I’m hoping if I write this down that I’ll finally get to sleep.
31/12 started as such a good day, I woke up in a good mood, had a lovely morning walk in the countryside, decided to go home for lunch then have another walk with my husband in the opposite direction at the RSPB. Completely chilled out when my mobile phone rings and it shows it’s my hospital. Admin were ringing to book me in for an appointment with a plastic surgeon and they have a hard to fill appointment that afternoon that they are hoping I can get to. My mind computed the short notice was just so that an appointment doesn’t go to waste but I thought my biopsy results from my lymph node meant I no longer needed surgery so a little confused, and voiced that but admin assured me that they had been asked to ring me, so I accepted the appointment as there was enough time for us to go straight there (although I’d have preferred not to have my walking shoes on) and thought I’d ring my cancer nurse before we left to double check I wasn’t wasting an hours trip.
I was/am a complete responder on Pembrolizumab but in March had a rogue lymph node removed that was growing larger while still on Pembro. Then in October I could feel a lymph node growing larger and a scan 2 weeks later in November confirmed it was 17mm instead of 8. By that time the 17mm felt like 50 but in the next 3 weeks waiting for a needle biopsy it began to shrink and I still can’t feel it. The histology report I was told confirmed melanoma but it was withering, I asked if that meant the full node dissection they were planning was no longer required and was told that’s correct. So I’ve had a relaxing few weeks where everything was right with the world.
The nurse I rang read out a note from the system that the MDT thought I should have one node removed so that I can restart Pembrolizumab as adjuvant again and that the surgeon will discuss that with me. The MDT had met after my info that Pembro was working and no node dissection required, my mind is thinking ah, I had thought no surgery at all but it seems they want just one removed but that hadn’t crossed my mind as Pembro was working. Other thing crossing my mind is when is Pembro due to stop and when is it safe to stop ? So off we go to the appointment.
We discussed my history, that I can’t feel the node, drs can’t now feel the node, that the MDT seem to be thinking the biopsy was inconclusive and that removing the node would give more info, that it’s difficult to do surgery on a node you can’t feel as the excision might not be made in the right place. This last bit didn’t compute as they removed one node in March that couldn’t be felt but the scan told them where it was and the surgery was laparoscopic. There needs to be some more discussion as the consultant surgeon that I saw had not been at the MDT, but he wanted to know if I wanted to go ahead with surgery if they could do it. For me that’s not a yes or no answer. I’m happy to go ahead with the best recommendation but I need to be convinced that it is best for me. I’m not concerned waiting due to Pembro working, I appreciate that surgery is often the best answer to ensure cancer removal but I value my mobility and for me because of previous involvement of many lymph nodes a system treatment has been the answer.
So I will get a call next week to advise me what course of action is being recommended.
I think if there hadn’t been noisy fireworks I might have gone to sleep, happy new year what ever it brings.
I hope you did manage to get to sleep KTatHome and have managed a nice, long lie in this morning.
Hopefully, writing down all that you're feeling and all that you went through yesterday has helped clear things up in your mind. It must be horrible thinking that you're following one course of action only to be told that it might now be another.
xx
"Never regret a day in your life, good days give you happiness, bad days give you experience"
Hi lgrgdg90, thank you for your kind words. I hope the scan results you’re expecting come in soon, and favourably. I had a look, I had #43 of Pembro at the start of December. We will have to have a positivity pact together 
.
Take care KT
Yes I agree x
Hey KTatHome, I think discombobulated is very apt description for this set of circumstances!
Now please excuse me because I’m drunk, and thinking/typing is extra challenging...
I have a science background (*disclaimer - although not a medical expert) yet I’m becoming slightly more sceptical of the need for surgical intervention. I believe that historically, there has been a wealth of anecdotal evidence suggesting we live with primary tumours for a long time, which actively suppress any secondaries. Death from metastatic cancer isn’t all that helpful from an evolutionary point of view (the tumour’s evolution that is). Surgical removal of primaries removes that inhibition, floods the body with growth factors for repair purposes, and may lead to uncontrolled growth of secondaries. Now obviously there’s more to it than that, but I’m drunk and this is hard work. On top of that, my personal belief that surgery is physically shaking all those cells around, it’s a risky business...
If the Pembro is working, which is clearly is, then is the benefit of further surgical removal great enough? It’s obviously never an easy or clear cut answer, but it’s something I’d give a lot more thought to now (she says with a new biopsy scar she didn’t think twice about)!
Just when you think you know where you’re at! 
Hope the chilled out state is persisting. X
