Seeing the Thoracic Surgeon April 11 a.m. - need advice

[nicola smith]

Hi all, my oncologist has referred me to see a thoracic surgeon about a couple of long-standing lung nodules. The appointment is tomorrow morning (April 11). I'd l appreciate your advice as to what questions you would ask in my shoes.

Here's the background.

These two nodules have been there at least since my first CT scan in December 2009, prior to surgery to remove my cancerous colon. They were "unchanged" according to the next three scans - post-op and post chemo in December 2010, March 2011 and June 2011. The small nodule has remained unchanged at under 0.5 cm. However, in the latest scan (March 2012), the dimensions of the larger node have changed from 1.1cm x 0.8 cm to 1.4cm x 0.8 cm. Since the nodes didn't change during chemo, the notion is that they are not cc but could be BAC, a lung cancer that has a good surgical prognosis if caught early.

Many thanks

[tammylayne]

No words of wisdom....just words of encouragement.....good luck!!

[jobasar]

Nicola,

Good luck tomorrow and I hope everything will go well.

Allie
Don't Worry, Be Happy!

[Apple1291]

It's past eleven, but I wanted to comment on your situation, because it sounds similar to my dad's experience. My dad had two nodules at 7 and 8mm discovered on a ct at the time of diagnosis. Two months later they had not changed size, but his thoracic surgeon seemed pretty convinced that they were mets. He skipped a pet and took my dad straight for surgery. My dad had VATS, removing both nodules, which turned out to be benign hamartomas (sp), much to his surgeon's surprise. My dad was then officially staged at 2b and began chemo. Coincidentally, he just met with his thoracic surgeon this morning, two weeks after completing 12 rounds of folfox, and was told that his lungs look great. While he has a multitude of other issues we are still concerned about, the good news about his lungs was quite a relief. I did a lot of research while we were going through this, and from reading about your case, considering that your nodules remained stable during chemo, I would be inclined to say, in my very unprofessional opinion, that they are probably benign as well.

Good luck with your appointment and your upcoming pet scan. I will be thinking of you.

Annie

[Apple1291]

Sorry, I misread. I thought your appointment was today. Good luck tomorrow.

Annie

[CRguy]

Hi all, my oncologist has referred me to see a thoracic surgeon about a couple of long-standing lung nodules. The appointment is tomorrow morning (April 11). I'd l appreciate your advice as to what questions you would ask in my shoes.

.....have been in your shoes with a single met in 2010 and after a positive PET scan saw the Thoracic Surgeon, BUT first concerns were that it still was not necessarily a met (proved to be after pathology done)

1. So ask what else he thinks it could be and get confirmation of that.... any other diagnostics to be considered before surgery ?????
.....there are other things which will grow and even light up a PET, which are not cancer. "size" increases can also be dependent upon imaging characteristics ( different resolution machines, catching a view in a different "slice", different radiologist "interpretation" habits etc. ) so no harm in asking.

2. Is it able to be biopsied ? BBagger had it, I did not... just based on size / location / "impressions" etc. My surgeon felt it would be VATS procedure and "whatever it is ....we want it out anyway" so I went with that opting to go straight to the surgery.

3. are they VATS ( MIS - minimally invasive surgery ) accessible ???? is he going after one or both ??? ( both sides or one ?? ) what are the options for changing to a full thoracotomy during the surgery ???
...... my Surgeon said when they did intra-operative frozen section pathology, if it proved to be a lung primary not a met, OR if the margins were not clear, he would proceed to a full thoracotomy and not complete the VATS, in order to get everything out at one time. (some chest primaries require a total lobectomy instead of just a local excision, and depending on location may not be VATS resectable.)

4. Pain control options ( more of an anesthesiologist question ) I had an epidural option planned but with VATS entry locations and sizes, the surgeon/anesthetist decided it was not needed. It in fact was NOT needed. See what he says for you.

5. You can ask about follow up but that will probably depend upon exactly what they find with the path report.

6. Ask about alternatives to the surgery ???????
Are the lung thingies amenable to other non-surgical thoracic procedures ( RFA, SBRT, etc. ???? )
I did not really investigate these as I was of the "I want it out" mindset, and so was my thoracic honcho. I did ask if a wait 'n see was acceptable with rescan in 6 weeks...he said " No."

7. I asked if doing this surgery now would limit or impact any future procedures if I had to do all this again. He said no, so off I went to the pre-op assessment.

(( mine was a rectal met so that eventually led to the 12 cycles of FOLFOX pseudoadjuvant chemo ))

any further info I can help with gimme a PM.

Cheers and swinging chickens for you !
CRguy

[GreenLakeGirl]

It's still an hour before 11am in my time zone, so I'll chime in to ditto what CRguy said. Where I was treated, the diagnostic steps were: CT -> PET -> Needle biopsy -> Surgery (preferably VATS). I can't remember whether I had a PET scan, but we definitely skipped the needle biopsy. Since my spots were all 1cm or smaller, the surgeons I consulted with said that if we got a negative result from the biopsy, we'd be left wondering whether it was truly not cancer or whether they had missed the spot and biopsied the surrounding tissue instead. And then, we'd proceed to surgery regardless.

I mention this in case your consult suggests a needle biopsy. Ask them: how can you be confident that a not-cancer response is truly indicative of the state of your lung spots?

Strongest thoughts today.

[nicola smith]

oh brilliant information from all of you. I've made a list based on your suggestions. Many thanks for the best wishes. I'll keep you posted.

[nicola smith]

I didn't even get to start my list of questions. After introductions and a bit of chitchat, the thoracic surgeon said there was "absolutely no sign of metastases" and "no sign of any other lung cancer". The nodules are most likely scars from previous bouts of pneumonia. He was all for cancelling tomorrow's PET scan but relented when I said I would be more comfortable going through with it. Results in 10 days or so so I'll update then. Meanwhile, I'm smiling

[BrownBagger]

I'm smiling, too. Wish my initial consults with various thoracic surgeons over the years had gone that well. So, I'm happy for you. Hope the PET confirms that preliminary dx.

[lauragb]

Congratulations on the good news! I'd get the PET too, just to be on the safe side.
Smiles,
Laura

[GreenLakeGirl]

Woo hoo, Nic!

[CRguy]

Meanwhile, I'm smiling

Colorectal butt is being kicked...... and nicola smith is taking names !!!!
Swinging chickens for a no news is good news kind of a plan.

Many Cheers
CRguy

[Mys]

"absolutely no sign of metastases"

Best thing I´ve heard all day! Good luck on the upcoming PET, hope the findings will be confirmed!

[hart2hart]

Hi - We're smiling with you!! whoo-hoo-hoo!



Julie and Pete
Stamford, ct