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Wednesday, January 22, 2020

BROTHER'S DENTAL APPOINTMENT

Transported my brother to his family dentist in order to get his impressions done.  Was a very short visit but they informed that the next visit will be about an hour long.  More impressions need to be done at that time.

The dental assistant said that his gums had not completely healed from the extractions done about 4 months ago.  Probably due to the Radiation Therapy.  There are some protrusions that he may be able to remove as they continue to come out of his gums.  She instructed him to use a q-tip to get them out.

He was given an appointment for a week from today.

Wednesday, January 15, 2020

BROTHER IS NOW N.E.D. - No Evidence of Disease

Transported my brother to the ENT doctor today to discuss the results of his Fine Needle and Core Needle Biopsy of the new lump on his neck.  Results show no cancer.  It is a Warthin Tumor not a lymph node.  

Treatment of Warthin tumor generally includes surgery to remove the tumor or careful observation to watch for changes in the tumor over time. Because Warthin tumor is almost always benign, additional treatment (i.e. radiation therapy and/or chemotherapy ) is rarely needed.

I asked the ENT doctor to look at the inside of his cheek as there is a white patch I am concerned about.  We don't know how long it has been there but was noticed a couple of months ago by the Nurse Practitioner.  Nothing was said about it at that time.

ENT looked at it and didn't say what it was.

We then had an appointment with the Medical Oncologist.  He informed us that there is no cancer in his neck.  I then asked him to look at the white spot on the inside of his cheek which is the size of a pencil eraser.  He looked and said it was Leukoplakia which could be precancerous.  It should be monitored and possibly have a biopsy taken.

I came home and did some research.

Treatment of Leukoplakia
Most patches improve on their own and don't require any treatment. 

If a biopsy comes back positive for oral cancer, the patch must be removed immediately. This can help prevent cancer cells from spreading.

Patches can be removed by using laser therapy, a scalpel, or a freezing procedure.

Removal of leukoplakia patches. Patches may be removed using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).  Follow-up visits to check the area. Once you've had leukoplakia, recurrences are common.

These white or red patches might be harmless. But they can also be precancerous and contain abnormal cells.  Only about 5 out of every 100 people (5%) diagnosed with leukoplakia have cancerous or precancerous changes.

Within 15 years, about 3% to 17.5% of people with leukoplakia will develop squamous cell carcinoma, a common type of skin cancer. The likelihood of developing cancer from leukoplakia depends on the size, shape, and appearance of abnormal cells.

Leukoplakia usually doesn't cause permanent damage to tissues in your mouth. However, leukoplakia increases your risk of oral cancer. Oral cancers often form near leukoplakia patches, and the patches themselves may show cancerous changes.

Mild leukoplakia is usually harmless and often goes away on its own. More serious cases may be linked to oral cancer and must be treated promptly.

A biopsy will likely be taken to rule out other causes, such as oral cancer. During the biopsy, a small piece of tissue from the lesion will be removed to be examined in a lab. A numbing agent will be used so that you will not feel any pain.

Leukoplakia is usually harmless, and lesions usually clear in a few weeks or months after the source of irritation is removed. If eliminating the source of irritation is ineffective in reducing leukoplakia, the lesion may need to be surgically removed. The lesion can be removed either by your general dentist or by an oral surgeon.

So we got some good news and some not so good news.  I did not feel relieved after these two visits.  I was so hoping that we would all feel extremely happy but we don't.

My brother will be going to get his dental impressions soon and if he goes to his Oral Surgeon - he will be able to assess the white patch and do a biopsy if needed.

Thursday, January 9, 2020

BROTHER HAVING BIOPSY TODAY

A Core Needle biopsy is scheduled with Dr. Rau.  This will be his second biopsy.   This should tell us whether it is cancer or just dead cancer cells.  We will not know for a week or so.

Will be seeing Dr. Long on the 10th.

Biopsy date changed to the 13th.

Monday, January 6, 2020

BROTHER'S NEW LUMP ON NECK

On January 1st a new lymph node popped out on the right side of my brother's neck.  Same spot as before.  Oncologist ordered a CAT Scan which lit up as cancer.

He then had his 3 month PET scan.

Made appointment with ENT doctor who ordered a Core Needle biopsy with Dr. Juks.

His options are surgery or Immunotherapy.

I'm hoping it is just dead cancer cells showing on scan.  The biopsy will tell.  

New Lump- 1.6X2.1X2.2cm
Node #1 - reduced to 2X1cm
Node #2 - reduced to 1cm

Now that I have had time to soak in what we heard today I can think a little clearer now.  And it dawned on me that his results of the CAT scan showed 3 different measurements of lymph nodes.  This leads me to believe that this is a new node.  

They give the size of the new lump, then node number 1 and then node number 2.  All different cm.  So if there are 3 different measurements then there are 3 different nodes involved.  Not good.  

Next thing I found is that nodes larger than 1cm are considered abnormal or malignant.  His node number 1 is 2X1cm.  Not good.  

Another question I have that the ENT couldn't answer is - did scan show anything throughout the body.  Is there another primary tumor?  The Medical Oncologist will be able to answer this for us on Wednesday. 

The biopsy will show if the new lump is Squamous Cell Carcinoma or not.  If there is no primary tumor then is it Lymphoma, which is cancer of the lymph node and not Squamous Cell Carcinoma.  If it is SCC then it is called Regional Recurrence with no primary tumor in the body somewhere.  

If the new lump is just dead cancer cells - we still have to worry about node number 1 being larger than 1cm.  This makes me want to throw up.  Been nauseated since seeing the results of the CAT scan.  It was like it was being told to me and not to my brother.

Looks like surgery is his best option.  Quick and done.  There is a 3-4 week recovery from neck dissection surgery.  Lots of folks on my support group have had it done.  Immunotherapy won't be quick and may not be as effective as surgery.  It's his decision.  And it is a hard one.    Not sure what I would do.