Surgery is a go

It's official, we're doing surgery on Tuesday at 1130.  We had a very informative meeting with Dr. Nisco.  Here's what we found out. 

Just as a recap... going into the consult we knew there was a nodule in my lower right lung that is roughly 1cm in diameter.  It is not very active but still there.  There is also a lymph node near my trachea that is very active.  I'll call it the mediastinal or MS node for now, it is the primary concern for us.

Dr. Nisco is a very nice man and very professional.  He came in and had us briefly recap what we had gone through already to make sure he wasn't missing anything.  Then, knowing that I'd understand the images, he invited us into his office so that we could look at the scans.  What we found out was pretty frustrating.  We were initially informed that the MS node was too small to be seen on the 1st CT scan but that it was noticed on the PET scan.  According to both Dr. Nisco and my inexperienced eye, the 1st CT was blatantly misread.  The MS node is not small, in fact its quite a bit larger than the node in my lower right lung.  Frustrating that 2 of my doctors misread the CT but now grateful for the node in my lower right lung.  Without it, they wouldn't have ordered the PET scan and wouldn't have seen the MS node.  Scary stuff.  The MS node lit up like a light bulb, almost off the chart on the PET scan scale.  I've had over 7 doctors look at the PET scan.  Not one of them has ever seen anything light up that strong that wasn't cancer.  It's somewhat disheartening because some hope was still there that this could just be an anomaly.  No such luck yet, but we'll have to wait to get the pathology report to know for sure.

In Dr. Nisco's opinion, or maybe his hope, the MS node is actually another node in my right lung.  This is the best thing we can hope for at the moment.  If it is contained within my right lung it means that the metastasis is likely contained only in the right side and it also means that it will be much, much easier to cut out.  If the tumor is a lymph node, it is sitting directly on top of a large vein called the azygous vein.  Until they get into surgery, he won't know if its inside the lung or on the vein.  Then, if it is on the vein, he has to determine if it sitting on top of the vein, stuck to the vein or growing into the vein.  As you can imagine, if its growing into the vein, things get a little more tricky.  Since its a vein and not an artery, it will be easier to stop the bleeding if it is punctured, which is definitely a good thing. 

Dr. Nisco's plan is to perform a thoracoscopy.  This procedure will require 3 small incisions and will allow him to access my right lung and the MS node area using scopes.  It'll still means I get a chest tube and will spend 2-3 nights in the hospital.  But after a few weeks I should be back to relatively normal activity.

If he can't access the MS node with his scopes or if he believes the tumor has grown into the azygos vein, he will have to remove a section of the vein (he claims this is not a very big deal and that the body will heal around it if necessary, which is amazing to me).  In that case, he may have to do a thoracotomy which involves a 4-5 inch incision on my right side and a nasty rib spreader.  Makes me cringe just thinking about it.  Not looking forward to waking up to that but I told him to do whatever he has to in order to get this crap out of me!  That would mean probably 4-5 days in the hospital and a much longer recovery time.  We are praying he doesn't need to go that route.

We are nervous but ready.  I feel that Dr. Nisco is the man for the job and that he will do an amazing job.  He is an expert with the scopes and I feel lucky to live in Spokane and have access to such a good doctor.  The best case scenario for us is that the MS node is contained within the right lung and that the thoracoscopy will be a success in completely removing the 2 nodules.  We have faith that everything will go well and that I can get these cancer cells out of my body.  I can't stress enough how lucky we feel to have friends, family, co-workers, casual acquaintances and strangers from around the world (yes, the world!!) voicing their faith and prayers in our behalf.  We are completely blown away by it and very touched.  Thank you for your love and support!!