lvpam
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My husbad was in hospital via ER due to a fall resulting in a broken arm. During his stay it was noted by a doctor of hemotology/oncology that something in his bone marrow was causing the blood to not re-generate sufficiently (as you can see I didn’t really get a handle on this). a CT scan of his chest was done and the results are below. A bronchoscopy was done and “nothing unusual” was found. A consult with a thoracic surgeon resulted in us being referred to a gastroenterologist as the masses are in an extrememly difficult place to get to for surgical biopsy. The plan is for a Trans-esophogeal biopsy of the subcarinal area to be done, the earliest appointment we can get is for the end of June and the waiting anxiety is really getting to me. We see the doctor of hemotology/oncology next week for a post-hospital follow up. My husband is 72, not in good health and a 50+yr smoker, currently still smoking 1 or 2 cigarettes a day. He has no interest in anything and sleeps 18 or 20 hours a day and has no appetite at all. I know nothing can be certain until a biopsy is obtained and analyzed but from the above and report below do you have any clues. Doctors have intimated Lung Cancer, but naturally won’t say so definitvely without the biopsy.
Any input will be most gratefully accepted.
Thanks,
Pam
The CT scan results
:History: Smoker
Comparison: None
Technique: Thin section axial CT images were obtained from the thoracic inlet through the lung bases and adrenal glands without contrast. Thin coronal images were reconstructed from the axial data set. All images were reviewed and interpreted.
Findings:
Small right and tiny left pleural effusions are identified. There are diffuse atherosclerotic calcifications. Coronary artery calcifications are present. Thyroid gland is heterogeneous.
There is a 3.8 x 2.7 x 2.6 cm mass in the subcarinal region. This probably represents a conglomeration of enlarged lymph nodes.
There is a right hilar soft tissue opacity measuring approximately 2.2 x 1.9 x 1.4 cm. Suspicious for right hilar mass or lymphadenopathy.
There is mild peri-bronchovascular soft tissue thickening on the right. There is a wavy, tubular appearing opacity in the right upper lobe measuring approximately 2.6 x 0.8 cm. Mild posterior atelectasis is present.
Fatty infiltration of the Liver is noted, nonobstructive tiny right renal calculus noted. Cholecystectomy seen. Chronic calcific pancreatitis identified.
Impression:
1. Subcarinal and right hilar lymphadenopathy or other soft tissue mass.
2. 2.6 cm nonspecific right upper lobe opacity. May represent an unusual vessel given its tubular and wavy appearance.
3. Small right and tiny left pleural effusions.
4. Tiny right renal calculus
5. Fatty Liver
6. Chronic calcific pancreatitis
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Dr. Weiss
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I’m very sorry, but we can’t review scan reports here. It’s time consuming and passes from the realm of information to medical advice. However, we are very happy to provide information and support. Can you perhaps rephrase as a specific question or questions?
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lvpam
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Sorry – I thought I was probably “pushing the envelope”, I’m just so anxious for information and so new to this area that I don’t really know what questions to ask:
Would a 3.8 x 2.7 x 2.6 cm mass in the subcarinal region be considered something that needed to be biopsied on an urgent basis or something there is no real urgency about?.
The same question for a right hilar soft tissue opacity measuring approximately 2.2 x 1.9 x 1.4 cm and a wavy, tubular appearing opacity in the right upper lobe measuring approximately 2.6 x 0.8 cm.
Also what does “mild posterior atelectasis” mean?
I really do appreciate any info you can give me.
Pam
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double trouble
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Hi ivpam. You must be shocked to have gone in expecting to leave the ER with a cast, and ending up having to try and absorb all of this. I’m a patient, not a medical professional, but the way I understand, and very loosely put, “atelectasis” means that he is not inflating his entire lung when he breathes. The word means collapse, which sounds scarier than it really is. As you can see from the report, this is not listed with the “Impressions” and it was described as “mild” so I would put this one on the “least of our worries list.” I think it is fairly common in people with lung problems and certainly not life threatening. I have seen this term on my own reports in the past, but the doctors never felt it merited discussion. I’m sure others, hopefully the doctors, will come along and confirm or correct my explanation.
I’m sorry for your situation, but I think you will find lots of support and information here. Please keep us posted.
