Another week or so later and Kathy and I were back in front of Mr W. He confirmed the results of the CT / MRI scan and also the ultrasound and needle biopsy on my groin. Everything was clear, although the needle biopsy result was inconclusive. It turns out that despite all the wiggling of the needle, the doctor still missed the lymph node he was after so all the pain was for nothing. Mr W then confirmed the details of the WLE and mentioned the possibility of them doing another procedure at the same time called a Sentinel Lymph Node Biopsy (SLNB). This was what clarified that our earlier celebrations may in fact have been a little premature. Mr W confirmed that although the CT / MRI scans showed nothing up, it didn’t mean that the cancer cells hadn’t started to travel around inside me. On the plus side, if they had started moving then they hadn’t set up camp anywhere on any great scale yet as the scans I’d already had would have shown this up. However, it meant I wasn’t quite as in the clear as we thought I’d been. The SLNB procedure involved them injecting a radioactive isotope into my foot, as close to where the mole had been as possible. They would then put me in another scanning machine and track the path that the isotope took. This shows them the path that any cancer cells in the original mole would have taken within my blood stream if they had started to move around my body. When the blood stream gets to my groin, the lymph nodes filter out any foreign cells that shouldn’t be there. This includes the radioactive isotope, as well as any potential cancer cells. The scanner shows the specialist where the first (or sentinel) lymph nodes in my groin are. They then proceed to undo all these high-tech and incredibly advanced processes by getting a felt tip pen and drawing an X on my groin to show where Mr W needs to cut me open to pluck out 3 or 4 lymph nodes. These nodes then undergo a microscopic biopsy to see if even a single cancer cell is present.

Having gone through the detail of the SLNB in detail Mr W then asked me if I wanted to go through with the procedure. Kathy and I were both a little confused. Why would we NOT want it to be done if it gives a pretty much definitive answer as to whether the cancer cells in my foot had started to spread throughout my body? I asked Mr W this and he almost dismissively said that some people would rather not know. I asked Mr W what he would do and he said he couldn’t advise me, just give me the options. I said that I thought I’d like to have it done and he suddenly kicked back into gear. As soon as I had suggested I wanted to do the SLNB that was enough for Mr W. He confirmed that in his view that was absolutely the right thing to do and that if he was in my position he would do it as well. He was unable to give us any recommendations but as soon as we had made that decision he was in full support of it. The thing that still scares the life out of me is that Mr W said that if I was being seen on the NHS then in some parts of the country SLNB’s simply aren’t offered. If I didn’t have private health insurance then I would have been sitting here right now with a clear CT / MRI scan, clear ultrasound result and clear physical examination of my lymph nodes, all topped off with the good old “inconclusive” but bloody painful needle biopsy. I would have been in the clear and my previous celebrations would have been entirely correct. As far as everyone was concerned it was all out of me and nothing to worry about. I would find out a few weeks later just how misleading that diagnosis was, but at that stage everything was good.

As I now know, Melanoma is a different type of cancer to most others. With most other cancers, the favoured initial process, if possible, is normally excision, or cutting things out in simple terms. The next stage is often radiotherapy or chemotherapy to shrink down or kill any remaining cancer cells. After (hopefully) successful courses of these processes and precedures, the patient is usually given the all clear and the cancer has been beaten and dealt with. I’m fully aware that it’s never that straight forward or simple so I don’t mean to offend anyone with that sweeping generalisation of the process, but that’s a very basic overview of the preferred treatment for a number of cancers. However, this isn’t the case with Melanoma. It has a very nasty habit of recurring. Given the stage of melanoma that I now know I am, there is more than a 50% chance of it coming back at some stage. When and to what extent is unknown but the chances are that it will return. What that means is I can never say I’m over it. I will never get the green light that it’s been beaten and I can move on without the cloud of Melanoma hanging over me. The best medical terminology that I can hope for is what is called NED – No Evidence of Disease. That may seem a pretty straight forward and positive statement to be given but it’s amazing how much you over analyse something when it’s got such a direct impact on how long you think you’ve got to live! If I’m having a glass half full day then its great. There’s no evidence of disease – they’ve got the bloody stuff out of me and as far as all their scans, gadgets and knowledge tells them, there’s nothing left in me. Happy days. If I’m having a glass half empty day then it can feel much more negative. There’s no EVIDENCE of disease. That doesn’t mean they’re saying there’s none in me, it just means that despite their scans, gadgets and knowledge, there’s possibly cancer still in me but they’ve just not found any just yet. Two very different interpretations of the same statement but a seesaw of emotions that I’m slowly getting used to.

So, as far as the scans and tests so far had shown, I was NED. I had also made the pretty straight forward decision, as far as I was concerned to sign up for the SLNB. This would need to take place at Frenchay hospital in Bristol as they had the facilities to deal with the radioactive part of the process. The operation was booked in for Friday 1st March 2013 which meant that I had to miss Bath Rugby v Gloucester at The Rec that evening but in the grand scheme of things, after some consideration, I decided to let that go….just this once.