Surgery #2 – Retroperitoneal Lymph Node Dissection (RPLND)

Getting ready for another surgery. Appearing calm for everyone around me.

So after a week or two I got a call from Dr. Brandes with the results from the biopsy. The details I need to confirm but they were worse than the last orchiectomy. Apparently there are various types of cancer and the way they spread is different. The reason to dissect lymph nodes is because that is where the disease would attack next and go in an upward fashion starting in the lymph nodes then going to your heart, lungs, brain, etc.

What are lymph nodes?
Lymph nodes are small, bean-shaped structures that are an essential component of the immune system. They are found throughout the body and are interconnected with lymph channels. Testicular cancer tends to spread through lymph channels that drain into lymph nodes in the groin area, into channels near the large blood vessel (the aorta) carrying blood from the heart, and into lymph nodes between the abdomen and back called retroperitoneal lymph nodes.

Different types of testicular cancer
Testicular cancer is broadly divided into two different types, seminoma and nonseminoma, based on the appearance of cells under the microscope. Nonseminomas are, in general, more difficult to cure than seminomas. Nonseminoma cell types include: embryonal carcinoma, teratoma, yolk sac carcinoma, choriocarcinoma, and various combinations that are referred to as “mixed cell types”. For nonseminoma cancer teratoma presents the lowest risk of spread and choriocarcinoma presents the highest risk of spread; the other cell types are of intermediate risk.

Treatment planning depends upon whether the testicular cancer is classified as seminoma or nonseminoma. Seminomas are more sensitive to radiation therapy and are easier to cure than nonseminomas. Patients with all stages of seminoma have a cure rate that exceeds 90%, and patients with seminoma confined to the testicle have a cure rate approaching 100%. If there is a mixture of seminoma and nonseminoma components upon examination under the microscope, the cancer is diagnosed as nonseminoma because the cancer will be more aggressive due to the nonseminoma part of the cancer.

The extent of disease, or “stage” is determined after surgical removal of the testicle.

My biopsy results
My results were determined to be “mixed cell types” and 5%-10% of the cancer found was very aggressive and I believe it was embryonal carcinoma. Due to this finding the doctor wanted to rush me in to get a PET scan (scan of my whole body) and a brain MRI to see if the cancer had spread to other parts of my body and even into my brain. To say the least I was freaking out. I got extremely nervous and this was the hardest part of the whole process so far…I decided to handle these tests by myself which was a mistake because I felt alone again when I really didn’t need to be.

The thing with me is I really do not want to bother people or ask for too much help. I always feel like I have to take on things by myself and tend to push away people that want to help which I really need to try to work on. I have so many loving people in my life and going through all of this has really shown me that.

I went into the tests and knocked them out but my anxiety, nervousness, terror continued until I got the test results back within the next week.

Results
Some good news was finally in and the tests were OK. The cancer hadn’t spread to my brain and we were ready to move on with the RPLND surgery and it was scheduled for June 28th 2011.

Surgery Day

The warm blanket calming me before I was put under.

I was all ready to go for surgery and this one was going to be a tough one. It was not outpatient and I was scheduled to be in the hospital for 3-4 days. My mom, her twin sister (Jane), and Gisela all went to the hospital in the morning and I got all checked in. I then went up to the prep area and got into my surgery gown and they confirmed my name, DOB, etc. As you wait you talk to so many doctors explaining different things such as anesthesia, the process, how long it will take etc. When I was ready to go into surgery they started the anesthesia and I slowly started to fade away. I saw my mom and Gisela but then they faded away. I was wheeled into a cold room and then everything went dark.

Post surgery
I woke up from the surgery and was in extreme pain on my left side. I was cursing uncontrollably and couldn’t remember much. I couldn’t open my eyes for more than a couple minutes and don’t recall waking up being this difficult. I later found out the surgery took about 6.5 hours which is an eternity for everyone who was waiting on me. I know my mom was a nervous wreck but I made it and she could finally see me.

I was then wheeled to my room and luckily I requested my own room because nothing is worse than rooming with someone when you have visitors and going to be there for a couple of days. They luckily let Gisela stay with me overnight and she stayed with me until I was released 2 days later. She was by my side the entire time and so patient I don’t know what I would have done without her.

The first night
Around midnight the nurse came in and asked if I was ready to try to get up and walk as much as I could. I was up for it and popped right up (catheter and all). I stood up and slowly made it to the door and this was the hardest thing I had to do that night. I was trying to push it and my body told me NO! My body got weak and I felt like I was going to pass out. The nurse and Gisela saw my face and said, “Maybe we should go back to the bed” and I murmured “ok”. I started to sweat and get real hot and Gisela later told me my face was yellow but the nurse said that’s better than what most people do on the first night. I was well on my way to recovery!

I didn’t sleep that much the first night becuase of the pain and it is not that easy for me to be completely relaxed in the hospital. Getting up was very difficult because the incisions were all located in the abdomen area so maneuvering around was quite a process.

Day 2
The next day I was ready to leave but they insisted that I stay another day and I got pretty frustrated because all I wanted to do was go back home. I had some visitors that day which was nice but I was still in a lot of pain and highly medicated so I wasn’t all there.

Early that morning the doctors came in and were checking on how I was doing. Little did I know they were going to pull out my catheter which by the way is just a miserable thing to have done. Before I could ask the doctor when they were pulling it out he said, “That’s what we are doing now and I am distracting you”. At that point the other doctor pulled it out and after a deep breath and shock everything was fine but now I would have to get up to go to the bathroom.

Later in the day I was more mobile and made it all the way down the hall walking and was going to the bathroom regularly. I was recovering quickly and really just wanted to get out of there.

The final day
I woke up the next morning quickly asking when I could go home. They had to do all of the paperwork and I didn’t get to leave until around noon that day. I got up and got in my wheelchair and was wheeled out waving to all the nurses who helped me and just overall excited to be in my own bed and on my own couch. I still had a lot of recovery to go but the worst was over and every day it was going to get better!

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