Decisions, Decisions

In a funk for the past few days. Why? Because I got diagnosed with Squamous Cell Carcinoma (SCC) at the site where I got radiated and where I’ve been dealing with this wound that hasn’t healed since I got a bad sunburn last March. My wound care doctor says this seems to be a recent occurrence because she took a biopsy of the same area last fall and it wasn’t malignant. But all the ‘what ifs’ have been running through my mind. What if she missed it, and I’ve had SCC much longer? What if it’s already metastasized to other organs in my body? I’ve had to pee much more frequently at night; does that mean it’s spread to my prostate?

SCC is a pretty common type of skin cancer. My grandfather had it more than once. There’re around 700,000 new cases each year in the U.S. (Too much sun exposure and tanning bed time). Normally, in an out-patient procedure, the doctor cuts out the malignancy and you’re done. That’s all my grandfather had to do. Sometimes they add radiation on top of the surgery to make sure they got it all—obviously, I won’t be doing that. In my case, since it’s in an area that has a hard time healing, I’ll probably need a skin graft or a skin flap to cover the wound. The skin flap is where they take muscular tissue from another part of the body and ‘flip it’ up to the wound. The muscular tissue stays connected to blood vessels so there’s a ready blood supply so the skin flap surgery is much longer and more detailed than the skin graft—where they just take a piece of healthy skin from my leg and put it over the wound.

Yesterday, Betsy and I went to Vanderbilt University Hospital in Nashville and talked to an ENT doctor. He said there is a range of options for me. The surgical option with the least risk would be just cutting out the SCC and then letting the area naturally heal. That's what most people do, but in my case I already know from experience that the site likely wouldn't heal. If it did, it would take over a year and I would have to go to wound care and deal with infections the whole time. The next level of surgery, like I said above, would be to cut out the cancer and cover the wound with a skin graft. I've had a couple of grafts there already and they healed up well. Unfortunately, the area the surgeon is talking about cutting is much bigger than those skin grafts. He wants to cut out every bad looking part of skin on my shoulder and neck just to make sure he's gotten every last bit of cancer. So, a simple skin graft would have a hard time adhering to the new site. The ENT was really steering us toward the most aggressive option: the skin flap.

The ENT thought he would be taking muscle tissue from my leg for the flap, then using a vein and artery from my chest to provide blood to the area. The procedure would be long, 6-8 hours, and the ENT would be doing all of it with potential help from a couple other doctors on his team. I would need to stay in the hospital at least 72 hours after the procedure to make sure the flap works. He also talked about potentially giving me a trach for the procedure. This is because there may be swelling in my neck and he didn't want my airway obstructed at all. Getting a trach scares me. I fear losing the ability to speak, but I see why it's a necessity and he will remove it (hopefully) right after surgery.

Today, I had an appointment with a surgical oncologist at the University of Tennessee (UT) medical center in Knoxville. He told us many of the same things as the ENT. While the ENT only focuses on cancers in the head and neck, the surgical oncologist operates on tumors throughout the body. He would work in concert with a plastic surgeon for my procedure. So, he would cut out the SCC, and the plastic surgeon would perform the skin flap. Next week, we meet the plastic surgeon and she will tell us how she plans on doing her portion of the procedure.

So, the decision we have to make is whether to go to Vanderbilt for my surgery (3 hours away in Nashville) or stay here in Knoxville. We liked both doctors. All the nurses are very good and they were more than willing to sit down with us and answer every question we had. I think I'm leaning toward Vanderbilt just because it has a good reputation, and because the ENT specializes in these types of procedures while the surgical oncologist is more of a generalist. Also, I get the impression that if anything goes wrong (horrible infection, too much swelling, bleeding in the brain, and now I'm thinking of awful things that could happen, great) Vanderbilt is better equipped to deal with it. They have all the specialists to stitch me back together. I'm reserving judgement until after we meet with the plastic surgeon.

Now, Betsy says she feels like we're leading these doctors on. The nurse at UT already got me an appointment with the anasteasiologist and set a tentative date for the surgery (March 2). So, in a couple weeks, we'll be calling her to say, "sorry, we're just not that into you." We have to keep in mind that they are being paid a crapload by my insurance to do this and in the end, my life is really a more important consideration that hurt feelings.

Next week, I’m also meeting with my regular oncologist at Thompson Cancer Center. He's a pretty straight-shooter, tell it like it is kinda guy, and he will hopefully have an opinion about Vanderbilt vs. UT. So, second and third opinions. With luck, I’m not missing anything. I worry abut the doctors who assume this is a ‘typical’ case of Squamous Cell Carcinoma. In my experience, my health is anything but ‘typical.' Thankfully, the doctors at UT and Vanberbilt all seem to appreciate the seriousness. They also seem pretty certain that my cancer hasn't spread, but they've ordered CTs and an MRI to make sure.

Now, I just wait for more appointments, CT scans and MRIs. This is the really shitty part about cancer: the waiting. Waiting for test results and waiting for doctor’s appointments. It'll be a month before the surgery. Waiting gives me more time to run through all the ‘what ifs’ in my head until the absolute worst possible outcomes become certainties in my brain.

Waiting…

Waiting…