Debra
09/10 CT Bil. GGO’s 12/10 L L VATS Segment Adeno/BAC Kras+ 1st Primary Stage Ib
05/11 CT L Stable RU 1.3 cm nodule, 1r & 2r LN
08/11 PET/CT L Stable, mild uptake in R nodule, LN
09/11 EBUS N1, N2 LN Adeno+ 2nd Primary Stage IIIb
10/11 Start chemorad Cisplatin 11/11 Stop chemorad 4 cis/38Gy blood counts
12/11 PET/CT FDG neg 03/12 PET/CT Stable R nodule R hilar SUV 3.4 06/12 Growth R hilar SUV 9.5
07/12 Surgery recommended Mayo thoracotomy pneumonectomy EBUS R Hilar Adeno+
08/15/12 Brain MRI Normal 2nd Opinion Duke recommends VATS pneumonectomy
09/12 PET/CT hilar growth, new R 2.2 SUV 1.5 by 2 cm Hilar LN Kras+
Bronch/Lavage (hemoptysis) Duke Mediastinoscopy R Lung Unresectable, Bronchoscopy #7 LN Adeno+ ALK+
10/12 HRCT 4 RUL nodules (3new) “enlarging” R Hilar
12/12 PET/CT 12/19 Start Xalkori
02/12 Decreased FDG R Hilar. New nodules “waxing and waning, sugg inflam/infect.” Not neoplasm! Part of RUL collapsed
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lvpam
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Thanks for the response Debra, it’s good to know there’s at least one thing “not to worry about” so to speak.
We’re just so un-informed about this. Right now we’re waiting to see if the thoracic surgeon can get an earlier appointment with the gastroenterologist. If not it means there will be at least two months between the time the CT scan was done and a biopsy (hopefully) taken – seems like an awful long time.
We we see the doctor of hemotology/oncology on Monday and don’t even know what questions to ask – I mean the obvious one is: Is it Lung Cancer or not and what’s the prognosis?
We just don’t know what we’re dealing with. In the meantime DH is not feeling at all well, has no energy, sleeps 18-20hrs a day and I mean sleeps, not just hiding under the covers; has no appetite, on a good day he might eat a PB & J and keep it down, usually it’s a couple of bowls of ice-cream and it’s not uncommon for him to bring it right back up again. Some days he can swallow ok, others he can’t, some days his voice is normal, other days its really gravelly. Something is obviously significantly wrong with him and until we know what it is it can’t be addressed; I live in fear of a doctor saying — if you’d come to me earlier I could have done something, but now it’s too late — I know I have no choice but to wait, but I just can’t stand it. I do believe in God and it’s holding me together to a large degree.
Thanks for the support – it truly does help.
Pam
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This reply was modified 12 months ago by
 lvpam.
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catdander forum moderator
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ivpam, my husband was in quite a similar situation. I found ensure with 350 calories and protein to be something he could take. Also lots of bacon and eggs and homemade protein shakes. What I found to be the case was that he didn’t eat what he usually did and I had to experiment with different foods. He is still underweight but is keeping it stable and has returned to many of his old favorites.
catdander’s husband:
8/25/09 thoracotomy biop dx stage 3a squam nsclc pancoast tumor right
9/16-11/4/09 chemorads cis/etop,
10/30 MRI to brachial plexus found c3 met changed stage 4
11/9-20 rads to c3 w/concurrent 11/9-1/18/2010 carbo/navelbine
Feb-Nov 2010 tarceva until first progression 11/29/2010 3cm upper left.
12/14/2010 Gemzar
Scans remain stable on Dec. 2011 still on Gemzar.
NED March, July, Nov 2012,Feb, and May 2013. Treatment break began late July 2012.
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Dr West
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In general, you only need to biopsy from one area of what is likely the same process, and ideally we like to biopsy from the area that will confirm the highest stage. Here, that would be the subcarinal mass, and if it shows cancer, it wouldn’t be especially helpful to biopsy two other areas that will likely show the same process.
I can’t really speak to the question of urgency. Is it an emergency? No, it’s something that we routinely work up as an outpatient over a course of a few weeks. But it’s not something that we recommend patients come back in 2 months to evaluate. It should be evaluated in a timely way.
Atalectasis means an area of lung that isn’t inflated well. That’s not necessarily a big deal at all — we often see that small portions of the lungs aren’t fully inflated, like the end of a long balloon.
-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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lvpam
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Thank you Dr. West, at least I have a little idea of what the process is. I’ll keep calling and asking if there have been any cancellations with the gastroenterologist and I have asked the thoracic surgeon if she would make a doctor-to-doctor call and see if there’s any way my husband can be seen sooner.
Thanks again,
Pam
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laya d.
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Hi Pam:
I’m so sorry to read about all that is going on with your husband – - and I am so sorry about your anxiety. Waiting truly is one of the worst parts for me. I’m not patient by nature.
Anyway, I just wanted to say that I would do exactly what you are doing if I were in your shoes. I think daily calls to ask about cancellations is a good thing – - even if you are labeled the most annoying spouse by the front office staff. I have been wearing my badge of “most annoying daughter” with pride since Jan. 2010.
