see. By way of background, I had a left orchiectomy 1/2005, 4xBEP through 4/2005, RPLND 5/2005. CT scans for the last year have shown a stable nodule in the lower lobe of my left lung. At the time it showed up, the oncologist and radiologist figured it was probably harmless, either histoplasmosis or some other calcification that had not appeared previously due to the slice spacing of the scans.

So, I went in for my regular surveillance CT scan today and the nodule seems to have grown slightly, from 0.9 cm to 1.3 cm. The oncologist is concerned it might be teratoma (which was present in the original tumor and lymph node met) and wants it taken out as soon as possible. He doesn't see the point in doing a needle biopsy.

I'm hesitant. We're trying to get a PET scheduled tomorrow, although I'm not sure what it would show that a CT doesn't show. My tumor marker results from today should be available in the next day or so.

Any thoughts from you TC gurus? If we do go the surgery route, how major of a surgery are we talking here? Is this another instance where we want to go with a major cancer center (my RPLND was done at IU) or will a local surgeon be up to the task?

[dadmo]

Vinny/Frank
If you only have one spot the operation can be minor. We have a friend who had a lung spot that the doc's wanted to look at and they were able to remove the spot by inserting an instrument in between the ribs. If however the spot is in a difficult location they may have to go in through the back. It really is best to check with what the doctor thinks is required.

P.S. Thanks for the reading list on your blog. Say hi to the Rev. and tell Kelly I'm pulling for her.

[danebert]

If I remember correctly, you had a fairly large abdominal tumor, and had teratoma in the RPLND specimen. There is a good chance this is teratoma. ( Slow Growth). IN addition, a mass of teratoma may remain indolent for a period of time then grow. Most studies ( At least those out of Indiana and MSKCC) have revealed that those who had teratoma resected from the retroperitoneal lymph nodes have a higher chance of a relapse of teratoma, not cancer. About 80% teratoma / 20 % cancer. If the markers come back normal, and I’m sure they will, I would bank on it being teratoma. One procedure known as Video Assisted Thoracic Surgery (VATS) involves the removal of a mass in the chest using video-assisted technology, a technique that uses tiny cameras inserted through small incisions to help navigate surgery. This is similar to the laparoscopic RPLND. Some argue this is more efficient. However, You will probably want to go with a wedge resection. I think it is more thorough. However, I’m not the doctor. I would recommend you call IU, their thoracic surgeons have done many wedge resections on men with TC. There are surgical complications associated with Bleomycin which Indiana is able to deal with. ( They use similar intraoperative tech. with the RPLND i.e. lower oxygen concentration, more regulated fluid intake ect. ). You want to be careful, specially considering the fact this is lung surgery. Good Luck, and Keep Us Informed. I'm pulling for you, I had my RPLND about a week or two after you with Dr. Foster, and reading your post helped me out.

[Vinny]

Well, the oncologist did the PET scan (looking for mediastinal disease, but perhaps also to meet his sales quota for the month ) and it came back completely normal. On to the thoracic surgeon today. The oncologist thinks this will be a minimally invasive wedge resection, but I'm waiting to hear from the guy who will do the actual cutting before getting too excited.

Also, I did get a nifty souvenir CD of the PET study so now I can display my body in an eerie 3-D view, rotating as though I were on a barbecue spit. Was it worth lying completely motionless for 2+ hours (the scan itself was about 45-50 minutes, but you have to "take a nap" while the PET dye works its way through your system).

To quote Paul Rodgers and The Firm, "I'm Radioactive."

[Mom]

Well that is certainly great news, Vinny. Now you have to go to the next step to get this behind you. After all you have been through it will be a piece of cake! Hang in there. Dianne

[dadmo]

I know how troubling it is waiting for the next operation but soon it will all be in the past. Please keep us posted. Say hi to the rev.

[Vinny]

Not what I expected...

Well, the good news is that the surgeon was able to use VATS to do the resection, so I went home today (Friday) after surgery on Wednesday.

The bad (or at least interesting) news is that the preliminary pathology results on the removed thingy are that it appears to have been active germ cell cancer. So, that leads me to these possible explanations:

- it's new growth; or

- it's been there since I was under chemo and for some reason it didn't respond to the chemo.

Not sure on which is the correct explanation; my tumor markers have been negative since the middle of BEP round 4. My onc has a message in to Dr. Einhorn @ IU and is awaiting his guidance and counsel. I'm guessing the options will be either salvage chemo or continued surveillance.

When the final pathology results come through, I'll probably have IU do a second opinion.

Anyway, it's good to be home.

[Scott]

Hoping for good news... Glad to hear you're home!

[dadmo]

It's good to know you're home. Rest well. I hate to give you an assignments but could you add to your reading list. I finished almost all the books.

[Vinny]

Fortunately, books are the Rev.'s department. She's always reading something, so I'm guessing there'll be some additions soon.

She just finished the latest Christopher Moore book "A Dirty Job". She says there's quite a few laugh out loud moments, but not as many as in his other books. The main topic in this new book is death, it may not be an ideal reading subject for everyone.

Still, she would recommend you head to your local library and check out all the Christopher Moore books and read them back-to-back. My favorite is "Lamb", but "The Stupidest Angel" was pretty good too. The Rev. liked "Island of the Sequined Love Nun" and "Practical Demonkeeping".

[dadmo]

Christopher Moore is great and yes "Lamb " is the best of the bunch. Now, how are you feeling? You've been through a lot.

[Vinny]

Really, compared to the RPLND, this was a cake walk. Aside from a few vomiting episodes the day after surgery, I haven't had much problem (although my sleep clock needs to be reset, as the time stamp on this message will attest).

The biggest impediment to me walking the day after surgery was having the foley catheter and the lung drain attached to me. Once I had my tubes pulled and the IV taken out, I was strolling around the hospital at a normal speed without getting too tired.

Started solid foods Friday morning after a Wednesday surgery, and they told me as long as I was up and getting around I shouldn't have any problem keeping food down. Even got to take a hot shower before going home. (Although I did have a young student nurse who voluntarily offered a sponge bath and a back rub the day before - how could I decline such hospitality )

I have a dull ache on my left side; three small incision sites and a larger one where the chest tube was. The pain level is about a 3 out of 10 without the Norco/Vicodin they gave me to take home.

Suffice it to day I think by the end of the weekend I'll be in much better shaper than my sister, whose two-week old triplets are coming home today (Saturday). My biggest impediment to recovery will be pushing myself too hard.

[dadmo]

Sleep clock? What's wrong with being up at this hour checking out the forum? When I saw your time stamp I had to laugh.

[Krokar]

I'm also glad you are at home and fine Vinny. It is at least 90% better at home then in hospital, even with young nurse behind your back. Or she was rubbing something else except your back

Best Regards,
Alex

[Scott]

my sister, whose two-week old triplets are coming home today (Saturday).

Wow, now there's an accomplishment! We have twin sons (and two older daughters), but when the babies outnumber you... My best wishes to your sister and her instant family!