More surgery

We've had a difficult week and, unfortunately, I'm headed for more surgery.

For a couple weeks, I've had a small nodule (around 1 cm) in my high left groin. When it became clear that it wasn't going away, we had a needle biopsy performed and pathology showed that it was consistent with my primary sarcoma. We got the news on Monday, so we spent last week working out what this means, what comes next, etc. I had a restaging PET-CT scan on Thursday, which thankfully showed no evidence of disease (other than this nodule).

Fortunately, this is a known (but rare, of course) behavior for angiomatoid malignant fibrous histiocytoma. While experience with this kind of cancer is limited, a reasonable estimate is that 10% of patients will have local recurrence (at the surgical site) and another 5% will have "local metastatic disease" with nodal recurrences like this. We've been talking with the sarcoma groups here at Hopkins and also at Dana Farber in Boston; the expectation is that another surgery will be all the treatment that I'll need.

So, the plan is that I'll have a left inguinal lymph node dissection sometime soon, probably around November 20 or 21. The schedule will be finalized mid next week after I have another consultation. Basically, I'll have all the lymph nodes in my left groin removed (and maybe a few nodes in the pelvis). This is not a high risk surgery, but I expect to be in the hospital for a few days. We don't anticipate any long term effects from the operation (other than several more inches of incisional scars to add to my already impressive collection). Of course, pathology review of the removed nodes and tissue will be important.

Certainly, as we thought we were done, this has been a shock. Gwyneth, William and I are doing fine, but - as always - continue to appreciate your thoughts and prayers.

Robert, Gwyneth, and William