Lung Nodule - Need Advice

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hopeinGod2
Posts: 5
Joined: Wed Dec 05, 2018 9:52 pm
Facebook Username: barbara.jamison

Lung Nodule - Need Advice

Postby hopeinGod2 » Mon May 02, 2022 1:31 pm

CT and PET scans show 1.2 x 1.1 nodule in right middle lobe.
Just had robot assisted biopsy with guided ultrasound (Monarch protocol) – path report says tissue samples from lung and from one lymph node benign, BUT thoracic surgeon thinks he prob. did not actually obtain samples from lesion; both he and the oncologist believe it is cancer, and is recommending surgery (likely lobectomy, due to location of lesion).

Thinking I should get a second opinion, but hard to know where to start. Ideas?

Thanks.
-----------------
12/4/2017 Colonoscopy - multiple sessile small polyps and tumor found "3 cm sessile distal rectal mass on a pseudo-stalk"
11/2/2018 Transanal excision (tumor removed) Dx CRC
Adenocarcinoma, RC, 3 cm from anal verge
Moderately diff
Stage 1, PT2
T2N0M0
CEA 11/18 <.5; 3/19 <.5; 7/19 1.6; 10/19 1.8; 11/19 1.9; 5/20: 1.5; 2/22: .7

12/18 Biopsies (10) EUA Clear
2/19 MRI - Clear
3/19 Colonoscopy - No evid of malignancy
3/19 PET Scan Lung right middle node 6mm "indeterminate for metastatic disease"
4/19 – 5/23/19 Chemo radiation (6 weeks total)
7/19 MRI Pelvis/rectum Clear
7/19 Colonoscopy - one "diminutive" benign polyp removed
7/19 - 11/11/19 CAPOX (6 cycles)
12/19, 7/20 (full colonoscopy), 1/21, 1/22- Flexsigs – Clear; all MRIs clear
6/20 CT Lungs clear
2/22 CT Lung nodule right middle lobe, 1.1 x 1.4cm, spiculated
3/22 PET Perihilar mass 12 x 11mm, 2.8 SUV “ consistent with malignancy”
4/22 Biopsy benign, BUT thoracic surgeon believes cancer there, recommends VATS / lobectomy
12/17 C-scopy - "3 cm distal rectal mass"
11/18 TAE
Adenocarcinoma RC
Mod diff
Stage 1, PT2
T2N0M0
CEA 11/18 <.5; 11/19 1.9; 5/20: 1.5; 2/22: .7

12/18 Biopsies NED
2-3/19 MRI / C-scopy- NED
3/19 PET Lung RM node 6mm
4-5/19 Chemo radiation
7/19 MRI - NED
7/19 Colonoscopy - benign polyp removed
7-11/19 CAPOX
12/19, 7/20, 1/21, 1/22- Scopes/MRIs NED
6/20 CT NED
2/21 CT 3 mm nodule LU lobe
2/22 CT 1.4cm nodule RM lobe
3/22 PET RML 12 x 11mm, 2.8 SUV
4/22 Biopsy benign, BUT surgery rec.

roadrunner
Posts: 240
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung Nodule - Need Advice

Postby roadrunner » Mon May 02, 2022 2:59 pm

I’d like to understand why he “thinks he did not obtain samples from [the] lesion.” Is it just that the cells didn’t show adenocarcinoma? Or was there other evidence of this? It bothers me a bit that they did a biopsy and are more or less ignoring it. Did they advise you that that might happen?

Next, what is the sensitivity (term of art) of the kind of biopsy you had?

Also, it looks from your signature like this grew over time then lit up on PET—is that right? What is the growth rate? Does it fit within the rate for pulmonary CRC mets?

Finally, have you considered other options that might preserve the lobe? SBRT, radio frequency ablation, and cryotherapy are all used in this context. While a lobectomy may be the easiest, best option, a concern may be that if this is metastatic disease you may want to preserve as much healthy tissue as you can as a sort of lung capacity “bank” against future pulmonary mets. At least, that’s what I thought on a first read. On the other hand, it’s “peri hilar,” so perhaps only lobectomy is doable?

If your team hasn’t addressed these topics, I’d do that with them. If the answers are not satisfactory, second opinion for sure (and maybe anyway). This is a high-leverage decision point.
Last edited by roadrunner on Mon May 02, 2022 3:15 pm, edited 1 time in total.
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; biopsies negative
TAE 11/20, tumor cells removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT for remaining nodule 1/22
CT 3/22: Clear

roadrunner
Posts: 240
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung Nodule - Need Advice

Postby roadrunner » Mon May 02, 2022 3:14 pm

Sorry, one last thing:

Your history is also somewhat interesting. Is this the 6 mm nodule from 3/19 or did that disappear? I’d also want to know why they found that, called it “indeterminate,” then waited 14 months to re-scan (if I’m reading your sig. right). Then it’s (apparently) clear, so they wait another year and 8 mo. to scan again?

