Surgery and PET/CT results

Okie dokie. We had Noelle's parents come in town today to help out and make life easier for the both of us.  It's good to have family here and fun to talk about things other than surgery or cancer.  Typically its the very end of the season for wakeboarding but the best time to ride.  The weather has been consistantly in the 80s and sunny, which is very unusual up here, and has been tormenting me since the day I had surgery 10 days ago.  I offered my services as camera man while some friends rode on Wednesday and we'll get to hang out on Lake Coeur d'Alene tomorrow.  It's nice to be occupied with something fun for a few days.

Surgery was a success.  I figured I will give a brief description of surgery just so those who don't know can learn more about it.  Its called a Radical Orchiectomy and involves approximately a 3" incision in my lower abdomen.  From that incision the spermatic cord is cut and the entire testicle is removed completely intact.  That way, there is no way for tumor cells to be left behind.  They can't do a biopsy of a testicular tumor and they can't cut a testicular tumor out.  Everything comes out.  Yes, I've lived with one boy for 6 years and now the boys are gone forever :( 

I'm still not sure exactely what to think or how to feel about this at the moment but in reality I'm not that upset.  Having a wife who couldn't care less and loves me for me is the biggest reason for that.  Love you sweetie!  I will have 2 absolutely gorgeous little girls and will likely have more in the future, thanks sperm bank in Tomball, TX!!!  I will never have to endure the pain of getting "racked" ever again!  Take that all you guys out there....  And go ahead and try to laugh and make fun of me for having no balls (even though I know you wouldn't), I'm still bigger than you and I can still do backflips on a wakeboard... Can you do that?

The pathology report told us what we had feared, that I once again had malignant tumors growing in my testicle.  For those interested, there are two types of tumor: seminoma and non-seminoma.  Seminoma's are essentially benign and are 100% curable.  My tumor was a non-seminoma mixed germ cell tumor.  That means there were at least 3 different cell types: 40% Embryonal Carcinoma, 30% yolk sac tumor and 30% Teratoma.  The primary concern is the Embryonal Carcinoma.  Thankfully, chemotherapy is extremely effective against all these cell types.  All of the tumor was contained within the testicle itself, no tumor on the epidimus and no tumor on cord (which is good). 

The day after my surgery I went in for the PET/CT scan.  This is really cool technology, I love this stuff.  They injected me with radioactive isotopes attached to sugar molecules.  The sugar molecules and the radioactivity will be highest in your brain, your heart and in cancer cells.  Even at rest, cancer cells are burning through energy (sugar) at a very high rate.  So, you then scan the body for radioactivity and match that picture up with a CT image taken at exactely the same time and you see if you have cancer cells. Very cool.  What's not cool is trying to lay perfectly still for 30 minutes on a flat board with my arms above my head while they did the scan.

The good news... The 1cm spot in my lower right lung is active but only marginally.  It could be cancer but its not definately cancer.  The only way to tell is to have surgery to either biopsy or extract it from my lung.  Then they can do a pathology report and see what it is.  Also, there was no activity whatsoever in any lymph node in my abdomen or pelvis.  Typically if the cancer has metastasized it will go to these lymph nodes 1st and they will be inflammed or have tumors.  I'm clean there.

The bad news... The PET/CT reveiled a lymph node in my chest with a possible tumor.  The area showed up as extremely active on the scan meaning it is highly likely cancer.  This one gets a little tricky.  The trachea is the light blue Y-shaped object with black stripes in the picture below. The lymph node in question is #7 on the left side image (image from  http://radiographics.rsna.org/content/29/2/403/F21.large.jpg ).
As you can see, the node is in a pretty tricky area.  Directly behind my heart.  Directly in front of my esophegeous and directly below my trachea. 



We were presented with a few options.  All involve surgery with the Cardiothoracic surgeon.  I'll talk more about that tomorrow. 

