Saturday, December 8, 2012

Recuperation

I need to admit to a bit of foolishness before I do anything else. I fully expected to be back at work on Monday. In fact, I planned on it. How hard could it be to recover from having part of your tongue taken out?

I survived a cord blood transplant, PTLD, a bone marrow transplant, and multiple bouts of graft versus host disease. This was supposed to be a walk in the park comparatively speaking. 

Turns out a partial glossectomy hurts more than you'd imagine. I spent all of Thursday trying to recover from the anesthesia that was administered to me for the procedure. My kind surgeons prescribed hydrocodone in liquid form which takes the edge off of the pain and puts me to sleep. They also prescribed a viscous lidocaine "swish" which is the consistency of partially set gelatin and next to impossible to actually swish around in my mouth with an open wound. I'm supposed to use it to coat my tongue before eating. Since I still can't eat, it's not really a problem.

The combination of not being able to eat and being high on painkillers means I'm out of commission for the next week. When I'm feeling more human, I'll write a bit more about this newest experience with cancer. Until then, know that I'm mending, the cats are keeping me company, and Chris is doing an excellent job of making sure that I take it easy and am behaving.

Wednesday, December 5, 2012

Recovery

Good news. Ann is out of surgery & Dr. G is very confident she got all the cancer. She characterized it to me as small and less than 2mm below the surface if Ann's tongue. Basically, it was just the remnants of what the punch biopsy from a few weeks ago didn't get.

Ann is recovering from anesthesia and although she's still groggy, she's moving in the right direction. We might not have to stay in Houston tonight.







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OSCC T1N0M0

Its been a long time since I set down to write a blog post and I'll confess I wish it was about a cheerier subject, but "needs must..." as they say.

The purpose of this entry is to cover the medical background of what we are going through, and I'm writing it as me and Ann are waiting for her to get called back into the OR for a partial glossectomy with a possible neck dissection and node removal.  The qualifier "possible" is important here because it relates to the official diagnosis we got yesterday afternoon, which is also the title of this post.

OSCC - Oral Squamous Cell Carcinoma  (of the mobile tongue)
The other numbers are whats called the TNM staging numbers. Tn - Tumor classification number, Nn - Number of Lymph Nodes invaded, and Mn - presence of metatasis from the original cancer site.

Common sense tells you the more of these variables are greater than 0 (zero) the worse off things are.  That being said Ann is a T1N0M0.  Her tumor was about 5 to 6 mm in diameter and less (according to the biopsy from weeks ago) less than 1mm in depth.  In the world of oral cancer any thing less than 2 cm in diameter and less than 4mm in depth is a T1.

Volumetrically Ann's T1 tumor was only 2.25% the size of the largest T1 tumor on the classification scale { d (ann) = 6mm D (ann) = 1mm V (ann) = 28.27 mm^3 vs.  d (max) = 20mm D (max) = 4mm V (max) = 1256.6 mm^3 and so V (ann) / V (max) = (28.27/1256.6 )*100 = 2.25% }.  Which is good news, its quantifiably very small and is statistically less likely to have sent out metastasis anywhere else. T2 tumors are anything between 2cm and 4cm in diameter and can be anything from 1mm to > 4mm in depth.

If you are interested there is a very good journal article about early stage OSCC that can be found here : Early Stage squamous cell of the oral tongue.   I'm going to borrow some figures from the journal article to illustrate what the prognosis is at this moment.


This figure (Fig.2 in the article) shows the percentage of patients with early OSCC with T1 and T2 tumors.  So based on what we know right now the prognosis is very good, and the overall survival rate percentage at 5 years is in the 90's.

Ready?  OK more graphs now - 


This is relapse of the tumor based on the "margin status" during the surgery.  Margins are what the  surgeons call the boundary of  tissue that surround the tumor site in the excised volume of tissue.  What this graph really says is that less people relapse if the cancer is compact enough for it to be cut away.  There is a phenomenon called POI (pattern of invasion) that they look at on a cellular level.  If the POI is diffuse (imagine scattering salt on a table) then its obviously harder to cut it all out.  If its compact (imagine gently pouring salt on a table) then its much easier to remove it all.

What we are hoping for here is that the POI of Ann's newest little problem is such that it can be removed with ease.  There is a suggestion that the earlier the tumor the more compact the POI is.  Its not definitive, but thats what we are hoping for.  I'll circle back around to this later.

last graph -

This shows the recurrence of cancer based on the DOI or Depth of Invasion.  Ann's T1 (1mm DOI) is on the upper - less than 2 mm line.

Now the part I said I would come back to:  There is a caveat with these charts.  The diagnosis of T1N0M0 is locked to a certain extent.  The CT scan Ann had the other day confirmed that there are no involved lymph nodes - but, it was not able to image her mouth clearly.  Too much metal dental work scattered the energy of the CT Scanner and made the image look like a disco ball.

So while Ann is under Dr. G will be doing a through and detailed search with some other scanning methods MDA is testing.  It is possible that the the T number or the M number could change.  Not likely but it is a possibility.  If they do then it will change the course of the planned surgery, and I'll try to explain how.

Ann is right now set to have a partial glossectomy - aka part of her tongue will be removed.  Hopefully not a lot, just the portion that is invaded and a good clean margin around it.  I think they aim for 5mm of clean tissue around the site.

If Dr. G finds anything else, or cant get good margins (because of a poor POI)  then things will be much more serious and Ann will have a Neck Dissection with removal of all the lymph nodes on the left side of her neck.  Do yourself a favor and DO NOT look up pictures of this procedure.  Its disturbing to look at but people do recover successfully.

OK so that is all we know and I hope it has answered some questions that some were having regarding the cancer diagnoses and surgery.  Right now we were scheduled to have surgery at 12:30pm, but have just been told they are running behind because of a difficult operation and we have been "asked" to wait until 2:45pm.  The "asked" part kills me - like we would want to be somewhere else right now.

I'm not proofing this, I'm going to spend time with my sweetheart.

EDIT:  Turns out I had to proof it after all

Tuesday, December 4, 2012

Surgery

I have been poked, prodded, X-rayed, hooked up to electrodes, scanned, examined, and interrogated.

I have also been cleared for surgery.

Dr. G. will attempt to excise the rest of the cancer from my tongue tomorrow. I'm scheduled to check in to the hospital at 12:30.

I had a CT scan on Friday which didn't show any other areas of cancerous tissue. Unfortunately, I have a lot of metal fillings and crowns in my mouth, which can obstruct the scan. It looks like light tracing off of a mirror ball on the computer image. This means there are areas in my mouth that could not be clearly seen. That means that even though the scan was declared to be clean, there may still be something in my mouth.

Dr. G. will use a few diagnostic tools to look for further areas of dysplasia, as well as good old fashioned visual examination. A camera will be fed down into my throat to allow the team to look for any suspicious areas that may not have been obvious on my scans.

Chris will probably update the blog in the next few days to keep you all posted. In the meantime, I'm feeling well and hopeful that surgery will be all that is needed to deal with this newest flavor of cancer.