Elderly mom has Upper right mass – we have ?'s

Portal Forums Lung/Thoracic Cancer Work-Up/Staging of Lung Cancer Elderly mom has Upper right mass – we have ?'s

This topic contains 2 replies, has 2 voices, and was last updated by penney625 penney625 2 weeks, 5 days ago.

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November 4, 2017 at 9:12 am  #1293460    
penney625
penney625

Hello, everyone – I hope I’m asking this in the right place.

My Mother in Law, who is 96 years old, was complaining of rib pain and visited her PCP 9/26/17. A chest x-ray showed a “mass-like opacity” which had not shown up on a prior xray taken in Nov 2016 (which was done due to an URI which resolved.) Follow up CT found this:

“There is a posteriorly located right upper lobe mass which appears partially cavitary and measures up to 4.5 x 3.1 x 4.5 cm with spiculated margins. This is suspicious for a primary pulmonary neoplasm. This contacts the pleural surface and abuts the adjacent ribs and vertebral bodies without definite evidence of intraosseous invasion.”

She didn’t want a biopsy, just wanted the mass removed in the belief that would resolve her rib pain. (My husband & I are highly skeptical of this belief & about surgery in her case, given that she is can only go about 100 ft with her walker & rises from a chair only with difficulty. Aside from surgical risk, we think the recovery might be dreadful and that she has only a slim chance of regaining even the mobility she now has.) Referred to a surgeon who then asked her to get a PET/CT before he even addresses her ability to withstand surgery.

Her PCP remarked that the mass had grown quickly having not been evident on the Nov. 2016 xray. The surgeon remarked that it was “slow-growing.” The remark has also been passed that, at 96, she could well be taken by another illness before this mass becomes a bigger problem.

Trying to get some clarity on whether a mass that it not evident on an earlier xray but clearly visible to the untrained eye on xray 10 months later and measures 4.5×3.1×4.5cm can fairly be called “slow growing.”

As with most immediate family, we want to make sure we ask the right questions, but so often the question only come to mind in the car on the way home!

I’d welcome some input on the slow/fast growth issue if anyone is willing. Thanks!

  • This topic was modified 2 weeks, 5 days ago by penney625 penney625. Reason: clarity
  • This topic was modified 2 weeks, 5 days ago by penney625 penney625. Reason: clarity
November 4, 2017 at 10:06 am  #1293462    
JimC Forum Moderator
JimC Forum Moderator

Hi penney625,

Welcome to GRACE. I am sorry to hear of your mother-in-law’s suspicious scan findings. Your mother-in-law’s mass is of significant size, and certainly developed quickly. Whether it will continue a rapid pace of growth is something that can only be known by comparing its size from one scan to the next, although if the PET scan reveals a high SUV (rate of metabolic activity) that may be predictive of faster than average growth.

Thoracic surgery is a major procedure, one which is challenging for much younger, more fit patients, so it is reasonable to hesitate given your mother-in-law’s overall health (known in the cancer world as “performance status”). Cancer treatment has two major goals – increasing the length of life and improving the quality of life.

As far as length of life, early stage cancer (one which has not spread outside its place of origin) may be curable. For a younger person, that chance of adding many years of life can offset significant side effects of treatment such as major surgery. For an older patient, or one with more health issues, there tend to be more risks than potential benefits when considering a major intervention such as surgery – you are not likely to add as many years and the pre-existing health conditions can make it difficult to survive or recover from the procedure.

This is when quality of life become the focus, taking precedence over procedures which may add years but at a cost. The complicating factor in your mother-in-law’s situation is the rib pain she is experiencing. It sounds as though that is her overriding concern. Has there been any discussion of the possibility of palliative radiation, at least to the part of the tumor abutting the ribs and vertebrae? In appropriate cases, radiation is used to reduce pain or other symptoms, although her age and overall health would need to be considered. Perhaps a consultation with an oncologist and/or radiation oncologist would be helpful.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

November 4, 2017 at 12:14 pm  #1293463    
penney625
penney625

Thanks for your reply, Jim!

Yesterday, we had a conversation with the PCP about the need for more consultation on options (to include palliative radiation, etc.) since the referral to the surgeon took nearly 5 weeks for her to be seen and didn’t accomplish much due to lack of communication.

My MIL has been very clear that pain is her overriding concern, so I think she will likely choose palliative care anyway – once she is fully informed. Due to the anxiety of the current situation and her own firm (but not always accurate) beliefs, absorbing the information is a challenge. She claims no interest in extending her life, which is not all that surprising given that she’s buried 2 of 3 children, all eight of her siblings and her husband, but she is very interested in being as comfortable as possible. We see our job as doing our best to make that possible. I have some experience having done hospice at home for both my parents, but everyone is different in how things go.

Thanks for your take on size/growth of the mass. Some perspective on that is very helpful! I know we’ll have more questions as this journey unfolds.

I have read several of your posts, including the post on your “backstory.” Your knowledge is hard-earned and you are a fine man to share it as you do. Please accept my thanks and good wishes.
Cathie

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