This may not be of relevance to your treatment plan, but if it’s accurate I think it’s potentially relevant to the focus and approach of your team.
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; biopsies negative
TAE 11/20, tumor cells removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT for remaining nodule 1/22
CT 3/22: Clear

zephyr
Posts: 326
Joined: Thu Aug 18, 2016 7:31 am

Re: Lung Nodule - Need Advice

Postby zephyr » Mon May 02, 2022 6:26 pm

I can't help you make a decision about surgery, but I might be able to help fill in some blanks. Biopsies are really good for ruling things in but not so much for ruling things out. It was once explained to me by an oncologist using the example of an olive with a pimento inside, where the pimento is cancer. When they do the biopsy, they sometimes don't know if they're getting the olive or the pimento. If they get the pimento, then they know they found cancer. Bingo! They found something. But if they miss the pimento and only get the olive, the results will be benign but it doesn't 100% mean you don't have cancer. It just means they missed the pimento. That's what I mean about being great for ruling things IN but not so much ruling them OUT. The second thing is about the right middle lobe. It's tiny, almost like an evolutionary leftover. It's really small. I had mine removed a couple of years ago and never noticed. I'm not saying you should have the surgery, that's a whole other conversation, only that if you decide to go through with it, I think there's a very good chance you'll never notice the loss of your right middle lobe (but it may take a few weeks to recover completely).
Nov-2009 Early stage CRC, routine colonoscopy
2010-2014 F/U colonoscopies, all clear
Jun-2016 CRC during F/U colonoscopy, surgery, Stage 4, KRAS, MSS, inop lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Dec-2020 Progression
Mar-2021 Forfiri/Avastin
Mar-2022 Ablation & Thoracotomy

Rock_Robster
Posts: 676
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Lung Nodule - Need Advice

Postby Rock_Robster » Mon May 02, 2022 7:13 pm

Great comments above. The only thing I’d also recommend is a consultation with a radiation oncologist specialising in SBRT/SABR. There is a rapidly-growing body of evidence suggesting this treatment is potentially as good as surgery for single small lung lesions, with a much shorter recovery time, fewer side effects, and significantly lower risk of complications.
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

prayingforccr
Posts: 317
Joined: Sun Jun 28, 2020 4:44 pm

Re: Lung Nodule - Need Advice

Postby prayingforccr » Mon May 02, 2022 8:45 pm

One word…….cryoablation.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 No growth in nodules 6 months…..most showing cavitation.

hopeinGod2
Posts: 5
Joined: Wed Dec 05, 2018 9:52 pm
Facebook Username: barbara.jamison

Re: Lung Nodule - Need Advice

Postby hopeinGod2 » Wed May 04, 2022 9:37 pm

Roadrunner:
Apparently it is possible for the Monarch protocol biopsy to miss up to about 20% of lung malignancies, according to one study I found.
Yes, he believes it is malignant due to the fact that was nothing one year prior, so fast growth/size and possibly because it is spiculated.
I recall being advised that if the biopsy was not successful, then he would try the CT-needle guided biopsy? But it appears he used guided ultrasound, along with robot-assisted navigation, not sure if that is a different thing altogether. However, now he is talking about going directly to surgery.

By "sensitivity," so you mean the diagnostic rate?

Looks like the growth rate was form 0 to 1.2cm in one year - don't know if it meets criteria for a lung met. Btw, my gastro surgeon actually thought it might be a primary lung cancer due to the spiculation. I think that because the CT scan does last year showed the 6mm RML nodule gone, they are starting from last year's scan in terms of growth.

No other options were really presented to me, other than post-surgery treatment, i.e.,. radiation, etc.

