May 25, 2007 - Here We Go Again

Today, I learn that some swollen lymph nodes in the vicinity of my neck will have to be biopsied. I haven't written about this unfolding develop- ment until now, because there's been an element of uncertainty to it. Now that I've got an appointment to consult with a surgeon, though, I suppose I'd better fill in the details.

The roots of this particular chapter of my story go back to March 9, when I met with Dr. Lerner after having a routine PET/CT fusion scan (I did write about that in the blog). A lymph node just below my right jawbone was lit up on the scan, indicating it was swollen. I'd had a cold several days before – which, in itself, could account for the swelling – so, Dr. Lerner thought it best to just watch and wait for a couple of months. When I saw him again on May 11, he spent an unusually long time palpating (feeling with his fingers) two areas: a spot under my right jaw and one behind my right collarbone. He told me he felt something that could be a swollen lymph node, beside the collarbone. It could be nothing, he said – or, it could be a recurrence of the cancer. He ordered an immediate follow-up CT scan of the neck – explaining that, if the area looked problematic, he'd send me to a surgeon for a biopsy.

That's exactly what happened. I went for the CT scan last Friday, May 18, and – with the intervening weekend – it wasn't until yesterday that I heard any more news. Claire was at a hospice team meeting with Dr. Lerner (he's the medical director of the hospice program). She got a few moments with him privately, to ask when he thought my scan results might come in. He said the results had just come in that morning, but he'd only had time to glance at the radiologist's narrative report, and hadn't been able to examine the pictures at all. Based on what the radiologist had written, though, he thought a biopsy was in my future. He told Claire I should call him back today, after he'd had a closer look.

This morning, as instructed, I left a phone message for Dr. Lerner. Around noon, I got a call back from Paula, a physician's assistant who works in his office. Dr. Lerner had asked her to call me, to explain that my CT scan highlighted three different lymph nodes: one by my right collarbone, another under my right jaw, and a third in my chest area. When I asked how that last one had shown up on a CT scan of the neck, she explained that it was in an area at the very edge of the scan – well beyond the neck region, but still visible.

Dr. Gornish, the surgeon - Paula explained - will have to decide which of these lymph nodes is most accessible. She thinks it will probably be the one under the jaw. He'll probably only need to remove one of them, because this surgery is for diagnostic purposes only. (Unlike some other cancers, lymphoma is not generally treated by surgically removing all problematic lymph nodes; one cancerous node indicates that the whole lymphatic system is already compromised, so surgical treatment is futile.) I'll see Dr. Gornish this Thursday, for a consultation.

Yesterday, I also phoned Dr. Portlock's office at Memorial Sloan-Kettering Cancer Center, to get the ball rolling for a second opinion, once the biopsy results come back. I asked Ernestine, the wonderfully helpful receptionist, if Dr. Portlock thought I should have the biopsy done in New York. After speaking with the doctor, she called me back and said that, while they could certainly do the biopsy at MSKCC, I could just as well have it done here, close to home, and bring the tissue samples and scan results into the city when I come to see Dr. Portlock. This is the same thing I did last time, with the core-needle biopsy results. I'm especially eager to have a second opinion, after my experience last time – when the MSKCC pathologist overruled the local pathologist, and changed the grading of my cancer to a more aggressive type.

It's just as well that I'll be having an excisional biopsy. The core-needle biopsy, a year and a half ago, came up with mostly scar tissue. Evidently, the pathologists barely had a big-enough tissue sample to put under the microscope. If there are any lingering doubts about what type of NHL I have, the larger sample, cut from an entire lymph node, ought to put those questions to rest.

So, now it's a waiting game, for the next several weeks. It's excruciating, of course – but, at least I've been there before. I know in advance how agonizing it will be, to have the thought of cancer surface in my mind, at unexpected moments. After a year of relative normality, it looks like everything could go topsy-turvy again.

But, then again, maybe there's some other explanation for the swollen lymph nodes. I'll know soon enough, I suppose...