| Author |
|
LucyM
Experienced user
Joined: 06 Jul 2009
Posts: 51
|
 Posted: Mon Jul 06, 2009 3:20 pm Post subject: . |
 |
|
Sorry, edited, thankyou for your help.
Last edited by LucyM on Fri Jul 24, 2009 7:52 am; edited 2 times in total |
|
| Back to top |
|
|
|
HaoleBoy
Senior User
Joined: 19 Aug 2008
Posts: 108
|
| Posted: Mon Jul 06, 2009 10:55 pm Post subject: Re: . |
|
|
First, I want to applaud you for being such a caring friend .... She will need all of the moral support she can get... I know just how emotionally overwhelming (indeed, even crushing) a melanoma diagnosis can be -- it really rocked my world to its very core foundation.... everything I worked for, everything I achieved, and everything that I still hoped for in the future was out there flying in the breeze....or so it seemed.... BUT, things do get better with time emotionally, if not always physically....
Secondly, does your friend live in the United States ? I ask because "standard of care" and related protocols are different in the U.S. compared to the standard of care in Great Britain, Canada, New Zealand, and some European countries...BTW, I'm an American.
To answer your questions..... No imaging technology in existence can [b]definitively [/b]diagnose malignancy in the lymph nodes... particularly CT technology alone... It can strongly suggest metastatic spread to the nodes or to a single node, based on nodal size, shape, and characteristics (i.e, loss in a node's fatty hilum).... I am presupposing that she does not have extracapsular extension in one or more lymph nodes where the cancer has basically taken over a lymph node and protrudes through the node's outer body -- this would probably be the exception to my comment on imaging technology fidelity...
Do you know if she had a combination CT/PET scan ? CT/PET provides a wealth of mutually complementary information but, even here, it really can't detect melanoma nodules below 2 or 3 mm in size, certainly it cannot detect microscopic mets....CT/PET imaging is the norm in U.S. National Cancer Institute designated Comprehensive Cancer Centers, but many of the smaller, community-level hospitals in the U.S. tend to lack this state-of-the-art (and very expensive) system.
The only sure fire way to diagnose metatastic spread to a lymph node(s) is to biopsy the node and to determine its status pathologically.... With a 3 mm thick primary tumor, the standard in the U.S. is to perform a Wide Local Excision of the primary tumor and a Sentinel Lymph Node Biopsy (SNLB) of the regional lymph node basin(s) which drains the area of the body where the primary tumor is located. I have to tell you that primary tumors in the head and neck region can drain to multiple regional lymph node basins (cervical, parotid area, jawline, etc.) ....
The SNLB is a minimally invasive procedure which removes as few as one lymph node and normally no more than 3 nodes, depending on how many nodes light up with the radioactive blue dye injected into the primary tumor location during pre-op.... Morbidity (not to be confused with mortality) is low and SNLB is highly accurate in determing the status of the lymph nodes (cancer free or metatastic), is essential to staging the cancer and in determing adjuvant treatment and elgibility for trials. Additionally, in recent U.S. studies, SNLB has been shown to provide a marginal survival benefit by removing a lymph node which may have sub-microscopic melanoma deposits in it before the node becomes clinically diagnosed, in which case, the cancer may have spread further to other nodes or viscerally to an organ....and in many American studies, SNLB status has been proven to be the most powerful idependent prognosticator of long-term survival.
Importantly, the SNLB will also determine whether or not your friend needs to have ALL of her lymph nodes in the regional lymphatic basin removed if the SLNB tests positive for melanoma ... This subsequent, follow-on procedure is called a Completion Lymph Node Dissection (CLND) and is highly invasive. In the head and neck region, the CLND can result in some substantial scarring (ala Senator John McCain's cheek and neck-line after he had a 2.20 mm thick melanoma removed)
It strikes me as strange that the doctors would want to remove the primary tumor and perform a CLND based only on a CT scan of the lymph nodes. At 3 mm, her tumor is T3.... You didn't mention if the primary tumor is ulcerated or not, but if it isn't ulcerated, AND HER LYMPH NODES ARE CLEAN, she could be Stage IIA (same as me), which carries a 5 year survival rate of 78 - 86 % and a 10 year survival rate of 64 - 73 %...I would also add that Stage IIA melanomas are considered potentially curable but the recurrence risk is also higher than Stage I melanomas....