I don't really know how to describe what I'm thinking or how I'm doing.  My mom's probably sick of hearing, I'm fine, but I don't know what else to say cause I'm fine.  I'm more nervous about the next few weeks and months than I ever have been about anything.  But, it's a strange sort of nervousness where I'm driven to learn as much as I can about it.  I wish I would have grown a pair and put myself through medical school.  Lol, sorry, it was the 1st that popped into my head.  I need to stop that.  I've spent a lot of time searching the web and trying to learn more about what I need to have done and what is happening inside my body.  I'm scared of the surgery that I will have to have but I would have done it a week ago if I had the choice.  I want this crap out of me, whatever it is. I'm excited about the future, I'm excited to fight against whatever this is and I'm excited to move on.

I should be caught up tomorrow, I hope....

Step 1

About 3 weeks ago I scheduled an appointment to see my Oncologist so that I could get my 5 year CT scan.  This is usually the last one and if it comes back clean, you are said to be in full remission of cancer.  I was about 3 months over due so I relented to Noelle's "reminders" and got the appointment to see Dr. Njuguna.  For some reason I was hesitant to get this last CT scan.  I'm not sure why, but I finally gave in.  Did you know that if you are one of the lucky 0.4% of people to have testicular cancer, you have a 2% chance of having cancer in the other testicle at some point in your life?  If my math is right, that means a random person has a 1 in 12,500 or 0.008% of joining the 2X club.  I should buy more lottey tickets.

About 3-4 days before the meeting I noticed something while in the shower.  It was just a small irregularity on my left testicle but definatly there.  I stood in the shower for what seemed like an hour trying to convince myself that it was nothing but I was too scared to examine it any farther. There are quite a few types of tumors/growths/masses that can be found on the testes so I tried hard not to worry too much.  But deep down I knew.
The day before my appointment I got up the courage to tell Noelle.  This girl is really good at hiding her feelings, especially if she is scared or worried, but I can always tell.  She was optimistic and glad that I was seeing the doctor on the following day.  Dr. Njuguna ordered an ultrasound and a CT scan to take place early the next week.  Exactly one week later he came in the same room, sat down at the computer and said "Ok, lets start from the top"  That wasn't exactly what I wanted to hear but I was prepared, or so I thought.

We went over the ultrasound first.  Ultraound is extremely useful for imaging soft tissue and is the 1st thing a doctor will order if there is a question of a testicular tumor.  It is pretty ridiculously uncomfortable if you ask me.  Slightly awkward with the ultrasound gel and typically some young female ultrasound technician.  Anyways, its a medical nessecity, moving on... The ultrasound showed two distinct tumors.. not good.  There is no physical way to biopsy a testicular tumor, I knew this, so I knew immediately what that meant.  More surgery for Adam, woohoo!  The 1st time around there was no real change in lifestyle, you can live with one testicle just fine.  I have proof that one chemo-surviving solo-mission boy is all you need to live a completely healthy life and have a beautiful family.  But another surgery meant something completely different 1) for the rest of my life I will have to give myself testosterone injections every 2 weeks and 2)we are done having children naturally.  Bummer...
The second bit of bad news.  On the CT image they saw another tumor on the lower lobe of my right lung.. not good.  My stomach dropped, my heart was in my throat.  I can handle testicular cancer, I've already beat it once.  The chemo sucked but I can handle that as well.  I blocked out what the doctor was saying because the thoughts in my head ran together a little like this... Lung cancer? What the...?  Is this because of the testicular cancer?  We can't sell the house now, Noelle will be so bummed...  I'm supposed to go to Minneapolis for two weeks in a few days... Has it metastasized to anywhere else?  Oh, Noelle... oh man, Brynnley.... oh my goodness... The baby.... Am I even going to get to meet this baby?  This can't be happening, hes got to be wrong.  Focus, focus, focus...... @*&$!!!  I've basically had the same thought pattern going on and on since I found out.  It mentally exhausting and plays with your emotions like crazy.  It's going to be very tough to stay positive but it's a lot easier with the support of family, friends and total strangers, so thanks :-). 