Best of luck to you,
Laya
1/10 – My Mom (58) dx w/ NSCLC-Adeno 3a; 1 cycle of neoadjuvent Carbo/Alimta before finding out EGFR+ (Ex. 19), then switched to 7 wks of neoadjuvent Tarceva/150 mg (major shrinkage); 4/10 – right pneumonectomy; 6/10 started 3 rounds of adjuvent Cis/Alimta w/ concurrent chest radiation (7 wks); 8/10 – NED; 11/10 – small nodule in left lung; 1/11 – 3 small nodules in left lung, start Tarceva/100 mg; 4/11 – suspected sclerotic met to hip, continue w/ Tarceva, add XGEVA, brain MRI clear; 9/11 – solitary 3 cm met (adeno w/ T790m mutation) to cerebellum, surgery and gamma knife, up Tarceva to 150 mg; 11/11 – 2 left lung nodules growing, biopsy on 1 shows mutation from adeno to squamous (shocker!), brain MRI clear, continue Tarceva & Xgeva; 2/12 – brain MRI clear, CT scan, remaining nodule slightly bigger – – monitor for now, Tarceva (reduced to 100 mg) & Xgeva continued; 4/12 progression and rebiopsy (confirmed adeno), stop Tarceva, switch to Carbo/Alimta; 6/12 maintenanceAlimta; 8/12 back to Tarceva; 10/12 Gemzar; 11/16 difficulty breathing; 12/12 hospice initiated…my Mom passed away peacefully on 12/19/12. Heartbroken.
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lvpam
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Hi everyone,
I just love this Thoracic Surgeon and her staff – they have been so informative, compassionate and helpful I just can’t describe what it means to me. Anyway she did call the gastroenterologist who reviewed DH’s file and told his staff that DH needs to be seen “asap” – so he has an appointment at 9:30 this Monday – sad to be excited about getting a doctor’s appointment, but I’m sure everyone here understands. At least we’ll have this doctors opinion and hopefully a biopsy scheduled.
I just hope DH has the energy to keep both his appointments on Monday – he also has one at 3pm with the doctor of hemotology/oncology and if we have to re-schedule that it’ll be weeks before we can get another… but I’m getting ahead of myself.
Thanks for the support – as you all know it means a lot even though I don’t know any of you.
I’ll keep you posted.
Pam
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Dr West
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Pam,
Good luck. I’m glad you were able to get things expedited and that your surgeon & staff were so responsive.
-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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lvpam
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The biopsy of the chest mass is scheduled for this Thursday – so grateful that we’re at least moving towards a diagnosis.
We also saw the doctor of medical hemotoloty/oncology yesterday afternoon and she mentioned that there is a cancer indicator in the bone marrow and the normal indicator number for a non smoker is 2, for a smoker it’s 3 and DH is 6 – I can’t find any reference to these numbers on the web – does anyone understand what these numbers are? Her office is so very busy I don’t want to bother them with a question like this. Her office is going to be scheduling a PET scan plus a biopsy of the bone marrow from the hip; they also took 15 vials of blood yesterday ! Oh.. and she reminded me that DH’s bladder wall is thickened and he needs to have that checked – that appointment had already been scheduled for the 13th of this month.
I am amazed at how well DH is handling all this emotionally, although there are hints of denial which I think is understandable.
Anyway, updating here helps me somehow, makes me feel less alone in the confusion of appointments.
Today it’s a routine checkup with his cardiologist.
Routine is good 8)
Pam
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catdander forum moderator
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Hi Pam,
I’m glad to see everything is moving forward in a timely manner. Don’t be afraid to check with the doctor’s offices when you have concerns. It’s worked well so far.
You mentioned denial by your husband and it reminded me of this wonderful article by an oncology social worker (I think? She’s retired) who has a lot of experience in the area. I love the article and haven’t seen it around lately so hopefully others will read it too.
Best of luck to you and your DH,
Janine
http://cancergrace.org/coping-with-cancer/2009/04/29/denial-coping-mechanism/
catdander’s husband:
8/25/09 thoracotomy biop dx stage 3a squam nsclc pancoast tumor right
9/16-11/4/09 chemorads cis/etop,
10/30 MRI to brachial plexus found c3 met changed stage 4
11/9-20 rads to c3 w/concurrent 11/9-1/18/2010 carbo/navelbine
Feb-Nov 2010 tarceva until first progression 11/29/2010 3cm upper left.
12/14/2010 Gemzar
Scans remain stable on Dec. 2011 still on Gemzar.
NED March, July, Nov 2012,Feb, and May 2013. Treatment break began late July 2012.
