Lung Mets - wrong staging? Experiences?

[Ana123]

My father's last CT (six months late, a year since the one before) 2 1/2 years out of surgery, chemo, etc, showed one nodule on his lung to have grown by 12mm. It is now 2cm. He is scheduled for a PET scan and a biopsy to see if there are other nodules and to determine what the cells are. It seems that his doctor wants to make sure that it is a CRC met rather than lung cancer.

The nodule was always present in his post-chemo CT scans, just never grew in size. Could it have been cancer all along?

For those of you with experience of lung METS, did you end up having to do chemo again? Onc said provisionally we are talking about surgery or RFA. I'm not sure if my father's lungs are good candidates for surgery as he smoked for 45 years and they probably function at an extremely reduced capacity.

Thanks for any experience you can share.

[Maia]

Onc said provisionally we are talking about surgery or RFA..

That sounds quite good and reasonable, Ana. If it's only one nodule, better to get it out. RFA might be the option, since it's less invasive that surgery, might means less loss of pulmonary capacity. And yes, those who are not candidates for some kind of ablation/resection are offered chemo.

[dianetavegia]

This might help you.

https://radiopaedia.org/articles/fleischner-society-pulmonary-nodule-recommendations

[Ana123]

Thank you both for your feedback and the link.

My father is scheduled for a biopsy today. I'm panicking. It seems to be a risky procedure, and the interventionist radiologist said he has 30%-50% chance of lung collapse, which with most patients can be dealt with in the clinic or through hospitalization. I googled it on this board and it seems that most had no issues with it. But it seems most of those who posted/wrote are under 60. Also, reading the dangers online just makes it all worse.

I'm also not sure if the benefits of a biopsy (which can return an inconclusive pathology anyway) outweigh the risks. His Onc seems to think so as he wants to be 100% certain of what he is dealing with before he recommends what we do. Its just that my dad is 73, and his lungs are very poor because of all the smoking, and he also has been taking aspirin for years (which he stopped for the procedure today).

I can't deal with this disease again after three years of discovering it, surgery, etc. The fear, uncertainty, panic

[Ana123]

Here is my post- lung biopsy update: My father DID have pneumothorax and ended up in ER for 24 hours. The radiologist and the oncologist were really supportive and seemed to have foreseen what happened (partial lung collapse, bleeding), BUT the pulmonary doctors who admitted him to ER were panicking. We were discharged after 24 hours. My father is recovering. We are all anxious about the biopsy results on Wednesday. Clearly my father's lungs are very weak and I'm not sure what kind of quality of life he will have if his oncologist recommends a lobectomy. And it seems that lobectomy is the best we can hope for. Which is so depressing.

[dianetavegia]

Did you get the results yet?

[Ana123]

Thanks for asking Diana.

PET scan only got one tumor. Pathology confirmed that it is a met rather than lung cancer. Just got off the phone with the Oncologist. Given his CABG and lungs state, the tumour board (including surgeon who did his initial CABG) decided that he is not a good candidate for surgery. They said that a lobectomy and the removal of the tumor using a technology similar to cyberknife will yield the same outcome in terms of survival rates and re-occurance, so they think that this new radiation therapy is the best option. I am going to schedule an appointment with the radiologist to discuss this with him, and possible side effects, etc. Oncologist said we are talking about chemo post removal of tumor non-invasively, and chance of re-occurance at around 70%.

Does anyone know or have experience with this latest technology of non-invasive removal of tumors through radiation?

Also, is it possible that the PET misses out on other mets which are too small at this stage?

[Maia]

Ana, your father is lucky he has an onc who is considering to perform that ablation, despite your dad's lungs condition. Others would offer only chemo, which is always palliative. He seems to be in good hands.
I only suggest try and find out, from the biopsy, the microsatellite status -MSS or MSI-High. That might give him more guidance for future treatment.

[Ana123]

Hi Maia, may I ask, do you say this because radiation ablation is known to be dangerous for severely emphysematous lungs like those of my father? My appointment with the radiation oncologist is not until Thursday.

I'm actually panicking about the Onc having managed to convince us to do the lung biopsy given the danger of seeding that I read about (although online it seems to be more of a problem with breast cancer, if I'm not mistaken). I understand that he wanted to be 100% sure that it was from his colon, rather than a new lung cancer, but given his bleeding and the ER episode I'm having worst case spread scenarios in my head....

One last question: what difference does "the -MSS or MSI-High" do?

[Maia]

Oh no, I said that because it's always better to have less tumour burden, via surgery or any kind of ablation
If they are talking about SRT (Stereotactic Radiation Therapy), it is a very localized radiation, don't be scared by what you read about (traditional) radiation to the lung. If they are talking about RFA (Radio frequency ablation), that is not radiation at all. So, don't be scared!
MSS or MSI means that immunotherapies (not chemotherapies) might be available to him, as systemic therapy, right now, even outside a clinical trial. Those are quite recent developments.

[Pita]

Hi Ana,
I am the same age as your father, tried my first cigarette at 12 and smoked for 40+ years, been quit for 9+, have COPD and a small amount of emphysema. Had a lung biopsy last year and my one lung collapsed, worst pain I've ever felt in my life but it showed it was definitely mets so was worth it imo.
Still have the nodules in my lungs, my case is going to be put in front of a Tumor Board so all I can do is tell you the results after they discuss it (not sure when).
I have one nodule that is over 3cm and a second one that I forget the size. My Colorectal Surgeon and my Onc said I should get them both surgically out since they won't shrink enough to be gone. Ten sessions of Folfuri and Avastin chemo did work on the other 4, they have shrunk, but the Avastin is now failing and the two big ones have started grow. I am MSS/KRAS Wild and may go back on Cetuximab aka: Erbutux which can only be used by KRAS Wild so it is important that they test your father's tumor(s), am also looking into a trial.
My Colorectal Surgeon said if I can walk up 2 flights of stairs without getting out of breath I should be ok for a surgery. Looking for a Thoracic Surgeon or Interventional Surgeon to be evaluated.
Sorry not much advice but maybe a little info will help. It's good to be cautious but at the same time remember "Reality is never as dark as the places your brain visits in anticipation".
Best wishes and hugs and prayers to your father...

[Ana123]

Hi Peta - any news from the tumor board meeting?

I spoke to the surgeon on the phone and he said my father's lungs were borderline and high risk and since they are talking about local control rather than cure, the tumor board are of the opinion that they shouldn't put him through a major surgery again three years after two major surgeries, esp. given the state of his lungs (they ran a pulmonary test on him). Apparently, his tumor is also in a place which means he can't have VATS and would need open surgery. So surgeon said SRT it is.

I'm googling SRT but it seems that it is a very new technology and the side effects mostly appear months after the procedure. Did anyone with emphysema and generally poor lungs/heart disease go through it on this board? I'm meeting the radiation oncologist tomorrow and wonder what I should ask him.

Thanks for all the tips on immunotherapies and nature of my father's cancer. These are definitely questions I'll have ready for when I meet the oncologist.

[Ana123]

I spoke to the oncologist about immunotherapy and the status of my father's cancer (which he didn't order on his tumor yet). He said immunotherapies are something he would consider as a last resort, when the cancer has spread beyond control. He also said that the drugs are pretty expensive, at around $10,000 per month!!

Has anyone had immunotherapies covered by their insurance? Is the last resort approach usual?