Thanks for your thoughts, and now I have some more Q's to ask.
12/17 C-scopy - "3 cm distal rectal mass"
11/18 TAE
Adenocarcinoma RC
Mod diff
Stage 1, PT2
T2N0M0
CEA 11/18 <.5; 11/19 1.9; 5/20: 1.5; 2/22: .7

12/18 Biopsies NED
2-3/19 MRI / C-scopy- NED
3/19 PET Lung RM node 6mm
4-5/19 Chemo radiation
7/19 MRI - NED
7/19 Colonoscopy - benign polyp removed
7-11/19 CAPOX
12/19, 7/20, 1/21, 1/22- Scopes/MRIs NED
6/20 CT NED
2/21 CT 3 mm nodule LU lobe
2/22 CT 1.4cm nodule RM lobe
3/22 PET RML 12 x 11mm, 2.8 SUV
4/22 Biopsy benign, BUT surgery rec.

hopeinGod2
Posts: 5
Joined: Wed Dec 05, 2018 9:52 pm
Facebook Username: barbara.jamison

Re: Lung Nodule - Need Advice

Postby hopeinGod2 » Wed May 04, 2022 10:02 pm

Is this the 6 mm nodule from 3/19 or did that disappear? I’d also want to know why they found that, called it “indeterminate,” then waited 14 months to re-scan (if I’m reading your sig. right). Then it’s (apparently) clear, so they wait another year and 8 mo. to scan again?

Oops, I see that I left off the 2021 CT scan in my signature (not sure how to edit the signature).

2/21 CT No suspicious lung mass. 3 mm nodule of the left upper lobe. No lobar consolidation.

The RML spot apparently disappeared, as well as the 3mm LUL from last year. Onc told me not to worry, could be a from a lung infection, bu that that he would keep an eye on it. He actually wanted do do another scan last spring/ summer, but the gastro surgeon managing my case (at my request to wait, said that it would be OK to wait a year before another scan, as the flex sigs and office exams were all clear.
12/17 C-scopy - "3 cm distal rectal mass"
11/18 TAE
Adenocarcinoma RC
Mod diff
Stage 1, PT2
T2N0M0
CEA 11/18 <.5; 11/19 1.9; 5/20: 1.5; 2/22: .7

12/18 Biopsies NED
2-3/19 MRI / C-scopy- NED
3/19 PET Lung RM node 6mm
4-5/19 Chemo radiation
7/19 MRI - NED
7/19 Colonoscopy - benign polyp removed
7-11/19 CAPOX
12/19, 7/20, 1/21, 1/22- Scopes/MRIs NED
6/20 CT NED
2/21 CT 3 mm nodule LU lobe
2/22 CT 1.4cm nodule RM lobe
3/22 PET RML 12 x 11mm, 2.8 SUV
4/22 Biopsy benign, BUT surgery rec.

hopeinGod2
Posts: 5
Joined: Wed Dec 05, 2018 9:52 pm
Facebook Username: barbara.jamison

Re: Lung Nodule - Need Advice

Postby hopeinGod2 » Wed May 04, 2022 10:10 pm

zephyr:
I take your point about ruling out. Which likely means I might not have any other answers even with a liquid biopsy. Per the nurse, the only way to definitively know is to take it out. Thanks for sharing your experience with the RML.
12/17 C-scopy - "3 cm distal rectal mass"
11/18 TAE
Adenocarcinoma RC
Mod diff
Stage 1, PT2
T2N0M0
CEA 11/18 <.5; 11/19 1.9; 5/20: 1.5; 2/22: .7

12/18 Biopsies NED
2-3/19 MRI / C-scopy- NED
3/19 PET Lung RM node 6mm
4-5/19 Chemo radiation
7/19 MRI - NED
7/19 Colonoscopy - benign polyp removed
7-11/19 CAPOX
12/19, 7/20, 1/21, 1/22- Scopes/MRIs NED
6/20 CT NED
2/21 CT 3 mm nodule LU lobe
2/22 CT 1.4cm nodule RM lobe
3/22 PET RML 12 x 11mm, 2.8 SUV
4/22 Biopsy benign, BUT surgery rec.

hopeinGod2
Posts: 5
Joined: Wed Dec 05, 2018 9:52 pm
Facebook Username: barbara.jamison

Re: Lung Nodule - Need Advice

Postby hopeinGod2 » Wed May 04, 2022 10:12 pm

Rock_Robster:
The only thing I’d also recommend is a consultation with a radiation oncologist specialising in SBRT/SABR. There is a rapidly-growing body of evidence suggesting this treatment is potentially as good as surgery for single small lung lesions, with a much shorter recovery time, fewer side effects, and significantly lower risk of complications.

How do I find someone competent? I live in FL.
12/17 C-scopy - "3 cm distal rectal mass"
11/18 TAE
Adenocarcinoma RC
Mod diff
Stage 1, PT2
T2N0M0
CEA 11/18 <.5; 11/19 1.9; 5/20: 1.5; 2/22: .7

12/18 Biopsies NED
2-3/19 MRI / C-scopy- NED
3/19 PET Lung RM node 6mm
4-5/19 Chemo radiation
7/19 MRI - NED
7/19 Colonoscopy - benign polyp removed
7-11/19 CAPOX
12/19, 7/20, 1/21, 1/22- Scopes/MRIs NED
6/20 CT NED
2/21 CT 3 mm nodule LU lobe
2/22 CT 1.4cm nodule RM lobe
3/22 PET RML 12 x 11mm, 2.8 SUV
4/22 Biopsy benign, BUT surgery rec.

