At Last - Some News

I saw Mr Lawrence, the Cardiothoracic Surgeon, yesterday.

We finally know what sort of cancer it is: it's a thymoma, a tumour of the thymus. It's a particularly big one. It starts at the thymus below my breastbone and has grown down inside my chest to the base of the ribcage and then across so that it is pressing against my ribs on the right hand side. As a result, my right lung is crushed into a squelchy pocket about half its normal size, and my diaphragm on the right side is probably not working at all because of the weight of the thymoma pressing down on it. That partially explains my exhaustion, also I have quite a bit of pleural effusion - fluid produced by the lung to stop the thymoma rubbing up against and abrading other tissues - and that make you tired, too.

There are 3 types of thymoma: A, B, C: A being non-malignant and C aggressively malignant. Mine's a B, somewhere in the middle. Thymomas which are benign can and often do become malignant, and sometimes the malignancy shows up microscopically, i.e. you can't see the difference by looking at the scans. Therefore the plan is, to try and take the whole thing out and send it off to the lab for a thorough check out before deciding on further adjuvant treatment such as chemo/radiotherapy.

Mr Lawrence says it appears to be encapsulated which is a good thing. He hopes to take it out in one lump, but because it's so big - it's the biggest he's ever seen - he may have to cut it into two pieces. If he does that, then of course he'll break the capsule and there's a risk of releasing bits and pieces back into the chest cavity. But getting it out in one lump might mean he has to move other organs out of the way - stop my heart and move it over to one side for example. Hopefully if that happens he'll remember to start it up again afterwards.

Next: there are 4 stages of Thymoma, stage 1 being a small local lesion on the thymus which is benign, and stage 4 being an aggressive and invasive cancer, invading other organs/vessels in the vicinity. Stage 2 and 3 are in between, and defined by the degree of invasiveness. Mine is probably stage 2 or 3. Although mine looks encapsulated, the surgeon won't know if the encapsulation is complete until he tries to get it out. It's not until then that we will know what stage it's at.

He's concerned about whether the pulmonary blood vessels are affected. These are the blood vessels which take oxygenated blood from the lungs to the heart to be pumped round my body, and then take the de-oxygenated blood back the other way. They're kind of important.

So, what was he like? He was a very nice chap, with a proper public school accent like wot I don't have. He talked to us for about half an hour and answered all the questions, but what was great was that although he was fine talking to us, what really rocked his boat was the prospect of doing some difficult and challenging surgery. His face lit up when he looked at the scans, you could see him holding an imaginary scalpel, thinking through how he was going to make the surgery work. That's what I want from a surgeon! He's going to take it slowly, because getting the tumour out through the hole will be problematic, particularly if there's some adhesions and/or invasions around anything crucial, and so he has set aside the whole morning for little old me, and asked his secretary to ensure he has a fairly easy afternoon afterwards. He'll need some time to recover, and so will I.

The operation is scheduled for 13th June, in the Heart Hospital in Marylebone.

David Lawrence Consultant Cardiothoracic Surgeon