Hello all. Here's an update after a week of confusion. Sorry for the long post - it was a long week.
Background: a dual-phase PET/CT this month showed "moderate" FDG uptake in my left supraclavicular lymph node. The fact that there was increased uptake on the second reading is highly suggestive of malignant activity, though I'm not entirely clear why. I guess benign causes tend not to produce higher second readings. Anyway it looks for the world like I have an isolated recurrence in that node.
The first thought was to do an excisional biopsy and find out what was what, perhaps also doing testing on the live tissue. The second through fifth thoughts were a ballet of angsty uncertainties. Finally we decided not to do the biopsy at all. We're watching, waiting, betting the farm on the PET result being a false positive.
-- Voice of Reason: What? Are you kidding me? Why not take out the node? If it's bad, then you'll be glad it's out. If it's good then who cares, it's out.
-- Voice of Jdepp: It turns out that in this case it is not a simple thing to just "take it out." It is non-palpable to 3 different doctors, so according to the surgeon I would have to be under general anesthesia. He would "dig around" to get it. There are risks to things like lungs & arteries.
-- VOR: Still, isn't it true that we are talking about the left supraclavicular node, aka Virchow's node, aka a "sentinel node," aka the Google-unfriendly node, the one that if you find swollen and you are over 40 years old has a good chance of being malignant, usually signaling metastatic cancer from somewhere?
-- VOJ: Yes.
VOR: If you leave it in don't you increase the risk of spread?
VOJ: Well, in the words of my oncologist: "If the node is positive for cancer then the chance of cure is very low."
VOR: So you're leaving it in because if it is bad then the news is already bad enough that you might as well wait until symptoms appear?
VOJ: Yes. It's what Justsing refers to as a come-to-Jesus moment. If I develop symptoms or if my next scan is bad then I'll take whatever action seems appropriate, but in the meantime I'm playing with the kids and drinking the good tea. Yes, the High Mountain Oolong I got as a gift.
VOR: Could there possibly be a good outcome to this?
VOJ: Two things give me hope. 1: colon cancer rarely spreads to this node and when it does it is usually part of a general spread -- to lungs, liver, other nodes... It is rare, though it does happen, for it to go to this node in an isolated fashion. 2: Benign etiology is possible, though given the obnoxiously numerical and visual PET results I do need some luck. My best hope here is that I felt sick on the day of the scan, developed a headache and later in the day I vomited. (Shout out for vomit! So under-appreciated.) The radiologist even noted sinusitis in his official report.
I'm hoping (gambling) the activity in the node is related to that.