Steps Toward Treatment - Week of August 7 Post 3

Damaris and I attended the Head and Neck Cancer Multidisciplinary Clinic this morning in the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital in Baltimore.  It started off with an interview of my record and medical history by Dr. Shanthi Marur, Medical Oncologist on the Mutlidisciplinary Team.  She took what she found and briefed the other clinicians and specialists in another room where they were reviewing results of my tests and scans, after which they then joined Damris and me in the examination room.  Present were Dr. Wayne Koch, head and neck surgeon and Director of the Head and Neck Cancer Center, Dr. Harry Quon, Radiation Oncologist, Sarah Bonerigo, Physician's Assistant in Medical Oncology, Heather Starmer, clinician in speech pathology, and the Multi-D Clinic Coordinator, Amy Brady, an oncology nurse.  A nutrition services specialist, Mary Eve-Brown, will also be on the team overseeing my treatment and recovery.

My nasal passages and cavity were anaesthetized and a fiber optic endoscope was inserted so the group could view my tumerous tonsil, throat, and nasal cavity.  We were told that the PET scan showed that my tonsil and lymph nodes on both sides of my neck were cancerous, but that there was no sign of cancer anywhere below my clavicles (collar bones), which was very good news.  They told us that the fine-needle biopsy taken by Dr. Gourin last Friday had revealed a marker for human papilomavirus, but didn't extract enough tissue to positively confirm presence of the virus as the likely cause of my cancer.  They also said that the PET scan had revealed another area on my nasopharanx (upper posterior area of my nasal cavity) that absorbed radioactive glucose and re-emitted radiation, a possible sign that the area is cancerous.  They viewed the area with the endoscope, and recommended biopsy of the cancerous tonsil and the new possibly cancerous area to to obtain enough tissue for confirmation of HPV and determine whether the new area is cancerous.  Dr. Quon explained that if the new area were cancerous, it would have to also be treated with radiation, and because of its location that treatment would present greater risk of permanent damage to my salivary glands.

The specialists participating in the Multi-D clinic stated that positive confirmation of HPV would indicate a different treatment regime with a very high success rate with fewer side effects than would be used for cancer from other causes or unknown cause.  So they are in consensus that treatment should wait to determine if the tumor is caused by HPV and the status of this new area in order to plan treatment to correctly target and shape the radiation beams from the cancer center's linear accelerator.

Dr. Koch said that he could do the biopsy today, but that he wanted to consult with Dr. Gourin, because she was my initial specialist for my Hopkins consultation.  Dr. Gourin was available and did the new biopsies today at noon in the Head and Neck Surgery Clinic of the Hopkins Outpatient Center.  The collected samples are being analyzed in the Johns Hopkins lab.  Dr. Gourin was quite sure that the area on my nasopharanx isn't cancerous; instead it seems to be a pocket of mucous, possibly in reaction to the cancerous tonsil.  More good news.

The results of the biopsy won't be ready until mid-week, and my next scheduled appointment is Tuesday, August 23, so it's apparent that treatment is unlikely to start before the week of August 28.  I'm a bit anxious that that treatment get started, to stop cancer growth and eliminate it from my body.  But the consensus of the specialists for the additional tests will ensure that I receive the best possible treatment.