A Bump in the Road

We were recently in Florida visiting family & enjoying Florida's beautiful, sandy beaches when one of our nephews (Ryan) mentioned that we hadn't posted an entry to the blog in a very long time.  We explained to Ryan that basically "no news is good news."  Unfortunately, we have hit a bump in the road, so we will get the blog up & going again to keep everyone informed.

On David's most recent surveillance CT scan in mid-March, it became evident that he has a growing nodule in his left lower lung lobe.  While he has had tiny nodules (less than 5mm in diameter) in both of his lower lung lobes ever since he has been having CT scans performed, they have come & gone, & have never been larger than 5mm.  These have most likely represented inflammatory / infectious changes in his lung & have never been of concern.  However, this nodule is different -- it first appears on the scene in July of 2014 & on each sequential CT becomes a little bit larger until it has now reached the size of 8mm (still small, but concerning).  In addition, his cancer markers on blood work have gradually increased over the same time frame, with a fairly rapid increase recently.  These changes prompted several appointments over the past month.  We first met with a pulmonologist who is convinced that this nodule represents a metastasis.  It is sitting in the very periphery of David's left lower lung lobe not far from the diaphragm, so not someplace that the pulmonologist could obtain a bronchoscopic biopsy to confirm his suspicions that it represents a metastasis.  He also felt that a bronchial washing in this area might not yield a definitive diagnosis & no one wants to try to do a percutaneous biopsy because of the risk of pneumothorax (creating a hole & collapsing this lung lobe) & the risk of spreading tumor cells into the pleural space & along the chest wall if it is a metastasis or a primary lung tumor.  So, he ordered up fungal screening to rule out an infectious cause (all came back negative), referred David to a thoracic surgeon (to discuss having a wedge resection of that lung lobe) & a thoracic radiation oncologist (to discuss having stereotactic radiation therapy to that portion of the lung), & ordered a PET scan to rule out any other areas of disease recurrence.  We have met with the thoracic surgeon & the radiation oncologist; however, the PET scan revealed a small "hot spot" at the site of David's abdominal surgery, which needs to be addressed before we proceed with any treatment for the lung.  So, on Wednesday (April 20th), David will have an endoscopic ultrasound-guided fine needle aspirate of the area of concern at the previous surgical bed.  If the cytology results reveal no evidence of cancer recurrence in his abdomen, we will proceed with stereotactic radiation therapy of the lung nodule (no matter what the nodule may be, the radiation treatment will get rid of it).  If the cytology results reveal cancer recurrence in his abdomen, then the recommended treatment will be some form of chemotherapy.

So here we are back in the fight holding on to the hope that Wednesday's study will show no evidence of cancer recurrence in David's abdomen, so we can go forward with radiation treatment for his lung, & resume our awesome life together.  As always, we are grateful for your good thoughts, positive energy, & prayers!

Big hug, Janet