Biopsy Done

Very long day, so I’ll keep this post brief. Lorie and I stayed overnight in NY yesterday due to the early procedure scheduled this morning at MSKCC. My appointment was at 9:15am and I was scheduled for the operation to start around 10:40am. However, my slot got delayed and I didn’t head into surgery until around 2pm!

Michael D. Becker in the recovery room after a bronchoscopy

The good news, if there is any, is that thoracic surgeon Dr. Park was able to get sufficient tissue from the suspicious lymph node via the bronchoscopy approach and he didn’t need to do the surgical resection to go after the other nodules in my lungs.

The biopsy results will take a few days, but it is clear from the surgeon that the node they biopsied didn’t look “healthy.” Given that disease progression to the lungs is relatively common in advanced head and neck cancer, in my opinion the biopsy will most likely confirm spread of the original cancer to the lungs. Or, it could just be an unrelated new lung cancer just showing up now.

I hope to have more to report in the New Year but for now am relaxing in the passenger seat as Lorie drives us home. She’s such a trooper and I know my cancer returning isn’t easy for her.

Biopsy Consultation

Early this morning, I had my biopsy consultation with surgeon Dr. Bernard Park, deputy chief of clinical affairs, thoracic service at Memorial Sloan-Kettering Cancer Center in NYC. During the meeting, he presented the pros and cons for a couple of scenarios.

The first and most attractive option is a bronchoscopy, which is an outpatient procedure that allows a doctor to look at my airway through a thin viewing instrument called a bronchoscope. During the bronchoscopy, the doctor will remove tissue from a suspicious lymph node near my airway. If they can determine the presence of cancer during the procedure, then we are done with the biopsy portion.

The second option is a wedge resection, during which the doctor will remove a portion of my lung around one of the suspicious nodules that showed up on the PET scan. This is an inpatient procedure and may include several days in the hospital.

Dr. Park offered to combine the two options, where he will begin with the bronchoscopy and only do the wedge resection if necessary during the same procedure. This spares me from having to schedule two separate procedures and potentially delay results.

The biopsy procedure is scheduled with Dr. Park on Thursday, December 29th. Assuming the results are as expected, the next step is to meet with my oncologist Dr. David Pfister at MSKCC on Tuesday, January 10th, 2017.

As you can tell in the accompanying photo taken by my lovely wife, I’m so glad to be traveling back home on New Jersey Transit on the Friday before Christmas.

becker_train

Michael Becker

Cancer: The Grinch that Stole Christmas

Of the +30 posts on this patient blog, this has been one of the hardest to write.

Lung metsIn the prior entry, I referenced that my next PET scan was scheduled for early February 2017. However, my radiation oncologist wanted to keep the PET scans consistent at six month intervals that resulted in moving the PET scan up to December 14 (last Wednesday). My prior PET scan was in June 2016.

Unfortunately, the latest PET scan did not contain good news. Multiple new spots consistent with malignancy showed up that were not visible six months ago. This includes activity in lung nodules, subcarinal/left hilar lymph nodes (near the trachea), and mild activity around the tonsils and in the region of the oral cavity. The results were confirmed by a subsequent CT scan this past Saturday.

In the world of medicine, however, cancer doesn’t exist until the abnormal cells are viewed under a microscope. Accordingly, I will soon need to have a biopsy taken from one or more of the suspicious areas highlighted on the PET scan. However, I don’t need to wait for that procedure and the subsequent results to know the outcome.

For head and neck squamous cell carcinoma (SCC), which was my initial diagnosis, pulmonary metastases are the most frequent and account for 66% of distant metastases¹. This information, combined with the imaging results, leaves very little chance that the biopsy results will be benign.

Michael D. Becker Awaiting PET Imaging

Michael D. Becker Awaiting PET Imaging on Dec 14 at MSKCC in NYC

The consultation for the biopsy procedure has been scheduled for late this week and the actual biopsy procedure still needs to be scheduled. If the biopsy confirms that cancer has indeed spread to my lungs, the next step will be a meeting with my oncologist to discuss treatment options, which will likely include recent advances, such as biologic agents and immunotherapies (e.g., checkpoint inhibitors).

¹ ORL J Otorhinolaryngol Relat Spec. 2001 Jul-Aug;63(4):202-7.
Incidence and sites of distant metastases from head and neck cancer.

² http://www.headandneckcancerguide.org/hnc-dev/adults/introduction-to-head-and-neck-cancer/distant-metastasis/