Dr. Mady explained that she found the surgery to be more difficult than expected, due to extensive scar tissue in my neck from my two previous thyroid-cancer surgeries. Her written report references “numerous challenges which increased the complexity, time, and risk of the procedures.” Her report also refers to “prior endocrine oncologic surgery as well as chemotherapy, radioactive iodine, and revision neck surgery which produced a tremendous amount of fibrosis in the neck and subsequent loss of normal tissue planes. The patient also had exceptionally challenging tumors involving multiple anatomically complex subsites of the neck. All of these factors together made the dissection and identification of critical structures more challenging than normal.”
She removed a large thyroid cancer tumor that had so thoroughly enveloped my recurrent laryngeal nerve (the one whose dysfunction has caused the paralysis of my left vocal cord) that it was impossible to save the nerve. Dr. Mady said she couldn’t even see the nerve, and it was probably removed along with the tumor. Bottom line is that there’s no hope of restoring healthy functioning of the paralyzed left vocal cord.
She explained that it was difficult to separate the tumor from my carotid artery — which the tumor had also wrapped around — but that she was eventually able to do that without damaging the artery.
She found thyroid cancer tumors that were in direct contact with the larynx, trachea and esophagus. In order to avoid damaging these essential structures, it was impossible to shave enough marginal tissue from those structures for testing to confirm that all the cancer has been removed. Dr. Mady explained that it’s likely that some microscopic thyroid cancer cells remain. Unless there’s something done to address this problem, there’s the possibility of the cancer invading the larynx, trachea and/or esophagus eventually.
The two treatment choices are watchful waiting and radiation beam therapy. She didn't mention the possibility of my swallowing another radioactive iodine pill, so I suppose that's off the table. Dr. Mady strongly recommends radiation because, if we were to wait and discover that the cancer had subsequently invaded the larynx, trachea and/or the esophagus, I could end up having far more serious problems.
We agreed that radiation is the way to go. She told me I could expect a call from the Johns Hopkins radiation oncology department to schedule an appointment with one of their specialists. I’ll also be having a consultation with Dr. Douglas Ball, my endocrinologist.
Dr. Mady shared a little about what to expect from the radiation treatments. For a period of 5 or 6 weeks, I’ll go in daily to the Sidney Kimmel Comprehensive Cancer Center in the Weinberg Building at the Johns Hopkins Hospital main campus for brief, daily radiation treatments to my neck. There are potential side effects from the radiation that the radiation oncologist will explain to me, including toughening of the tissues in my neck and superficial, sunburn-like burns to the exterior of my neck. They’ll need to monitor my carotid arteries carefully to make sure they retain their flexibility. For all the downsides of this approach, she thinks radiation therapy does offer the best hope of stopping the cancer’s advance.
Not the news we’d hoped for, but it’s not a huge surprise. I’ll await a call from the radiation oncology department to schedule that consultation and get the radiation therapy appointments onto the calendar.
It’s fortunate that we live here in Baltimore City, just a ten-minute drive away from this world-class cancer treatment facility. I know I’ll be receiving the best care available.
More to come, as I learn more about what’s ahead...
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