Saturday, March 21, 2015

My Journey

Hi, I would like to introduce myself and my family.  My name is Aundrea, I have been married to my husband Donald for 11 years this year. We have 2 beautiful children Makenzie 11, and Keenan 7. I, Aundrea will be writing this story/blog about my husband Donald and our journey with this tiny mole.

In February 2014, Donald's journey begin.  I noticed he had a mole that he had for years started to change.  Over a couple weeks it started to grow and change.  Here is the tiny mole that begin Donald's journey that changed our lives.

 This tiny mole was biopsied and the results shown Donald had Melanoma.  Melanoma is a form of skin cancer caused by sun exposure or tanning beds, it runs in genetics as well so now our children will have to be watched closely.  It often is in light skinned, blond hair, blue/green eye people.  After the biopsy come back, Donald went back to the dermatologist and had a wide excision surgery to remove the cancer.  The Melanoma was 0.9mm and a Clark's level IV. Skin cancer is the most common of all cancers. It accounts for nearly half of all cancers in the United States. More than 3.5 million cases of basal and squamous cell skin cancer are diagnosed in this country each year. Melanoma, the most serious type of skin cancer, will account for more than 73,000 cases of skin cancer in 2015.
This is after the shave biopsy performed by the dermatologist.
 This is after the wide excision surgery to remove the cancer.  Donald had about 50 stitches.  After this procedure, he was referred to a Oncologist (cancer Dr), Donald met with him and he confirmed he had stage T1a cancer meaning his melanoma is less than or equal to 1.0 mm thick (1.0 mm = 1/25 of an inch), without ulceration and with a mitotic rate of less than 1/mm2.   When his biopsy come back it showed clear margins were reached meaning all the cancer was removed from the area.  From there because his cancer had just gone threw some fat and tissue, the oncologist released him to his primary Dr to just keep and eye on the lymph nodes.  Once cancer spreads it goes to the lymphatic channels, blood stream, liver, lungs, brain, bones etc.  It took me a while to understand this but cancer starts in microscopic cells, you cannot see these cells with the naked eye or test, test can see a cell at 1mm and about the time the test picks it up, you have a tumor forming.  During the past year of 2014, Donald met with his dermatologist for check ups and primary Dr once every 3 months.  We thought we were in the clear, we caught this and felt relief.

In January 2015, I noticed a slight swell on Donald's neck.  He never noticed it, never felt it, never felt sick or any side effects.  January 14, 2015, he went to our local clinic in hopes to see our primary family Dr but she was booked so he seen whomever was available to see him.  From there he went to the hospital and had a ultrasound.  The ultrasound come back for possible melanoma to the lymph nodes.  The next couple weeks he went threw a series of testing.  Donald have a fine needle guided biopsy to take tissue from the node, it also come back as worrisome for melanoma.  After that he had a ct of the chest, abdomen and pelvis,  a MRI of the brain and a PET scan.  All test come back good that there was no mastitis of the melanoma to other parts of my body except the area to the neck where he had the previous melanoma, the primary tumor.

 He met with a surgeon and we set up surgery.  On February 25, 2015, Donald had surgery.  He had a modified radical neck dissection and a partial protidectomy.  They removed about 30 lymph nodes in the neck area and part of the parotid gland (saliva gland).  The parotid gland was removed because the cancer was up against it and the dr felt if the cancer was to reoccur it would go there next.  We spent 2 days in the hospital after his surgery.  He come home on February 27 (it snowed that day in Texas)!  Donald was sent home with 2 drain tubes that come out from the neck and drained fluid to help keep from swelling and getting a infection.  Those tubes were quite painful and he couldn't wait to get them out.  He got the tubes removed a week after.   He recovered from surgery pretty good.  The surgeon did a great job on gluing him back together.  He didn't have stitches, they used derma glue to close  the incision.  The part of the parotid gland that was removed contained the nerve that worked the bottom lip on the right half, he lost use of that portion of his lip when he smiles, but that's fine, we can deal with a little droopy lip!  I just want my husband to be cancer free so we can grow old together!   Here is a picture from after his surgery with the drain tubes.  

After the biopsy come back from his surgery, we once again reached clear margins, he had cancer in 5 lymph nodes.  But that takes me back to the microscopic cells that cannot be seen.  Donald was confirmed a stage IIIc Melanoma.  He is considered in remission now.  The hardest part is the not knowing.  Is he healed?  Is there any micro cells left that traveled threw his lymphatic system?  We don't know.  The doctors don't know.  The test won't know for a while.

Once we met back with the oncologist for follow up to discuss treatment options, it was very limited. Remember, THERE IS NO CURE.  The oncologist gave us few options.  He could take radiation to target the neck area for 6-7 weeks but that would only treat that area, not the rest of the body.

The second option was Interferon.  This is one of the oldest FDA approved drugs to treat melanoma.  You have to remember new drugs are being tested daily to find whats works better.  Interferon-alfa can be used as an added (adjuvant) therapy after surgery to try to prevent these cells from spreading and growing. This may delay the recurrence of melanoma, but it is not yet clear if it improves survival. 
Interferon had some serious side effects with daily major flu like symptoms.  Treatment this route would be 1 tear worth of high dose Interferon.  Most patients don't make it threw threw the whole year of doses.  The first month would be high dose given intravenous followed by 11 months of maintenance phase dose given by a shot 3 times a week.   

The third option we had was to do a clinical trial.  We went to Dallas 3/19/15 to meet with this doctor.  He is a melanoma specialist so he has the top of the line treatment and is up to date with the statistics on how effective all the melanoma drugs are. Remember, most cancer treatment drugs have only been out 5, 10, 15 years so they can only base statistics on how effective it is and compare new drugs with the old.    We have chose this option to do the clinical trial.   This trial is of 2 different drugs that are FDA approved in treating stage 4 melanoma.  They have not yet been approved for stage 3 yet, hence the trial.  This trial is in its 3rd phase.  A clinical trial has 4 phases I believe before it goes on the market.  Baylor Sammons Dallas is the only place in Texas offering this trial.  This trial will be to compare the effectiveness of nivolumab to ipilimumab in patients with completely resected stage IIIb/IIIc or stage IV melanoma who are high risk for recurrence . (Both drugs FDA approved for stage 4 that is unresected).    Donald's cancer has a 70% chance of recurring.  I hope we have made the right decision in this journey and we hope Donald will be approved for this trial!  We feel one of these drugs will be the best option we have and the Doctor did too.  Below is a picture to tell about the trial, it just kicked off so there is not  any info about it online.  If you click on the pictures they will blow up more clear.  Because we chose this option, Donald cannot participate in radiation or any other treatment while he is in the trial.

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