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it's not usually what you think it will be (or was)!!

ken f.

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well, i went to a major cancer center monday last for a 2nd opinion and was told that my surgery was inadequate and without adequate margins so i should do it again. my look back probably said a lot.

as it happened, tuesday night i was in my local hospital visiting my mother (who was just hospice discharged wednesday) when i encounted my surgeon in the cafeteria. (nothing like smaller towns). i explained to him what i'd been told. he ranted a minute then took a few minutes to explain again to me, perhaps in a little more detail than 1 week post surgery, that he had reached into my right lower lobe, grabbed the 1cm. tumor which had showed up on CT and PET SCANS, pulled it up and out, and then used the cautry to cut a big hole around it. he said the margins were good tho the pathologist couldn't say what the margins were to the resulting mangled mass of tissue he presented for frozen section examination.

so i met friday with my oncodoc to review all this and get a grip on where to go. he said, as he had before, the surgeon was quite competent, that he had discussed the procedure he undertook with him, and couldn't explain why he would proceed in that fashion that didn't result in pathologically confirmable margins now that we are all into microbiology and such.

i knew tho and so did my oncodoc. the surgeon saw what he thought was a "pushing" rather than an "infiltrating" tumor, in short what he took to be a confined rather than fingers extending tumor, and determined that he could get it all without removing the entire right lower lobe (and right middle lobe as well) as he told me he would have to before the surgery. he determined to not take the whole middle and lower lobes so i could have some function.

i don't know about this trade off. it is difficult to assess. on the one hand, i didn't get the "protocol" treatment but on the other i did get a "custom" treatment. on the one hand, i can now 60 days post surgery hike 2 miles gaining 800 feet in an hour without being winded, and on the other i've got more than usual uncertainty about local recurrance.

after consulting with all these people, each of whom i think has my best interests at heart, i suppose the best way to proceed is not to now do another thoracotomy but to follow with regular Scans in the hope that should there be a local recurrance, a 2nd surgery could possibly be undertaken before the recurrance "gets loose."

+ the margins may, after all, have been fine as the surgeon said. there are downsides to another surgery too, after all.

so next week i will get scanned to be sure i'm getting adjuvant therapy and then start rounds of chemo cocktail.

it's not usually what you think it will be (orwas)!!!


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sheeesh Ken.. why do things have to be so complicated, eh? anyway, I think your idea to do chemo and closely monitor is the best approach. you can catch it when it's early if it comes back and then do surgery again if needed. Just be sure you read the radiologist reports yourself.

Don M

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Yea, wow...Id sure hate to undergo a second Thoro....sounds to me like youve opted for the best plan , make sure its really necessary before another surgery. Its what I would do too, if I had similar circumstances. Its really no different than what I am doing, ...surgeon says tumor all gone....onc. says screening every few months to spot any recurrence. I had one follow up chemo (taxotere) but stopped right there when it gave me pnuemonia like infection. Guess its all we can do....hope what we have done is enough to finish off the beast. Good luck to us all...Rich B.

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