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Dr West
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I don’t know what is being referred to as a cancer indicator in the bone marrow. Perhaps this reference was to the CEA level, a notoriously unreliable blood test that in lung cancer that isn’t widely accepted at all as a good correlate for cancer. Otherwise, I can’t guess what was being suggested.
Good luck with the upcoming biopsy.
-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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lvpam
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Thanks Dr. West:
The biopsy was done this morning and Cancer confirmed.
We have a PET scan scheduled for Monday. A consult with our Oncologist on Friday to talk about staging and prognosis etc., if she still feels she needs to do the bone marrow biopsy she will do it at that time.
It’s strange, but I find I don’t know how to feel – I’m kind of numb, even though the diagnosis was suspected and tired … so tired.
DH is handling it really well. I wonder if the reality will suddenly hit us when it’s “staged”?
I’ll keep posting – it does help.
Pam
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Dr West
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What often helps is getting information and arriving at an actual plan so that, after the anxiety and open questions, you can move to having answers and moving forward.
We’re here for further questions as they come up. In the meantime, good luck with the upcoming scan and visit.
-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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lvpam
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We saw DH’s oncologist this morning. He has small cell lung cancer that has metastasized and is also in his blood stream. The doctor said the stage didn’t matter because it’s in the blood stream.
He is scheduled for four chemo treatments each consisting of 4 days in hospital and one month apart; between the chemo treatments he will be receiving radiation and injections at the cancer center. The doctor feels that if the chemo works he’ll be ok and “something else will kill him” if they don’t work he’ll “be gone by Christmas” and we should know after the second treatment if they’re working or not.
She also told us that he’ll have to have a round of x-ray treatments after the chemo is finished to kill any cancer that may have developed in his brain.
He starts his first chemo this coming Monday.
I have a lot of confidence in this doctor and feel she is really “in charge” of it – it’s a huge help. At least we know what it is and have a plan of action. We’re both ok with whatever the end result is, just as long as he is kept pain-free.
So glad this forum is here.
Pam
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catdander forum moderator
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Hi Pam, I know you and your husband will move forward with better focus on what happens next. I’m so sorry y’all are going through this. I really hate cancer.
Below are links to information about sclc. sclc isn’t divided into 4 stages but into 2 grps, limited and extensive. We have members with sclc who do well for some time even with extensive sclc.
I think there’s some leeway between the timing of six months and cured. Our doctors at Grace admit they are really bad at predicting how long one may live. So I don’t either and hope for the best. It’s a good goal that can always pertain.
Breath,
Janine
http://cancergrace.org/lung/2006/11/24/small-cell-lung-cancer-101-an-introduction/
http://cancergrace.org/lung/2010/08/03/intro-to-sclcref-lib/
http://cancergrace.org/lung/2010/08/07/treatment-of-small-cell-lung-cancer/
catdander’s husband:
8/25/09 thoracotomy biop dx stage 3a squam nsclc pancoast tumor right
9/16-11/4/09 chemorads cis/etop,
10/30 MRI to brachial plexus found c3 met changed stage 4
11/9-20 rads to c3 w/concurrent 11/9-1/18/2010 carbo/navelbine
Feb-Nov 2010 tarceva until first progression 11/29/2010 3cm upper left.
12/14/2010 Gemzar
Scans remain stable on Dec. 2011 still on Gemzar.
NED March, July, Nov 2012,Feb, and May 2013. Treatment break began late July 2012.
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catdander forum moderator
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Pam, this is a thread about newly diagnosed sclc that you may find helpful to read and possibly respond to.
Janine
http://cancergrace.org/lung/topic/sclc-are-there-any-new-developments/#post-11482
catdander’s husband:
8/25/09 thoracotomy biop dx stage 3a squam nsclc pancoast tumor right
9/16-11/4/09 chemorads cis/etop,
10/30 MRI to brachial plexus found c3 met changed stage 4
11/9-20 rads to c3 w/concurrent 11/9-1/18/2010 carbo/navelbine
Feb-Nov 2010 tarceva until first progression 11/29/2010 3cm upper left.
12/14/2010 Gemzar
Scans remain stable on Dec. 2011 still on Gemzar.
NED March, July, Nov 2012,Feb, and May 2013. Treatment break began late July 2012.
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lvpam
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Hi catdander,
Thanks for your supportive comments and the links – I will certainly check them out. I’m realizing how little DH and I know about this disease even though he “beat” Cancer twice before – he had his right eye removed in 1977 and had a partial Nephrectomy in 2005. I don’t even know what a port is  – do you know if there’s a section of this (or another) forum that has a “definition” section
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Dr West 11 months, 1 week ago.
