Thursday, May 6, 2010

Surgery Notes and Pathology

I had my post-surgery appointment with Dr. Wagreich today, who was pleased with my progress but indicated that it would still be a couple of months before internally I was entirely healed. When I asked her about my appendix having to be cut away from my abdomen, she said that she had already spoken to Malone about it - and Malone would have to go in and biopsy that entire area since Wagreich, unaware of the potential for cancer, left some "scar tissue" that was connected to my appendix attached to my abdomen wall.

Wagreich also gave me copies of her and Dr. Davidov's surgery notes (he is the general surgeon who performed my appendectomy), as well as my pathology reports. I also went to University Radiology to pick up my barium drinks and CT / MRI reports.

I don't want to brag, but I've passed a couple of pretty tough tests in my day, most notably the California State Bar Exam and English Praxis Test. The feeling is always the same when you see that envelope, and today's little white envelopes were no different. The butterflies still fluttered even though this time I already knew, for the most part, my results. Unlike the CA Bar and Praxis, however, I didn't pass my pathology tests on my first try. (Warning to the medical world of rare cancers: I'm bringing my A-game to all future exams.)

Interestingly, since most of my medical tests and reports were so focused on my ovarian cyst and fibroids, little to no mention of my appendix appears. It is a little scary that no one seemed alarmed until pathology came back. Perhaps the most unsettling report concerns the CT scan because Dr. Malone said that she couldn't even see the appendix on the CT films, yet the CT report indicates the appendix looks normal.

The relevant report findings appear below:

3/18/10 CT Scan Report: "the terminal ileum and appendix appear unremarkable"

4/21/10 Surgery Notes from Dr. Davidov: "appendiceal tip slightly swollen and edematous in a clinical picture that might be consistent with a history of possible appendicitis that had improved, and now has recurred."

4/22/10 Pathology Report: "the tip of appendix is enlarged measuring 1.2x0.8x0.8 cm. sectioning of the tip reveals an area with soft yellow mass measuring 3x0.5x0.5 cm and extends to 1cm from the appendix base. Final pathological diagnosis of appendix, appendectomy: appendiceal carcinoid (3 cm in greatest dimension). Tumor infiltrates through the muscularis propria of the appendix into periappendiceal adipose tissue. Perineural invasion is noted."


  1. It is hard to believe that no one ever focused on the appendix? How both strange, and unfortunate is that! You have always been a "winner", Sweetie...and I know that you will come though this ,too ,with flying colors. The medical community has met a match with your "A" game. Hold all these doc's feet to the fire.

  2. Marlena,

    Keep up the good spirits and that strong fighting will. These are essentials in combating your cancer. Our prayers and strong faith continue that all will soon be well with you.

    Herbert and Linda

  3. Thanks for the encouragent -- your love is very felt :)

  4. Marlena- sorry for posting again but your pathology need a very important indicator of the aggressiveness called KI index. You are looking or, an should have 0-2% (best is 0% staining, the most indolent form). Secondly, there is not indication of lymph nodes being removed or if they were, if they tested positive for NETs. This is very important in reoccurance! Get both pieces of data, and work with your Md to schedule a Oscan and Ct scan on regular basis as post surgery work up.
    I went 18 months without anything and thought I beat this monster...I did not, but mine was mix bag of issues and compilation of errors, yours is not.

    pg 6 is one piece of data, but everyone id different Marlena! Enjoy your life and that you found it have gotten it! But imaging will be your friend! Oscan or Pet wga68! Take care, lst note, promise! smm