Lung cancer met to abductor leg muscle - 1252276

Hi Bill,

I hope you are doing well with treatment, aside from this peculiar complication. Was radiation to your leg muscle suggested by your oncologist? How was the mass found, or did you identify it and it lead to Dx? I'm very, very interested, as earlier this year I developed a lump in my left forearm muscle. I've palpated it and speculated it might be a cyst. But now I worry and have mentioned it to the nurse practitioner whom I sometimes see on the clinical trial I'm in.

The lump now seems to cause sensation in my arm, whereas it used to be just something whose presence I was aware of. There's an underlying fear that if it's examined and discovered to be a new malignancy, it will disqualify me from LC clinical trials which are my only hope at this point.

Docs, any insight?

Best wishes to you, Bill.

Jazz

There's no specific protocol for treating metastases to an extremity, as opposed to some other location. It's completely reasonable to radiate any metastasis causing symptoms directly, such as pain in the area or compression if a nerve nearby, but otherwise, the systemic therapy against the cancer in other areas should also be comparably useful against a metastasis to a muscle.

As for Jazz's question about whether to biopsy, a separate soft tissue cancer, which would likely be a sarcoma, is actually quite uncommon when playing the numbers, so if it were cancer, odds are greater that it would be an uncommon pattern of spread of the existing cancer rather than a new primary cancer that is actually a very uncommon cancer type. But if you want to avoid taking the chance of finding something you don't want to find, you'd have to follow the "don't ask, don't tell" approach and not pursue a biopsy.

-Dr. West

Thanks, Dr. West. I think I'll stick to "don't ask, don't tell" until I'm on the next trial and stabilized. It's something of a similar situation to having additional breast imaging. Dr. C remarked with the same "running the numbers" odds and so far nothing is as aggressive as LC. So I'll just stay the course for now.

Jazz

Hi Bill, Welcome to Grace, not exactly the kind of place you want to need but it's terrific for putting context to all the info out there.

Don't get me wrong, denial is a perfectly wonderful coping mechanism, there's even a blog/post written on the subject, http://cancergrace.org/coping-with-cancer/2009/04/29/denial-coping-mech… .

However when knowledge is forced upon you as it can be with lung cancer, it's good to know your options, so you really need to show your hand when in doubt. It's very possible to miss a window of opportunity with a treatment if you wait too long. A lot depends, so be up front with your docs and ask lots of questions if you want to be part of the decision making process. Of course it's fine to let your doctor make all the decisions, but then you'd probably not be here if that was your style ;) . Jazz is a seasoned veteran who knows her cancer, the game, and playing to her advantage.

I agree it certainly seems that docetaxel (taxotere) gets a lot of grief in the side effects discussions though when you look at the research comparisons it really doesn't rank that much worse than others. It all sucks and I'm no expert or patient so I'm just repeating what I've read.

I hope you do well and again, welcome,
Janine

Jazz, any chance it can be a lipoma? I just had one removed from my arm last year and I've had two removed from my back several years ago. This is a benign fatty tumor. Funny, but both my sisters have them in their arm and never got them in their back. They just let there's grow and it's very unsightly. When I noticed mine last year in my arm and confirmed it was a lipoma, I had it removed. They continue to grow and attach to tissue. So I'd get it checked out, especially if it can be cancer related.
Take care, Judy

Just wanted to add that I saw a patient today who has had a hard time with Taxotere as a 3rd line treatment but also showed a pretty nice response to his first scan after starting it. We decided to pare down the dose a bit, hoping to get a better balance of efficacy with a more favorable (milder) side effect profile, but he was far more eager to continue with it in some fashion after learning it was doing some real good against the cancer. And I'll say that I was impressed with the shrinkage we saw when giving it after he had received other treatments for about two years.

My point is that we wouldn't want to paint a picture that it's a cake walk, but it remains on our short list of useful drugs in previously treated patients for a good reason, and many patients do tolerate it well, even if some don't.

-Dr. West

Judy,
Thanks for the input. It could very well be a lipoma, but again, I'm hesitant to investigate should it turn out to be a new malignancy, thereby reducing my chances of enrolling in LC clinical trials. As Dr. West said, it's probably NOT a sarcoma or something like that, but if it's a metastasis, then hopefully the next tx I do will address it. If not, I'll put it off until it becomes bothersome enough to risk trial qualification.

As for Taxotere in third line, this is very helpful, Dr. West. I may be looking at that for my father (who will start Gemzar second-line soon, awaiting results of tissue testing).

Jazz