Cancer Update: Post-Op Follow-Up

Please note, this language was adapted from an email, so please pardon if there are any lingering email references.

TL/DR: My incision is healing great. I have some swelling from lymph fluid that I'm treating with ice packs and time. Is my cancer gone? We don't really know yet. It's unlikely to be completely gone, but we know there's less of it, so that's a win!

For more details, read on.
I got to take my bandages off in advance of my video call with my surgeon yesterday morning. The incision is outrageously precise, and healing very well. It already looks amazing, she's a very skilled sewist. And while I don't mind scars, it is its own kind of magic to have such a subtle scar.

As I mentioned, I have some swelling. It was present from the time I woke up from surgery and has stayed mostly the same, which is a good sign because otherwise it would mean it's still accumulating. The plan is to avoid having it drained by icing it more often than once a day (applying some pressure) and letting it do its thing. Fun fact: if I cut fat out of my diet for a week, it will also slow the release of lymphatic fluid and possibly help it absorb faster. Fascinating! As someone who's done a major elimination diet before, that isn't far out of my purview. Steamed veggies here I come! Avoiding the draining process is simply because any time there's a needle involved, there's a chance for infection or complications. So, while unsightly, if the swelling will go down on its own, that's ideal. 

For my next learning adventure, I want to learn about how to best support my lymphatic system/drainage. It sounds like exercise and massage are beneficial, and my naturopath will also weigh in next week with some ideas.

The big question: do I still have cancer? Probably! But less of it anyway. For now, the identified tumor is gone, and that's a great thing. I had 17 lymph nodes removed (makes for my lucky number 23 overall) and 5 had cancer growth (making 8 overall), including the largest growth of 7mm, which was the tumor we found in December. The whole point of removing so many lymph nodes was to get rid of any existing growth (which we did) and prevent future tumor growth, which will make it less likely I'll need surgery in the left half of my neck in the future (they don't recommend surgery for the same area more than once or twice).

How will you know where the cancer is going forward? It's very difficult to use imaging to find tumors that are mostly microscopic at this point (more on this in the "what's next" section below), so uh yeah, we wait? :)

THE PATHOLOGY
Everything was still the same as my 2018 surgery, no news there. Same papillary thyroid carcinoma with 20% aggressive cells. It seems it didn't come roaring back with guns blazing, but more like a slow rolling glacier or something. I was frankly more interested to get the update on my lymph nodes this appointment. It's funny how cancer makes certain things less alarming than it would seem.

TUMOR MARKERS
When I get my bloodwork done, we check thyroglobulin (antibodies) to get a sense of how much tissue still exists. It's assumed that any tissue is cancerous, because any thyroid tissue has the potential to mutate and be cancer anyway. It kind of reminds me of when you have a loaf of bread and one slice is moldy. The other slices are fine for a minute, but somewhat inevitably will mold. I feel like maybe I'm two slices removed from the mold right now? All slicing/surgery puns intended (ew!). Wocka wocka.
My tumor markers went down ever so slightly, but it will take time for my antibody levels to even out, before we have an idea of how much tissue is still hanging out. So, more waiting and watching. I wouldn't hold your breath.

In the meantime, I had a smug chuckle at how pleased my non-conformist self is to be one of the few (jk!):

Speaking of being statistically unlikely, my identical twin, Jenna is in town visiting >heart eyes emoji<. On the docket: puzzles, walks (when it's not pouring), meditation, getting our nails done, hitting up some of our fave restaurants, and otherwise soaking in our twin time between me icing my neck on the couch and some one-off meetings. :)

Here's Jenna and I working on the latest puzzle at my apartment (shoutout to my Aunt for sending it! And truly thanks to everyone for all of your puzzles, cards, messages, and prayers). Selfishly, I think you should Zoom in and admire how neatly my incision is healing -- you can see the swelling there too if you're curious.

Next up: appointments in late March with my endocrinologist and surgeon.

I will have more follow-up bloodwork (living that cancer life!) at the end of March followed by a video call with my surgeon and possibly also my endocrinologist. We'll check in on the swelling, as well as check where my tumor markers are at that point.

If they have gone down a lot more, it's likely we'll just go back to maintenance mode, getting bloodwork every three months and ultrasounds every year.

If my tumor markers haven't decreased significantly, that would suggest that I have some other cancer growth elsewhere in my body. It might be nearby, or it might be in a lymph node far, far away (should we . What makes that tricky is, until the growth is larger, it can be hard to find on a scan. So we may have to just watch and wait until my tumor markers creep up again. 

The scan we would use would require me to do another dose of radioactive iodine treatment followed by a full body scan. On occasion they'll try a PET scan, but mostly for thyroid cancer, they tend to use the iodine. I'm not keen on that because my lifetime radiation levels already seem high enough, and the last scan was somewhat inconclusive (likely in part due to inconsistent uptake of the iodine and also because any growth was too small to effectively show up on the scan). My future tumor marker levels will inform whether my doctors recommend it or not. It's all very TBD!

So pretty much, we wait! So much of cancer life is waiting it seems. Waiting to see how things play out. Waiting for the next test. I suppose that's why cancer inspired my interest in the present moment. May as well make the most of the present while it's here! After all, that's all there ever is. >I feel like that's my take on an updated Looney Tunes tagline<