Rock_Robster
Posts: 676
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Lung Nodule - Need Advice

Postby Rock_Robster » Thu May 05, 2022 12:33 am

hopeinGod2 wrote:
How do I find someone competent? I live in FL.


The main thing you want is plenty of experience with using SBRT (stereotactic body radiation therapy), preferably thoracic focussed. Hopefully your medical oncologist can refer you to someone good nearby, however when in doubt I would always suggest an NCI-designated cancer center to make sure they are across latest best practices and research. There are two in FL - Moffitt in Tampa, and the University of Miami. Not sure if either is convenient for you, but for a second opinion it may well be worth the trip. I’ve heard good things about Moffitt.
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

User avatar
Peregrine
Posts: 41
Joined: Tue Mar 01, 2022 1:18 am

Re: Lung Nodule - Need Advice

Postby Peregrine » Thu May 05, 2022 7:04 am

Hello, and welcome to the forum!

I have one suggestion right now, and that is to create a proper signature that can go at the bottom of each and every future post when you enable Signatures. This is better than just putting your signature details at the bottom of your very first post, since some readers may not realize that this information even exists if they are only reading your most recent posts.

The link to create/edit your signature is here, but remember, you are limited to a maximum of 512 characters:

Create signature

https://coloncancersupport.colonclub.com/ucp.php?i=ucp_profile&mode=signature

Here is the signature information from your very first post. You can cut-and-paste from this so that you don't have to type everything over again, but remember that the whole signature cannot be more than 512 characters, so you may have to abbreviate some things or delete them altogether, to stay within the limit, otherwise the Signature cannot be saved if it is over the size limit.

    12/4/2017 Colonoscopy - multiple sessile small polyps and tumor found "3 cm sessile distal rectal mass on a pseudo-stalk"
    11/2/2018 Transanal excision (tumor removed) Dx CRC
    Adenocarcinoma, RC, 3 cm from anal verge
    Moderately diff
    Stage 1, PT2
    T2N0M0
    CEA 11/18 <.5; 3/19 <.5; 7/19 1.6; 10/19 1.8; 11/19 1.9; 5/20: 1.5; 2/22: .7

    12/18 Biopsies (10) EUA Clear
    2/19 MRI - Clear
    3/19 Colonoscopy - No evid of malignancy
    3/19 PET Scan Lung right middle node 6mm "indeterminate for metastatic disease"
    4/19 – 5/23/19 Chemo radiation (6 weeks total)
    7/19 MRI Pelvis/rectum Clear
    7/19 Colonoscopy - one "diminutive" benign polyp removed
    7/19 - 11/11/19 CAPOX (6 cycles)
    12/19, 7/20 (full colonoscopy), 1/21, 1/22- Flexsigs – Clear; all MRIs clear
    6/20 CT Lungs clear
    2/22 CT Lung nodule right middle lobe, 1.1 x 1.4cm, spiculated
    3/22 PET Perihilar mass 12 x 11mm, 2.8 SUV “ consistent with malignancy”
    4/22 Biopsy benign, BUT thoracic surgeon believes cancer there, recommends VATS / lobectomy
Here is a link to your first post

☆☆☆
My first post:
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=66180&p=512376#p512376
☆☆☆

Tip: You can simplify things by just putting a link to your first post in the signature block when you are creating your signature. In this way your signature will always refer back to your first post if the reader clicks on the link. To do this, copy all of the text between the two rows of stars above, and then when you click on the Create Signature link above. paste the result in your signature. This way you signature will always have a link to your first post and readers can easily see your signature information by clicking on the link then scrolling to the bottom of your first post where the signature information is.

Then after you have created and saved your signature be sure to select "Attach my signature by default" in the following link:

ucp.php?i=ucp_prefs&mode=post

roadrunner
Posts: 240
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung Nodule - Need Advice

Postby roadrunner » Thu May 05, 2022 10:43 am

Rock Robster is right. If you go with SBRT you need an experienced radiation oncologist to do it, particularly because it sounds like your nodule is in a difficult spot (peri hilar). As you can see from my signature, I just had this done (on a 6mm suspected net that was close to certain central structures). Mine was a total
non-event side effects-wise (back to running a couple of days later, and could have done it same day), and the only challenge was holding my breath for the count (and, honestly, that was no biggie). But CRC pulmonary mets, unlike primary lung cancers, are radio-resistant, so they need to give you a high dose to achieve local control. You want someone who really gets this to do it for that reason alone. There can be significant toxicities if the dosimetry is off, and you also want the best chance of local control. I love my radiation oncologist (super experienced, super engaged, AND one of the most caring humans I’ve ever met), and he pulled me off the table at my first treatment (several days delay) because he saw that the dosimetrist had “cut a corner” that put the field too close to a bronchus. Point is, this is a great health system with good folks and high-end tech, and I still needed the real-time intervention of the senior physician (and ultimately the senior dosimetry guy). And boy, was I thankful!

