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.