A Second Opinion Preview

We got up very early this morning and drove into Seattle for John's second opinion.  After reviewing the latest CT and PT scans, this urologist confirmed that John has more than a 90% likelihood of having renal cell carcinoma.  In addition, he concurred that John needs to have his right kidney totally removed because the cancer is quite large.

This urologist, however, did not agree that the swollen lymph nodes next to John's liver need to be biopsied or removed.  In this doctor's (and a colleague's) experience, kidney cancer does not typically spread to lymph nodes near the liver.  Also, these swollen lymph nodes did not show positive for cancer on a PT scan.   That is, the lymph nodes do not look "clinically suspicious" enough  to warrant the risks associated with an invasive surgical procedure. 

Furthermore, if a lymph node biopsy did showed positive, then cancer cells are very likely already throughout John's body anyway.  This urologist explained that new drugs show promise at shrinking metastasized kidney cancer, but they don't do well when it has only spread to the lymph nodes.

But, before this urologist firms up his "official" second opinion, he wants to thoroughly review all of John's radiology scans, including those from 2007.  So, we should hear back from him in a few days.

If John decides to go ahead and get the lymph nodes next to his liver removed, it'll mean an invasive surgery with a large chevron incision on his abdomen.  If he decides to leave the lymph nodes intact, the right kidney will likely be removed using laparoscopic surgical methods.  Laparoscopy is less invasive, reducing both hospital and recovery time significantly, as compared to the use of a chevron incision.

Regardless of his choice of surgery, John will follow up with regular scans to make sure the cancer has not spread.

Heart is Good

The internal medicine doctor's office called this morning to let John know that his heart test came out negative.  Good news.  As a preventative measure, they are starting him on a beta blocker before his surgery.

Brief Update

On Monday and Wednesday of this week, John went in for tests to check his heart health.  Monday's procedure was a stress test; and Wednesday's was a rest test.  We are scheduled to learn the test results from the cardiologist a week from today.

On Monday of next week, we will be meeting with another urologist for a second opinion.  We are still waiting to consult with the surgeon that will be doing the chevron incision to reach the lymph nodes by John's liver.

John seems to be over his cold.  I'm about a week behind on my cold and hope to feel better next week.