But as Rob said, this is a good approach in the right hands. I would:

1. Go to an advanced facility and center that does lots of SBRT on pulmonary mets for CRC (and make sure your rad onc is top-notch—no substitute for this);
2. Discuss location and any potential related toxicities or risks;
3. Make sure that your team agrees that it’s a CRC met not LC primary (SBRT approach is different);
4. Read about cryoablation (as suggested by Prayingforccr). I recognize that you’d likely have to travel for it, but it’s very good, and might be superior for a very central lesion.
I wish you the best!
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; biopsies negative
TAE 11/20, tumor cells removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT for remaining nodule 1/22
CT 3/22: Clear

roadrunner
Posts: 240
Joined: Sun Jan 12, 2020 8:46 pm

Re: Lung Nodule - Need Advice

Postby roadrunner » Thu May 05, 2022 12:30 pm

Sorry, I was rushing when I wrote my above post, and left a couple of potentially material things out. The question of approach seems for you to be very interesting. First, it’s right middle lobe, so a lobectomy would not take as much healthy lung tissue as in the case of other lobes (as someone mentioned). Mine was left upper, which (lobectomy) would have been a bigger hit. This question is a big deal, as SOC is still generally regarded to be metasectomy, though as Rob said this may be changing. The biggest issue is whether you will have more mets. If you end up playing whack-a-mole, which can occur, preserving healthy lung tissue is a big plus. But it’s the smallest lobe, so there’s that.

Next, it seems really important to try to nail down (if possible) when this first appeared so you can look at growth rate. The big scan gap may make that impossible, so discussions of further possibilities for biopsy may indeed be in order, *especially* because there is a possibility of lung cancer here as well. It would also be better—all other things equal—to have material to test to determine ideal treatment if there is a recurrence. In my case, I had two nodules. Wedge for the first one (and tested), SBRT for the second. Mets can have a different genetic profile than primaries, which can affect follow-on therapy.

So there’s lots to discuss. I would, by the way, discuss these with your medical (and perhaps your radiation) oncologist, not your colorectal surgeon.

Finally, what to do after it is treated(whatever you decide to do) is a big—and much vexed—question. Some oncologists would regard this as disseminated disease and recommend chemo. Others would say it’s a “speed bump” and simply recommend frequent scans. It’s certainly a discussion to have, though. And second opinions may be appropriate for any/all of these decision points.

I may still have missed a few things, as this is a pretty complex, high-leverage decision point. But others will likely point those out. :D
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; biopsies negative
TAE 11/20, tumor cells removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT for remaining nodule 1/22
CT 3/22: Clear

User avatar
Peregrine
Posts: 41
Joined: Tue Mar 01, 2022 1:18 am

Re: Lung Nodule - Need Advice

Postby Peregrine » Fri May 06, 2022 12:08 am

roadrunner wrote:...
But as Rob said, this is a good approach in the right hands. I would:

1. Go to an advanced facility and center that does lots of SBRT on pulmonary mets for CRC (and make sure your rad onc is top-notch—no substitute for this);
2. Discuss location and any potential related toxicities or risks;
3. Make sure that your team agrees that it’s a CRC met not LC primary (SBRT approach is different);
4. Read about cryoablation (as suggested by Prayingforccr). I recognize that you’d likely have to travel for it, but it’s very good, and might be superior for a very central lesion.
I wish you the best!

Here is a link to the U.S. News & World Report rankings for best cancer hospitals in Florida. You can scroll down the list to see if you can find a highly-rated hospital near you.

https://health.usnews.com/best-hospitals/rankings/cancer/florida

Once you have found a good hospital and have names of the radiation oncologists there, you can check whether they have been Board Certified in Radiation Oncology. To do this, click on the link below and look for the "Is Your Doctor Board Certified" section near the bottom of the web page. Then enter the doctor's last name, select the state of Florida, then select "Radiation Oncology" or "Radiation Oncology - Recertification" from the drop-down Specialty list. Then click on the "Find my Doctor" button to check his/her certification status.

Certification Matters website
https://www.certificationmatters.org/


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