Tuesday's surgery

So, I had surgery on Tuesday.  I had a "wide area excision" and a "sentinel node biopsy".  It was day surgery and I was at the hospital pretty much the whole day.

When I had the tumour on my leg removed in August, no one suspected that it was cancer.  The growth was just bothering me so I elected to have it removed cosmetically.  The surgeon removed the growth, which he initially thought was a psoriasis lession or a cyst, and sewed my leg back up.  The tissue was sent off to be biopsied as a matter of course, but no one was expecting it to come back malignant.

When it turned out that it was, in fact, malignant, they called me back in and explained that I would need to have more surgery.  Normally when a tumour is suspected of being melanoma, the tumour itself along with a "border" of skin surrounding it is removed.  The size and depth of the tumour determines how big of an area needs to be removed.  In my case it needed to be a 2-3 cm margin.

The pathology report on the tissue came back with some findings that indicated that the cancer is "moderately aggressive".  Some of the indications that the cancer may have spread are:

• if the tumour is 4mm or more in thickness (mine was 23mm)
• the length of time it has been growing (18 month in my case)
• the rate of mitosis - ie. how quickly the cancer cells are reproducing (mine were turning over rapidly)
• if the tumour has ulcerated (mine did - it was what prompted me to have it removed)
• swelling of the lymph nodes can be felt by a physician (mine could not be felt)

Based on the pathology report and physical examination, the surgical oncologist felt that there was a "significant" chance that the cancer has already spread from the original tumour site to the lymph nodes in the groin.  

Apparently removing all of the lymph nodes in the area has a pretty high risk of complications, so they don't like to remove them all unless it's necessary.  Instead, they remove a few of them to be thoroughly biopsied.  If they don't find cancer cells in the ones they remove, then they assume that the rest are ok too.

When they explained that to me, I thought it sounded like a bit of a crap shoot - I mean what if they biopsied the wrong lymph nodes?  But actually they know that this cancer progresses in a pretty orderly fashion and that it will traverse the lymph nodes in the same order that the fluids in the body ordinarily drain into the lymph nodes.  If they can determine that "order" in my body, then they can remove first 3 or 4 in the chain closest to to tumour.  If there is no cancer in the first bunch, then it probably hasn't gone beyond into the latter nodes.

So a few hours before I went into surgery, I went down to nuclear medicine where they shot me up with a radioactive tracer in the tumour site.  The tracer then went off to the lymph nodes.  After a while, the lymph nodes that had taken up the tracer began to glow in the dark  KIDDING!!!  No, they could see it on the scanner and a doctor then used that to kind of draw a map with magic marker on my groin and abdomen for the surgeon.  That part I'm NOT making up.  So they had the scans and the magic marker map and then during the surgery itself they injected me with a blue dye that goes to the nodes as well - they are really well prepared before they start cutting.

The surgery only took about an hour and a half.  The tests, and pre-op procedures took much longer than that.  All and all I was in at 7:30 in the morning and out around 6 pm.  Long day.

The recovery has been much easier than I thought it would be.  I don't have much pain any more (although the first night and day were bad).  I just have to be really careful that I don't bang my leg or use it too strenuously because until the skin has stretched out, there is a chance that it can split open.  EWWWWW!!!!

In a week or so I should find out the results of the sentinel node biopsy.  I hope they don't find anything, but I have been mentally preparing myself for that eventuality.  In a couple of days I can take off the bandages and see what my leg looks like.  I am a bit squeamish with that kind of stuff, so that should be interesting.