He showed me the image and I could clearly see a small white lump in the bottom of my right lung that was obviously not supposed to be there.  It's less than 1cm in diameter but whatever it is, its there.  He didn't have any answers but tried to keep my from worrying because there is so much that is unknown.  He set me up for PET/CT scan soon after surgery.  More on that later, but a PET/CT scanner is designed to look specifically for fast growing tumor cells so it would tell us if this spot could be cancer.

Surgery with the Urologist, Dr. Golden was scheduled for Monday Sept 20th and a PET/CT was scheduled for the 21st.  More tomorrow.

A little background

1st post... I'm not a great designer by any means so I'm sure this page will change when my wife takes a look at it.  I honestly don't know what I'm doing there, sorry...


Roughly 6 years ago, just 2 months after marrying my sweetheart Noelle, I was diagnosed with Stage I Testicular cancer.  I had surgery to remove the tumor.  Even though the doctors were pretty sure that I was cured with surgery, I didn't want to take any chances so I went through 6 weeks of chemotherapy.  Home Free!! Or so I thought...  Cancer is has got to be one of the sneakiest most devastating diseases that someone will ever have to deal with.  I say devastating because even though technology is amazing and survival rates keep going up and up; mentally, it can just destroy you if you aren't careful. Its never straight-forward but comes at you sideways and when you least expect it. Sorry, more on that later.... There are actually very few people who even know what we went through, we only told our very good friends and some of the people in our church in Texas.  I regret not telling more people. 

Some facts...
Testicular cancer is most prevalent cancer in Caucasian adult males ages 15-40.  Roughly 1 in 250 (or 0.4%) of us will have to deal with this in our lifetime.  If it is caught early, before it has metastasized into the lymph node system, the cure rate is nearly 100%.  Even if you catch it late and the tumor has metastasized into the lungs, brain or other parts of the body (as with Lance Armstrong who had more than 10 tumors all throughout his body), the survival rate is greater than 85% with chemotherapy.

This is why I regret not being more open.  If you are a male in this age group, you HAVE TO DO SELF EXAMS!  The better you know yourself the more likely you are to realize that there is something abnormal.  And if there is even a slight question, go see a Urologist and have an ultrasound done.  There is absolutely no reason not to.  

So, we endured cancer, graduated grad school and moved to Spokane, WA.  We love it here and have spent the last 4 years making a home in the beautiful Inland Northwest.  We spend every spare second on the lake or in the mountains in the summer time.  In the winter time, I stay very active in 2-3 basketball leagues and we just try to maintain our sanity until the next spring/summer.  We love it.  Even after all that nasty chemotherapy we were able to conceive our beautiful baby girl naturally.  Brynnley is the light of our lives and has to be one of the smartest, cutest kids on the planet :-)  Her eyes are going to make her mommy and daddy lots of money one day :-)  Here are just a few recent pictures taken a few months after her 2 year old birthday.  

 

And, for those of you who didn't know, Noelle is now 5 months pregnant!  Another little girl is due January 28th or so, once again conceived naturally!  We can't be more excited and Brynnley can't wait to be be a big sister.  She is so excited!

So, as you can probably guess by now, our world was turned upside down a few weeks ago when my cancer returned.  This time, I'm not keeping quiet.  We've made some great friends, we're very active in our church.  Also, because of my job and Noelle's job we're pretty connected with the medical community in Spokane.  I hope that people knowing about our fight will help to spread the word and raise some awareness.  It's not an easy thing to talk about but it is so important.   

In my next post I will detail a little bit more of whats been going on in the last few weeks.  My goal is to update this blog everyday as I work my way through more surgery and chemotherapy.  I'm doing this as an outlet for myself, an easy update for family and friends and to spread awareness that testicular cancer is very real and needs to be openly discussed within families and by all men.  I'm sure that some days will be mundane and might just be a sentence or two. I'm sure some days it won't be pretty and might be hard to read but its reality.  So, here we go again.....