Stage 1

Well, folks, the results are in.  In the words of Dr. Neil Barth, “I am cautiously optimistic that you have been surgically cured.”

The last week or so has been difficult not because of any physical pain, but because of the uncertainty of not knowing if I still had cancer. Unfortunately, after my surgery I was referred to a HMO physician whose office staff was perfectly content to allow the HMO to delay authorization of the diagnostic studies needed to answer this crucial question. In fact, the authorization is still pending.

Given the difficulty with the HMO, I decided to take matters into my own hands. Luckily, my insurance also is PPO, meaning I can choose a doctor outside of the HMO network. Of course, the downside is higher cost, but I contend that the extra money was worth it as it bought peace of mind.

Enter my best man at the upcoming wedding, Adam. Adam's father is a cardiologist, who through his own successful practice and work at Hoag Hospital, knows perhaps the best oncologist in Orange County, Dr. Neil Barth. I talk to Adam, Adam talks to his dad, Adam's dad refers me to Dr. Barth. Here's Dr. Barth's curriculum vitae if you are interested.

Once I had the referral to Dr. Barth's office, things went quickly and smoothly. I received the results of my blood work. The two tumor markers, beta-hcg and alphafetoprotein, dropped dramatically post-surgery. In fact, the beta-hcg marker actually dropped to normal levels. The alphafetoprotein was still slightly elevated, but it also has a higher half life. More blood work to be done in a week or so.

Next, I had my first set of CT scans. The first time I went to Dr. Barth's office, I was incredibly impressed by what I call “the Newport difference.” Now for you out-of-towners, Newport Beach is known for being an affluent area of Orange County. Think Real Housewives of Orange County. Luckily, there was no snobbery at the doctor's office. There was extremely friendly staff, a receptionists who was not hard on the eyes, private changing areas (to put on your gown), lockers to put your stuff in, and white-fluffy robes to wear over your gown. Too bad the only cocktail they offered me was berry flavored barium.  Needless to say, I was impressed with the office.

Actually, I was really impressed with the process of the CT scan itself. The machine they use is so brand new and advanced that it talks to you! “Breathe, hold your breath,” it calmly instructed. I didn't have any problems with claustrophobia (you don't stay inside the tube for very long, as the machine slides in and out), and the technician did a good job of inserting the IV (for the iodine contrast). All in all, the CT went smoothly.

Yesterday, was the big appointment with Dr. Barth. My wonderfully supportive Bride-to-be, attended the appointment. While waiting, I'm pretty sure she read the entire FamilyCircle magazine. The Newport difference was on full display inside the examination room. Yes, inside the exam room was a 36-inch plasma screen hanging on the wall. Now you are probably asking yourself why one would need a plasma screen inside an examination room. Well, let me tell you, faithful reader. Dr. Barth used the monitor to go on a guided, narrated tour of the inside of my body. Using a wireless keyboard, we went through every slide of the CT. Essentially, we saw an animation of a cross-section of my body from my neck all the way down to my...ahem, pelvic area.  It was soooo cool.

Oh, it was also informative. First and foremost the CT scans did not show any evidence of metastatic disease. The also showed that I have freaking scoliosis!!! I exaggerate. Only one joint curves slightly to the right. Insert joke about lawyers being crooked. I also learned that my heart muscle is perfectly healthy and that I have fantastic abs.  Shoot, he could have just asked Venessa if he wanted to know about that ;-).

So where does that leave us? Dr. Barth was confident in the stage 1 diagnosis, but he wants to have additional information before advising us on whether or not he would recommend observation or adjuvant chemotherapy. In the coming week, he is going to have his own pathologist give a second opinion on the actual tumor. They are going to look at type of cell, internal vascularization, and whether the tumor had extra-testicular vascular access. Also, I am going to have a PET/CT scan on Monday. This will more clearly show if the cancer had spread.

A CT scan only shows structures. It is useful, but not foolproof. For example, all of my lymph nodes in the CT scan were within the normal size range. That doesn't mean that one has a small amount of cancer in it. To help get a better picture, you do the PET scan, which images the cancer as it metabolizes radioactive glucose. Essentially, a PET scan actually has the ability to see cancer as cancer.

Another thing Dr. Barth is going to do is send the tumor off to genetics lab to do a complete genetic profile of the tumor. This is where Dr. Barth is on the cutting edge of oncology. The idea of getting a genetic profile of the tumor is to determine whether or not it would be genetically-predisposed to being aggressive. They are going to learn information about the very first cancer cell such as did it go from being a normal cell because it was promoted to become cancer or because the gene for preventing cancer failed.

Once we have as much information as possible we will roll the dice. That's actually a pretty accurate description. Dr. Barth is going to assess the odds of a recurrence, and how much that chance would be reduced by adjuvant chemotherapy. If the odds of recurrence are good and those chances would be reduced by chemotherapy, he might recommend the chemotherapy. On the other hand, if the tumor didn't have vascular access, and isn't the type of tumor that would be aggressive, he will likely recommend observation.

So stay tuned. The odds that I have been cured are very good. I, like Dr. Barth, am cautiously optimistic, but there is a part of me that is reluctant to believe the news. I love you all for thinking that I am Stage 0, I just don't know if I can believe it quite yet.