Question – 72 Year Old Mom

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This topic contains 4 replies, has 4 voices, and was last updated by  Dr West 2 years, 3 months ago.

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May 3, 2012 at 10:19 am  #2039    

limajo

My mother has had a history of benign lumps and polyps. She’s been having them removed most of her adult life. She suspected a polyp in her rectum several years ago but did nothing about it due to her dislike of her current doctor. Eventually, that polyp turned into an intestinal blockage and she ended up having quite a bit of her colon removed, leaving her with an ileostomy bag. At the time of surgery, they tested her lymph nodes and found nothing. I believe the mass was the size of an orange and had become either pre-cancerous or cancerous, but they said they got everything and more. She spent a long time in ICU and had a very difficult time with recovery and had many complications including Afib and circulation issues. At her first oncologist visit 4 months post surgery, her CEA level was 1.6. They did a PET scan and found a small spot on her lung and something “suspicious” on her liver. They didn’t feel she could withstand further surgery and also didn’t feel she was strong enough for chemo. At her next appointment 6 months later her CEA level was at 6. Nothing was discussed. At the next appointment an additional 6 months later her level was at 22. The oncologist sent her for a CAT and PET scan and told her she had a 1 cm spot on her lung and 3 cm spot on her liver. He didn’t feel there was any appropriate treatment. He dismissively told her she could “try” surgery but didn’t feel anything would change the prognosis. He basically encouraged her to focus on quality of life.

My question is this. Is it at all possible that the spots on her lung and liver are more of the benign lumps she has been experiencing all her life? It seems strange to me that they found them 16 months ago and they don’t seem to have changed. I read that CEA levels can become elevated if there are benign tumors in the organs the test is geared to. Is there any way to know for sure if these spots are cancerous or benign or cancerous without having a biopsy? My mother refuses a biopsy because she strongly believes, if the spots are cancer, having a biopsy accelerates the spread.

I would hate to have her walking around every day thinking she has cancer if she doesn’t. I know the odds are that she does, but if there were some non-invasive way of confirming one way or another I think that would be helpful.

May 3, 2012 at 12:43 pm  #2040    

catdander forum moderator

I asked the same questions 3 years ago when my husbands biopsies came back non diagnostic while the doctors felt it was all but positive. So his situation was different but the same question was asked. The answer I suspect you’ll get is medical personel need to have cancer in hand so it can be confirmed through a microscope. I’ll find a doctor’s quote and post in a few.


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

May 3, 2012 at 1:11 pm  #2041    

cards7up

Is there a reason they don’t biopsy the lung or liver nodules, preferably the liver being the larger of the two? This can be done by fine needle aspiration and requires no surgery.
Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011. Local recurrence, surgery to remove LRL 8/29/13. Chemo carbo/alimta x3.

May 3, 2012 at 1:11 pm  #2042    

catdander forum moderator

Dr. West stated in another thread, ” There’s no way to determine a diagnosis of cancer vs. not, and certainly not SCLC vs. NSCLC, without actual biopsy tissue to look at under the microscope. PET scans don’t clarify the matter. ”

Here is a link to the thread I took the quote from. It’s the first comment (after the original post), 2nd pp. http://cancergrace.org/forums/index.php?topic=6304.0


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

May 3, 2012 at 3:55 pm  #2044    

Dr West

Yes, the short answer is that there is no way to confirm cancer without a biopsy. I agree that it does sound very suspicious for progression/recurrence of her cancer. The idea that a biopsy will spread the cancer is not a realistic concern here, but I don’t suppose that there is any evidence that will dissuade her on this point — because it’s not based on any fact that she has reached that presumed conclusion.

The bigger question about a biopsy and whether it’s worth pushing that question is what would be done with that information. If she is not a candidate for treatment and/or isn’t interested in any intervention, the value of chasing down a definitive answer isn’t very clear. This would be different of confirming cancer would lead to her pursuing chemotherapy.

Good luck.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

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