The start of our cancer journey

My husband, Dennis, was diagnosed with kidney cancer on April 3, 2009. Months before he would sneeze, grab ahold of his ribs, and wince. I asked what was wrong and he kept replying that he thought he had cracked ribs, although he could not remember doing anything that would cause cracked ribs. A few weeks later the pain started to ease up so we thought whatever was going on was healing. About a month later Dennis was kicking/pushing snow out of the back of his truck and thought he pulled a groin muscle. At this same time the pain in his ribs returned. A few days later Dennis comes into the bedroom, pulls up his shirt and shows me a bump on his left side. Hmm... that's not normal. You need to see a doctor right away.

Dennis saw his doctor and she sent him to have a chest x-ray. The radiology report indicated a large, rounded soft tissue opacity in the right lateral midlung, with an approximate diameter of 6cm. This opacity is adjacent to the lateral chest wall on the right, and overlies the posterior right fifth through seventh ribs. This opacity is not appreciated on the lateral view. There is no evidence of a rib fracture or osseous rib lesion. The left lung is clear. There is no evidence of an effusion or pneumothorax. Cardiomediastinal structures are within normal limits.

IMPRESSION: Large, approximately 6 cm soft tissue opacity within the right lateral midlung suspicius for a neoplasm. Correlation with CT of the chest is recommended.

The only opening the hospital had for a CT scan was that night but Dennis had to work, so they scheduled a CT chest w/contrast for the next morning.

The report from the April 3, 2009 CT scan.
IMPRESSION:
1. Large exophytic left renal mass (6 cm), incompletely visualized, is consistent  with renal carcinoma.
2. Expansile right third rib mass, most consistent with metastatic disease.
3. Indeterminate pulmonary nodules, which could reflect metastatic disease.

Dennis called me at work and gave me the news. He was choked up when he told me, and I hated that I wasn't there when he heard the news. After that, the day was a blur. I honestly don't know how I kept it together.

On April 9, Dennis had another scan, a CT of the abdomen w/ contrast. We also had an appointment with Dennis' urologist, Dr Nielsen, and his oncologist, Dr. Rathmell to discuss the radiology reports and the available options. The recommendation was to have a laparoscopic nephrectomy. We were also presented the option of a clinical trial of sorafenib for 5 weeks before the nephrectomy. Dennis entered the clinical trial and was scheduled for a PET/CT, and a whole body bone scan.

The following day Dennis had the PET/CT. The day didn't start off very well. He was poked way too many times as they tried to find a vein. He also had to wait an extra hour before they could start since he had milk in his coffee, a big NO, NO. The only new information from the PET was a hypermetabolic focus involving lateral left 6th rib. Unfortunately, the day didn't end well either. Dennis found out he was allergic to the contrast. His hands started to blister and by the next day he couldn't stop itching. I felt so bad for him.

Around April 12th Dennis started the clinical trial of sorafenib. The trial was to evaluate shrinkage before surgery. Dennis tolerated the meds well, and he could feel them working. All his spots were sore for a few days.

On April 17, Dennis had a whole body bone scan. We were starting to feel like regulars in the scan area of the hospital, and the café as well. At least we weren't on a first name basis with anyone. You know you're spending too much time at the hospital if they shout your name when you walk in. Anyhow, here's the findings of the bone scan using the PET/CT 4/10 and the CT chest 4/3 for comparison.

There is focal uptake in the right 3rd rib, corresponding to osseous findings on the CT of the chest and worrisome for osseous metastatic involvement. There is a subtle, elongated focus of increased radiotracer uptake along the anterior aspect of the fourth right rib, which is not visualized on CT, but suspicious for metastatic involvement. There is also  increased uptake within the 6th left lateral rib, corresponding to findings on PRT/CT and worrisome for metastatic involvement. Within the pelvis, there is increased radiotracer uptake within the left sacroiliac joint and the right proximal femur. No CT or PET/CT correlation. The areas are suspicious for metastatic involvement.

Good grief, more bone mets!! At least we know where all the pain was coming from. What he thought was a pulled muscle in the groin was really pain from the femur. What, another scan? Dennis went for a AP+LAT of the right femur on April 20th. By now with all the scans I'm surprised he isn't glowing green!! The findings were a 11.4 x 3.5 cm lytic lesion seen in the proximal right femur, concerning for metastatic involvement, and worrisome for impending fracture.

Ok, it's April and turkey season. Dennis is out walking for miles unaware that his femur is close to breaking. At his next appointment he mentioned how much walking he was doing and his oncologist then told him of the dangers along with setting up an appointment with Dr Esther, an orthopedic oncologist. Hmm... would have been nice to know that little tid bit of info earlier, don't you think?

On April 24th we met with Dr Esther and went over the planned surgery. Dennis was to have a steel rod  put in along with having endovascular surgery the day before to cut off the blood supply to the tumor in the femur. After looking at the x-ray of the femur we were amazed it didn't break. He really was lucky considering he fell a few times while out hunting, and stepped into a deep hole that actually jarred his leg. Dennis had his bionic leg surgery on April 30th, and was released 3 or 4 days later. He still has some pain were the screws were put into the hip, but he deals with it.

Dennis had his laparoscopic nephrectomy on May 18th. His whole family came down from New York. His mom, brother, sister, and 2 nieces. All went well with his surgery and he was able to leave in a few days. His incisions healed nicely, and he was getting around pretty well in a few weeks.  Soon after his family left his cousin Pete came down for his treatments at Duke. Pete had Glioblastoma Multiforme Grade 4, and unfortunately lost his battle Sept. 13, 2009. Cancer Sucks!

Before the nephrectomy  Dennis had another scan to see if the sorafenib worked on shrinking the tumor. It did! The tumor shrank a little more than 1 cm, and he wasn't even on it for very long due to the unexpected surgery on his femur.

At the June follow-up with his oncologist it was determined that since we knew the Nexavar/sorafenib worked Dennis would continue taking it, and have scans every 2 months. We also received a copy of the pathology report.

Renal Cell Carcinoma, Clear Cell Type
Fuhrman Grade 2
T1b, Nx, M1

Well, that's enough for tonight. I've got a UNC-Duke game to watch! Go Tar Heels!