Saturday, July 4, 2015

Recovery...and Final Pathology

It's been a while since I've written...I haven't posted anything since recovery began!

Recovery went pretty well...I stayed at my parents house for a week and change after the surgery, during which I had many family and friends visit, which was nice.  My sister came down with the whole family, which was really nice too.  Between resting, US Women's World Cup games, the NBA Draft, and various other things at home, I didn't quite get as much done as I thought I would.  While I read through most of the graphic novels that I brought home to read through, I didn't really play any tablet games or watch anything on Netflix...that's a fail, I guess.

Over the course of the week, my neck and its range of motion improved, and I was able to drive for the first time exactly 1 week after my surgery.  I took my mom to see Jurassic World...it was pretty good!

The only thing missing from Jurassic World?  More Goldblum.

The recovery process was marked by a few doctor's visits:

1) First post-op with my surgeon

Dr. Sigari took a look at my neck and the bruising and felt things were progressing nicely.

2) First post-op with my endocrinologist

Dr. Winikoff drew some blood to make sure my calcium levels, as well as other things, were looking normal.  They were!  Too early to tell if my thyroxine hormone levels are correct though, as it takes several weeks for the levels to normalize after commencing thyroid hormones (Note: I am on generic Levothyroxine (Manufacturer: Mylan) of 125 mcg.)  But besides an extreme amount of hunger that only lasted the first few days after surgery, I've been feeling fairly normal, which is good (and I know is not always the case).

3) Second post-op with my surgeon

This was the big one, as the final pathology report was in.  It's official: T1a NX MX!  USA!  USA!

Wait, what does that mean?  Long story short, I had Stage I papillary thyroid cancer.  Here's what all those letters and numbers mean:

T1a: T signifies the size of the tumor.  Unless the biopsy was a false positive, there was no way I was scoring a T0.  T1a is the next size up, meaning the tumor was 1cm across (or smaller).  This is good!

Just FYI, here are the next steps up.  T1b means the tumor is between 1cm-2cm across.  T2 means the tumor is between 2cm-4cm.  T3 means the tumor is larger than 4cm, or it has just begun to grow into tissues outside the thyroid.  T4a means the cancer has grown extensively into surrounding organs/tissues (moderately advanced), while T4b means the same level of growth as T4a, as well as growth into the spine or nearby large blood vessels (very advanced).

NX: N1 signifies if the cancer has metastasized to the lymph nodes, something that doesn't necessarily cause a significant decrease in survival rate in cases of PTC, while N0 means no metastasis to lymph nodes  I received an X because Dr. Sigari didn't remove any lymph nodes during the surgery, as he inspected them and they did not appear abnormal.  In some higher-risk cases, a surgeon will remove these regardless of their appearance, but in my case, going after them came with an increased change of surgery complications, so my surgeon didn't do them.  However, by analyzing the vascularity of the tumor (meaning the proximity of blood vessels connecting the tumor to the "outside world", the pathology report assessed that there there was no vascularity present, which significantly decreased the chances of metastasis to the lymph nodes or other organs/tissues.

MX: M1 signifies if there has been distant metastasis to organs/tissues other than lymph nodes, while M0 means that there was no distant metastasis.  During the surgery, there was no clear metastasis to surrounding tissue, and because of the vascularity test that I mentioned above, the chances of this were also largely decreased.

So I had my staging...what else did the report mention?

"LEFT LOBE: Papillary thyroid carcinoma, classic type, 1cm..."

Right, no surprise there.  Classic type is good though.  There are variants (tall cell, Huerthle cell, insular, etc.) that you don't really want to see on your pathology report.

"...The tumor focally extends to within less than 1 mm from the posterior margin and to within 1mm from the anterior margin."

Whoa.

Me, as cancer whizzes past my face.

The tumor came LESS THAN 1MM away from leaving my thyroid gland.  Had it breached the edge of the thyroid, I probably would have been upgraded in terms of my risk category.  But, it didn't...by 1mm, AKA 0.1cm, AKA an extremely small margin.


My surgeon was very happy about this and said we took care of this at exactly the right time.  PHEW!

Ok, what else do you have for me, pathology?

"RIGHT LOBE: Papillary thyroid carcinoma, classic type, two foci, 3mm and 1.5mm."

Whaaaaaaaat?  Yup, cancer had shown up on the right side of my thyroid, too small for any ultrasound to detect.  According to Dr. Sigari, "multifocal" occurrence of PTC was very common, so this fact wasn't particularly alarming, especially since the two occurrences were so small.


Those micro-carcinomas did come within 2mm of breaching my thyroid gland though.  By sheer luck (or lack thereof), all 3 of my tumors happened to be extremely close to the edge of my thyroid.  Not necessarily bad in and of itself, but it probably meant that I wouldn't have been afforded the luxury of finding this years down the road, as many people tend to.

On a funny side note, the pathology report described my thyroid tissue as "red brown, firm and beefy."  That's right, I had a beefy thyroid.

You heard me, Khaleesi.

So that was it.  While a final scan after my radioactive iodine will give a more conclusive decision on if I had any metastasis, the results of the pathology report were overwhelmingly positive.  Good stuff!

Here's some photos of my progress during recovery:

2 days after surgery...note the minor redness above the tape, which turned into...

...this.  3 days after surgery.  Looks worse than it felt.

I also grew a "beard."  I never go longer than a week without shaving, so I figured this was a good opportunity to try it.  I went 2.5 weeks without shaving, and my "beard" was pretty pathetic.  Worst part is that I forgot to take a picture right before shaving.  I'll never be able to remember it now.

-W

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