Dr. Hoopes

We met Dr. Hoopes this morning (Radiation Oncologist) and what a great doctor! He was so nice and informative. He is only a captain, so he must be fresh out of residency. He went to school at Indiana University (IU). IU just happens to be the epicenter of testicular cancer research and development. He studied under Dr. Larry Einhorn (click the link to learn more about him!), who is the doctor who discovered the cure for testicular cancer, and also the lead doctor who treated Lance Armstrong! In fact Dr. Hoopes sent Dan's CT Scans & lab data to Dr. Einhorn for a second opinion who confirmed that chemotherapy would be the best route to take.

Dr. Hoopes reviewed everything we knew and explained some more things in detail. First, Dan's cancer has been reclassified to T2N3Mo (or Seminoma Stage IIC). The original classification was based just on lab and pathology, and this new one has the CT-Scan info added in. He explained that normally if a testicular cancer is going to spread it goes into the lymph system and shows up high in the abdomen near the kidney. You would think it would go to the groin first but actually the testicles have a different lymph system from when you are developing as a fetus the testes are high in your abdomen and slowly descend taking the lymph and vascular system with them. So they expect those to be enlarged, they don't expect the groin ones to be. In Dan's case his abdominal & groin lymph nodes were enlarged which is apparently pretty rare. The abdominal ones were so large they actually pushed some of the cancer downwards into the groin.

Based on the size of the largest cluster of lymph nodes (9cm) Dan is considered the worst Stage II you can be (IIC). The only thing worse is metastasis to another organ which would make him a Stage III. Right now Dr. Hoopes feels there is about a 30% chance that there is cancer beyond the abdomen that is microscopic and cant be picked up on CT-Scan. That is why Chemotherapy is the only option. Chemotherapy will be able to knock out the cancer no matter where it is or how small it is.

The pictures below were imaged using Computed Tomography (CT) scans, which is where a large machine moves up and down the body taking many images of horizontal slices of the body. The imager spins 360 degrees around the body taking snapshots from all directions. These images are then combined in software to create a three dimensional model of the area being imaged. The imaging machine captures a great deal of information, and the imaging software is capable of enabling and disabling features, as well as identifying common features. Check pattern recognition, a subtopic of machine learning, which is itself a subtopic of artificial intelligence, which is what Dan is studying for his PhD work.

The scans below are the result of taking a chest/abdomen/pelvis CT-scan. Each image is referenced with a paper doll in the lower left corner of the images, as well as a three dimensional axis reference. The doll has a red nose, red left hand, and blue feet. Thus, the top left image, labeled "Transveral - CT_1" is an image of somewhere in the midsection, viewed from feet to head, with Dan's left hand on the right side of the image. The top right image is a standard frontal scan, slightly turned. The bottom left image is frontal, zoomed to the center abdomen, with some of the additional internal features included. The bottom right image is a view from Dan's right side (not his better side), again of the mid section.

Picture time! Click on them to see them larger. Thanks Dr. Hoopes for the CT-Scan pictures!

Quick explanation of what your seeing.

Top Left: (Transveral) Standard CT-Scan slice of Dan's abdomen. His bones are colored green with his spine in the middle. The dark areas on either side of his spine are his kidneys, the 2 red circles are where his aorta biforcates (splits) into his legs to supply blood, the blue circle is his inferior vena cava which returns blood from his legs back to his heart & lungs. The green circle/blob is his para-arotic lymph nodes. Most of the other things are his intestines.

Bottom Left (Frontal): Same colors as before for artery, veins and lymph. The red line with boxes at the top and bottom are measurement lines. Exceeding 5cm is the break between stages IIb and IIc. From that angle you can see the large lymph is about 5cm and there is a smaller one below it.

Bottom Right (Sagittal): Just another angle from the side, here the lymph node measures the greatest. As you can see it's far longer than the 5cm ruler (actually measured 9cm).

Finally the Top Right is a 3-D model putting all the slices and views into 1 image. If we were in the office you could spin it around and see all sorts of cool stuff. This gives the best idea of the dimensions. All organs except the major vessels & bones are removed. You can see how the lymph (green blob) wraps around and is bulky. The blob here is the cancer in the abdomen.

This is just another larger 3-D model at a slight angle. Normally the green lymph would run along the vessels but much skinnier, this shows another good view of the bulky & large nature of the lymph nodes.

Well that is all from Dr. Hoopes. We met with Dr. Wood this afternoon to talk about how the chemotherapy will work and I will have more information for you again later tonight or tomorrow. Dan and I also have an adoption meeting to go to tonight in Columbus so a ton of stuff going on today.