Mets Day 33 – Pathology Results: 12 nodes positive

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This afternoon we met with Dr. Steinberg, who gave us the results of the pathology of the bladder. prostate, and lymph nodes.  Anytime a doctor starts his comments with “this is not the news we were hoping for,” you feel yourself tightening up inside, waiting for the hammer to fall.  In short, I hit the trifecta:  the bladder cancer was more extensive that previously thought; 12 lymph nodes had metastatic cancer, and I also had prostate cancer.  The prostate cancer is the least important, since it was all contained within the prostate, and it’s now been removed. 

The bladder cancer was found to have penetrated the outer fatty layer of the bladder, which means that I have been “upstaged” to pT3a, from pT2b.  The higher the staging, the more serious the cancer.  The staging drives the future treatment, which I’ll get to later.

Most serious is the fact that, of the 61 lymph nodes that Dr. Steinberg removed from my pelvis and abdomen (35 from the right side, 26 from the left), 12 on the right side were found to have metastatic bladder cancer.  The prior scans had showed only three that appeared to be increased in size, and during surgery Dr. Steinberg did not see any that visually appeared to be suffering from necrosis.  That’s why he was so hopeful coming out of the surgery.  But the pathology pops that balloon. 

Meanwhile, my recovery from the surgery is proceeding faster than usual.  It helps that I am so young (relatively speaking).  The LPN removed the 27 staples that had closed my primary incision, and covered it with steri-strips.  They decided to leave the Foley catheter in for another week, but cleared me to travel home tomorrow.  I’m looking forward to that. 

But we’re still in shock from the bad news from the pathology.  Dr. Steinberg said, “we’re in uncharted waters here.”  There is no established treatment for where I’m currently at.  The first line of chemotherapy failed, and there is no proven second line of defense.  Dr. Steinberg said that he’d like to be able to identify the specific genetic pathways that my cancer is taking to spread, then give me a therapeutic treatment that would stop that – only he didn’t know how to do that.  He was quite candid on admitting the limits of his knowledge, and he’s one of the leaders in this field.  I got the sense that he was telling me that he’d given it his best shot, it didn’t work, and he was now turning me over to the oncologists for further treatment. He did say that he was going to have dinner this weekend with Dr. Schoenberg, my doctor from Johns Hopkins, and that they were going to discuss my case in detail. 

He recommended that we investigate clinical trials, and identified one in particular.  I’ll write more about that after I’ve had a chance to read about it and contact the investigators.  Dr. Steinberg said that clinic trials were like throwing darts – maybe you’d get a bulls-eye, but more likely than not it would have little beneficial effect.  He did note that he had a patient who had T3 and positive nodes, and five years later she was cancer-free, so you never know how it will go. 

So right now Jennifer and I are sitting at Promontory Point, which juts into Lake Michigan at the end of 55^th Street.  While we had hoped for better news, we both had understood that the pathology likely would confirm the fact of metastases.  The path going forward is far from clear.  Our days and weeks will be saddled with the looming uncertainty of whether the cancer will show up elsewhere, and if so, when, where, and whether it can be treated.  I accept that the odds are not in my favor.  I also accept that I have no control over the course of this disease.  I can seek out the best treatment, find the sharpest darts to throw, and trust in the professionals to aim them as best that they can.  But I know that they are all blindfolded, as am I. 

My vision is clear to the things I can control.  I can live one day at a time, grateful for each moment that I have to spend time with my family and friends.  I can strengthen my faith.  I can live with honor and dignity, doing unto others as I would have them do unto me.