If her melanoma has spread to the lymph nodes, then she will be Stage III, which has 3 sub-categories which depend on a host of variables... 3A has microscopic mets to a single node and the primary tumor was not ulcerated (Reference the American Joint Cancer Committee's 2002 Staging Criteria for melanoma for specifics... just Google it). Stage III is very problematic... Not many melanoma oncologists or oncology surgeons will say Stage III is curable.. the cancer has metatasized to the lymphatic system and melanoma is notorious for laying dormant for years only to erupt with a fury later on .... However, very long term survival is possible.... Sam Donalson, the former American ABC Network News Anchor, is alive 14 years and counting (disease free I might add) at Stage IIIA....
Lucy, this is what I know.... I'm sorry to hear that your friend is going through this ..... but she is fortunate to have people who care about her as you so evidently do....
Prayers and Blessings,
Haole Boy (aka Hawaii Bob on other melanoma forums)
Stage IIA
2.40 MM Breslow Thick Primary Bottom of Left Foot's 2nd Toe (amputated in WLE), SLNB negative 21 August
10.5 months No Evidence of Disease (NED) |
|
| Back to top |
|
|
|
LucyM
Experienced user
Joined: 06 Jul 2009
Posts: 51
|
| Posted: Thu Jul 16, 2009 11:59 am Post subject: Re: . |
|
|
Thankyou x
Last edited by LucyM on Tue Jul 21, 2009 1:56 am; edited 1 time in total |
|
| Back to top |
|
|
|
HaoleBoy
Senior User
Joined: 19 Aug 2008
Posts: 108
|
| Posted: Fri Jul 17, 2009 6:22 pm Post subject: Re: . |
|
|
Lucy, I haven't had to go through a Completion Lymph Node Dissection -- not yet at least and hopefully not ever I pray... but from being a "regular" on other melanoma fora, it is not unusual for a patient undergoing a CLND to be watched in ICU initially...
CLND has a low mortality rate but morbidity complications are common -- usually concerning lymphadema (built up of lymphatic fluid)... and possible blood clot concerns (which is automatically a concern in the head and neck region around the carotid artery for obvious reasons)....
Cosmetic complications are also a factor -- is your friend going to have plastic surgery as well ?
From what I've read, she will be in the hospital at least a week, perhaps a little more....In the US, the docs try to get people out of the hospitals as soon as possible in order to reduce the risk of infection (and as you know, hospitals are notorious for various bacterial infections regardless of all the constant cleaning)....Don't know what the norm is in UK....
Best of luck to your friend.... |
|
| Back to top |
|
|
|
LucyM
Experienced user
Joined: 06 Jul 2009
Posts: 51
|
| Posted: Sat Jul 18, 2009 1:27 am Post subject: Re: . |
|
|
I'm sorry I had to edit as it was coming up on google search, and I didn't want her to accidentally find it. I hope you understand, tried to contact mods but no reply.
Thanks again for your advice, it is good to have a place to ask questions. |
|
| Back to top |
|
|
|
brainman
Site Admin
Joined: 13 Oct 2005
Posts: 5617
Location: Tennessee
|
|
| Back to top |
|
|
|
LucyM
Experienced user
Joined: 06 Jul 2009
Posts: 51
|
| Posted: Wed Jul 22, 2009 4:32 pm Post subject: Re: . |
|
|
Thankyou Jim, you're a dear. Once again, I'm sorry to have messed about with my threads.
All good wishes to you all
Lucy |
|
| Back to top |
|
|
|
|
Search 
Email Digests
Register to post
Profile 
Check private messages 
Log in
What is this ?
We subscribe to the HONcode principles. Verify here. All content and posts are copyright.
