When the report came back, for the first time, worrisome hypermetabolic activity was noted. Five of the eight known nodes in my lungs had lit up. Each node's SUV* was very low--too low to be sure of anything. It was just ambiguous enough that a clear path forward wasn't obvious. My oncologist offered three options for how to proceed:
a) Wait and see. Repeat the PET scan in a few months to see whether anything changed.
b) Act now. She could prescribe oral chemotherapy (Xeloda, which is the pill form of fluorouracil, and Avastin, which is a drug that inhibits the tumor's ability to acquire its own blood supply) under the assumption that it was colon cancer in my lungs.
c) Biopsy. I could undergo a lung wedge procedure wherein a thoracic surgeon would slice off a section of my lung that contains a nodule and send it to pathology for analysis.
I was too impatient for the first option, though in retrospect that may have been the better choice. Option two held no appeal at all. I was firmly opposed to more chemo unless it was warranted. The third option made the most sense to me at the time. It would give us unequivocal results, but I wasn't keen on returning to the same facility where my spleen had been so-recently biopsied. I found a different hospital.
I updated my friends:
...hopefully we will put the question of "What ARE those things in my lungs, anyway?" to bed. Finally. [My oncologist] described the procedure as "removing a wedge of lung tissue". A wedge?! A...wedge. Ugh. I am glad I will be asleep when they do it. They will use a procedure called "video-assisted thoracoscopy", or VATS. It is an outpatient procedure. I decided to go to a different facility to have this done.
...Pat and I will meet with a thoracic surgeon from [a different hospital] to discuss my case. I will bring to him a stack of CDs containing many hundreds of images for review, along with the associated medical reports. I will have a lot of questions, chief among them, "Will my spleen be involved in any way?" ha ha
We met with him in his office shortly afterward, and I wrote:
He's going to remove one of the nodes from the base of my right lung (far, far from my spleen). It is fairly close to the chest wall, and he thinks he will have no problem extracting it. He explained that the tool he uses to obtain the tissue will staple as it cuts, which at once nauseates and intrigues me. I will be under general anesthesia. The doctor will somehow stop my lung from moving (breathing) for the duration of the procedure. I will have a "chest tube" coming out of my side when I wake up. ack! ack! ack! I will remain in the hospital until the chest tube is no longer needed. This could be several hours, or a day, or several days. He said that I should expect to be in the hospital at least a day.
The surgery was scheduled for December 12, the Feast of Our Lady of Guadalupe. I scheduled a follow-up with my oncologist for five days after that. Whatever the news would be, I wanted to hear it from her.
*SUV = standard uptake value. It is an indicator of hypermetabolic activity. Prior to the PET scan, radioactive glucose is injected into the patient. This substance is attracted to areas in the body that are experiencing rapid cell-division, as with growing cancer cells, or in areas undergoing tissue repair.