Posted by: cg00n | July 19, 2008

More from the Mail Bag

My previous posting (Indecision) generated a surprising number of comments, some of them quite passionate.  I am most grateful to you all for taking the time to express your opinions, especially the negative ones:  they are usually the hardest to state.

Ms. H.H-J, last seen in London, England, observed:

I think I may be confused. The study you cited (here) doesn’t seem relevant to your decision. … Since you are trying to decide /whether/ to have all the lymph nodes near the cancerous one removed, the study isn’t very useful, unless I’ve misunderstood something.

Almost right, but you are not the one who is confused; that would be me.  Although that study is interesting, the one that I had in mind (Melanoma Cripples Lymph Node Immune Function) is the one that mentions, in passing, that:

Patients with a sentinel node that tests positive for melanoma usually have all the nodes in the immediate area removed because there’s a more than 30 percent chance that there already is cancer in the other nodes.

Presumably they arrived at this number by testing the nodes they removed.  If you accept the theory that melanoma primarily spreads through the lymphatic system, removing the other nodes “in the immediate area” presumably goes a long way to preventing recurrence in that 30% of sufferers.  However, Ms. H.H-J goes on to say:

Peer-reviewed papers state that the operation would not help, would help a little, would help a lot, or would be more likely to make you worse. These opinions are not all equal; I’m mentioning them all out of a combination of humility and cowardice.

This brutally honest assessment pretty much sums up why I have been so tentative in my decision making to date.  Several people suggested that I really ought to be going for a comprehensive shotgun treatment including interferon and, indeed, that I am morally obliged to do so.  The studies on the effectiveness of interferon treatment are at least as confused as those on lymph node excision.  I have explained why I am reluctant to go for the full course one year treatment in the Interferon and Where I’m Coming From postings. However, I have heard that there is a short course treatment (basically just the one month of high dosage)  so when I see the oncologist in October I may ask about that.

In the meantime I have hand-delivered a letter to the surgeon telling her that I have reassessed the risks involved in the proposed surgery and that if it is something she recommends I will go for it.  My next appointment with her is August 8th so I might have this done by P‘s birthday for which, I think, she will be happy.  Not everyone’s idea of a birthday present, I know.

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Responses

  1. Have you gone to “medscape.com” to search for information? You need to join but membership is free. Some of the articles are medical research and more difficult to understand, others are written for the lay person.

    From a logic perspective … if you do not take treatments, and the cancer returns in short order you will regret not having done more earlier. On the other hand if you do secondary treatment measures, and you survive, you will always consider it to have been a good move on your part as that might have been the extra bit of effort that made the difference.

  2. Dude, I remember weighing all this stuff and trying to figure out what to do. Crazy. Seems like you’re getting a lot of support and the research seems to be paying off, too. Keep us posted if you schedule a surgery.
    As for my point of view (I know what you’re thinking- but I’m giving it anyway, lol) I would at least recommend the first month of high-dose Interferon. Yes, it sucks, but it’s totally do-able. The year of it, now, that’s another story.

    Anywho, I’m thinking of you and sending you lots of positive vibes. Glad to hear the foot is coming along nicely, too.

    Besos,

    -MM


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