Now a lung met...what to do ?

[ziggymonster]

Again, I turn to the great folks here for advice and support. Looks like "whack a mole" continues for me !!!!

Did a Ct today and 2 lung nodules were noticed to have increased in size over 12 months the first from 3mm to 5mm , the other from 5mm to 7mm referred to as a "cavitary nodule "

Now what...will meet with my onco in 2 weeks and want to go to the appointment prepared. Forbackground I completed 7 rounds of folfiri for my liver met in Jan 2015 , and did 10 rounds of folfox finishing in July 2013. I really do not want to do any more chemo.....

Is a biopsy needed, or should these damn things be removed no matter ?

Is a surgical solution possible ? What type of surgery ? VATS ? How difficult is it compared to a LAR or liver resection ?

What about RFA ? Is this possible....is it readily available ? My care is at UCSF, but Stanford is only 15 miles from where I live .

What about SBRT ?

I sure would appreciate some guidance from the trenches.

OH, lastly my prostate cancer has gotten active again, got my first met to my ribs....so it looks like I am fighting 2 cancers.....daily double...now time to have a few drinks.

Thanks to you all....this board and all of its people are a true gift.
Z

[Bev G]

Hi Ziggy,

I'm so sorry to hear this, and the prostate progression as well.What a nasty double whammy. I know you're sick of it.

I don't have any experience with lung crapola. Butt, as you well know, dozens of our folks here have had them and treated them successfully (RFA, SBRT,surgery, etc) Of course they'll be around to give you their thoughts about all the options you have.

Best wishes for a rapid and successful resolution of this, ZM.

Bev

[ams5796]

I've had three lungs mets successfully removed. The first two were done easily with VATS which were much easier that any other surgery that I've had. The recovery was easy. The third met was not in a great location so it was recommended that I have SBRT. That worked too, but I would only go that route if there were no other options. While the radiation was painless I was left with a tremendous amount of scar tissue from it. It was hard to see the area in my lung with a scan because the scarring was so extensive.



Ann

[juliej]

Is a biopsy needed, or should these damn things be removed no matter ?

Is a surgical solution possible ? What type of surgery ? VATS ? How difficult is it compared to a LAR or liver resection ?

What about RFA ? Is this possible....is it readily available ? My care is at UCSF, but Stanford is only 15 miles from where I live .

What about SBRT ?

I sure would appreciate some guidance from the trenches.

Ziggy, as I've said before, when it comes to lung mets, it's just like real estate. It's all about location, location, location! Depending on the number of nodules and where they are located, they could either be resected, RFA'd, SBRT'd, or LAPM'd. Resection (either a full thoracotomy or a VATS procedure), RFA, and SBRT are readily available in most large cancer centers. LAPM (Laser Assisted Pulmonary Metastasectomy) is only available in Germany and England as far as I know.

I have had three lung resections and they were all VATS procedures. VATS is by far the easiest type of lung surgery to have (compared to a full thoracotomy), but it's very dependent on the location of the mets. All three procedures were easier than my LAR and liver resection. I was only in the hospital a few days and although I could walk a couple of miles when I was released, it did take a few weeks of recovery to feel like I had my full lung capacity back. There was some pain initially after the procedure but it was easily controlled and went away quickly once the drain tubes were pulled.

Biopsies are controversial - some say they are too prone to "false negatives" or "false positives" and you should simply go by the fact the nodules are growing, which most likely means they are a met. Others think that lung biopsies can lead to "seeding" of the tumor, possibly causing more mets. I had one nodule everyone thought was cancer that turned out to be a benign granuloma. That is rare but it happens. It was good news, but an unnecessary surgery. However, the thoracic surgeon said even if a biopsy had been taken, it would have been "suspicious" if it turned out to be negative since the nodule was growing. In that case they often refer to the results as "inconclusive" - a medical way of saying we just don't know! I was happy to have it gone because then I knew for sure that I was NED.

Hope this helps! And please feel free to PM me if you have more questions.

Juliej

[BrownBagger]

Everything Juliej said is true. I've had it all, except SBRT which, like Ann, would be a last resort for the reasons she mentioned.

RFA is easier than VATS because there are no drain tubes, nights in the hospital, etc. That would probably be your first choice if possible, followed by VATS, followed by a thoracotomy, followed by a lobectomy followed by SBRT. At least that would be my order of preference, assuming you have a choice.

Chemo is not always prescribed after lung mets are removed, but in your case, I wouldn't be surprised. I didn't have chemo after my first lung met was removed (full thoracotomy), mainly because it was small, it had been there for awhile and wasn't growing very much and nothing else had popped up. But I had a recurrence. Every lung procedure after that has been followed by chemo. The one time my doc took me off the juice, I got another recurrence. Personally, I'd go for the chemo, but that's probably influenced in large part but the fact that I tolerate it remarkably well.

Good luck. As Julie says, it's all about location.

[Mastan]

I second Eric's suggestion of the order of treatment preferences. I would also suggest chemo after resection. I have had 3 thoracotomies and SBRT. SBRT should be al last resort because of the collateral damage that it causes.

Mark

[KWT]

Zig, I like the idea of RFA wish I'd looked further into it when I had sbrt done. Also a f ew rounds of chemo afterwards seems prudent.

[Nik Colon]

So sorry Z. I have no knowledge to give but I would opt for some kind of surgery to remove them instead of a biopsy. As mentioned, the possible chance of spreading and you may have to have surgery anyway. Jmo of course.

[Hapa]

Sorry to learn of your double battle. DH had recurrence. In March he had 2/3 of 1 lobe removed via VATS. The recovery was quick. Unfortunately, because of ongoing fistula, he can't have chemo right now.

[ziggymonster]

Thanks to all for responding with advice and support...I did meet with my oncologist today.....the plan to rescan in 3 months and see if there is further growth, but in the meantime she has referred me to a Thoracic Oncology Surgeon who specializes in VATS for his opinion....I am waiting for a call to set that up now. I am also going to search for a specialist in RFA for a consult as well. More to follow.

ZM

[Kiwi Debz]

Zingy, sorry to hear about your double trouble!

I had a biopsy done on the largest of the innumerable nodules they found last month. Very very small and benign they say. Watch and wait for me with regards the lungs. For me this was the best option as had too many to consider surgical removal.

Deb

[Sophy]

I thought you might be interested in this study showing a beneficial effect of chemo both before and after surgery for lung mets.

http://link.springer.com/article/10.118 ... ltext.html

Although the laser lung surgery which I had is only available in UK and Germany as far as I know, the chemo mentioned for before and after surgery is available everywhere and it looks as though the statistics show that it is really the perioperative chemo which makes the most difference to survival and not the surgery.

Hope this helps

Sophy