Surgery to Remove the Primary Tumor – Initial Treatment

It was mid November. Things suddenly began to move very quickly. I went with Pete to his first appointment with Dr. S, a local oncologist. Although the reason for the appointment was terribly frightening, the doctor’s manner was very soothing. He was extremely professional, but not at all condescending. Calm and compassionate, he helped both Pete and I to relax a bit because we felt we were working with someone who was extremely competent and confident. After he had done a physical examination of Pete he spoke with us and explained that it would be necessary to have a biopsy done for an accurate diagnosis but that all the signs pointed to a “soft tissue sarcoma”. He ordered special CT and PET scans and initiated arrangements for the biopsy.

Within days the scans and biopsy were completed and Pete returned to Dr. S to get the results. They confirmed the suspected diagnosis. The doctor recommended that because of the rarity of this particular cancer (only about 1% of adult cancers are identified as sarcomas) Pete should seek treatment at a cancer center where they had the experience to effectively deal with sarcoma. Pete chose to go to Memorial Sloan-Kettering Cancer Center in New York City.

We were into the holiday season, starting with Thanksgiving. Fitting in appointments, tests, and more appointments during this hectic time was difficult, but we got it done. Surgical resection of the site is generally the first treatment. Pete underwent surgery at MSKCC on January 26, 2009, to remove a soft tissue sarcoma from his left arm.

Dr. S-2 was the surgeon who performed the removal. He met with Pete’s father and me at the conclusion and felt confident that he had successfully removed the mass with sufficient “margins”. Because of this, he felt that the adverse effects of post-operative radiation therapy outweighed the advantages and for the same reason, no chemo therapy would be administered. The size of the mass was approximately 5.2 cm x 4.2 cm x 4.5 cm. The stitches closing the incision were rather large, which the doctor explained allowed him to close the wound without resorting to the use of a skin graft taken from Pete’s thigh.

Pete’s recovery had some rough spots. Because of the size and depth of the incision, the amount of tissue, muscle and skin removed to assure that a sufficient “margin” was achieved, he was sent home with a Jackson-Pratt drain. For those who are unfamiliar, this is a plastic bulb at the end of a tube, the other end of which is in the surgical site. Every morning and evening we had to “milk” the site and record the amount of fluid we removed. He suffered two infections that prompted visits to the MSKCC emergency room for antibiotics during the first few weeks before the JP was removed.

Eventually, everything did heal and Pete underwent some physical therapy. Much of the muscle on the underside of his upper arm was gone, so the therapy helped him regain some of his strength. Winter turned to spring and on warm days that Pete had off from work you could find him working on his boat, preparing for summer, the season he enjoyed the most. He had lived close to the Jersey shore all his life and had inherited a passion for ocean fishing from my dad. He was feeling pretty good and had his vacation planned around fluke season.