The Surgeon Suggests

I have returned from a visit with my surgeon. He suggests that we immediately remove the affected area. After consulting with the biopsy, his recommendation is that not only the obviously affected area be removed, but also a “periphery” around the cancer. The cancer is “advanced” enough that it is reasonable to assume that some has spread beyond the area it originated in. The theory is that we need to find out how far the cancer has migrated. Once a cancer starts moving, it is said to be “metastasized.” This really means “change of state” from the Greek. It would mean that the cancer is moving.

The first use of “cancer” was a Greek doctor who observed a tumor that looked like a crab, with spindly legs leading to other locations. The Greek word for “crab” is “cancer.” (Think of the zodiac sign for cancer—a crab.) Anyway, we don’t know yet if my cancer has spread or not, but it is aggressive enough, and it has spread enough that it is reasonable to assume that it didn’t stay nicely in one place, but that it has started moving. So, the surgeon needs more tests, which he has ordered.

Test 1 – Complete Bone Scan

The first test is a complete bone scan. It seems that the most likely place for this particular cancer to go is into the bones. This is what causes cancers to become so excruciatingly painful. Literally, they eat the bones away, leading to easily broken, fractured, and damaged bones. In order to get a complete bone scan, I’ll be given a shot of technetium 99, an isotope of a mostly man-made chemical. This chemical decays through a Beta decay (which means it ceases to be technetium) by giving off a Helium atom (two protons and one electron), and decaying into stable Niobium. The radioactive isotope helps contrast the bone material and allows the doctor to see abnormal growths of bone tissue—the sign that the cancer has entered the bones.

I’ve completed the bone scan, but don’t yet have the results. Waiting is part of the game. I will explain the procedure as much as possible.

The Bone Scan Procedure

First, I was given the injection of the Technetium. This process took just a moment or two. The injection felt no different than any other shot in the arm. You feel the needle prick, and then, not really anything else. After the initial shot was given, an additional injection of a saline solution (saltwater) was followed to help the Technetium push through the bloodstream. I felt the saline go through my blood vessel for about six inches. It wasn’t particularly uncomfortable, but it was noticeable.

Then, I was told to go about business as usual, but it was suggested I drink a lot of water, which I did. “Keep hydrated” was the actual verbiage of the technician’s lingo. I was then to come back in three hours (giving the isotope enough time to circulate completely through my body) to do the actual scan. I was asked to “empty my bladder” before the scan began. I used the restroom to pee—which with my cancer is sometimes a little difficult.

I remained dressed, and merely removed things that would show up oddly in the scan—my cell phone, wallet, belt, comb, and coins in my pockets; apparently clothes don’t show up on the scan. With those items removed, I laid down on a large slab of a machine. I was told not to move for about twenty minutes once the procedure started. The technician placed armrests under my arms; taped my shoes together (so my feet wouldn’t wiggle); and centered me on the device. I then stayed as still as I could, while the machine did its work. The table slab I was on moved toward the specialized camera which encircled my body. I stayed still—and even fell asleep for a few minutes—while the machine did its thing. Maybe 20 minutes later, the doctor told me I was done (which woke me) and he then un-taped my shoes, I sat up and got off the machine.

That was the scan. The results of the scan are instantaneous—except that a different technician must “read” the scan. Then that reader sends a CD of the scan to my surgeon, who re-reads it and makes a diagnosis. That diagnosis I don’t get for several days. Again, waiting is part of the game.

Test 2 – MRI

My next appointment is tomorrow. That is for a Magnetic Resonance Imaging (MRI) of the affected area of my body. The MRI may show tissues that are affected, and help the surgeon know specifically where to remove tumors and tissue. Every atom in tissue wiggles and we can—sort of—control the rate of the wiggle. That is, the atoms vibrate. If a strong enough magnet is applied, you can get atoms in tissue to vibrate at a specific frequency (or resonance.) Then, taking a picture of where the atoms are vibrating allows a picture to show the different textures of differing tissues. Some tissues are denser than others.

Taking a picture of all the tissues being excited by the magnet can give doctors a pretty good look at an affected area. The theory, in the case of my cancer, is that the cancerous tissues will “wiggle” at a different rate than the normal tissue. This different rate is expected because the amount of Hydrogen atoms in any area differs from organ to organ. And, Hydrogen is in every cell of the human body, but in differing concentrations. Water (H 2 O), fat, sugar, and every other molecule in your body will have a differing amount of Hydrogen in it. So, the machine makes those Hydrogen atoms resonate, and measure the concentration levels in the tissues.

So, my MRI is tomorrow, and the surgeon will have those images back in a few hours too. By my appointment with him on Monday, he will be in a much better position to determine how to treat my particular cancerous tissue. At this point, the hope is that a single surgical operation will remove the entire cancer. However, if the results come back that the cancer has spread to other areas, well, that’s called “metastasizing” cancer, and it is bad news.

That means chemotherapy first (that is trying to kill the growing cells with drugs) and radiation later (killing the cells by targeting specific areas with radiation.) Both of those (chemotherapy and radiation) have serious long-term negative effects. We don’t want that to be the case, but until the two scans (bone scan and MRI) come back, we won’t know. More waiting.