Lung Cancer Diagnosis w/ No Biopsy - 1255576

Hi devia13, I'm so sorry your dad and family are going through this.
Without a definitive diagnosis of a positive biopsy (cancer cells under a microscope) it is highly unlikely any doctor would treat for cancer. Here is a link to as blog post about work up for diagnosis of lung cancer, http://cancergrace.org/lung/2010/05/12/general-work-up-and-staging-of-l…

It is common to watch a nodule before a decision is made on another biopsy, especially when there is reason to be concerned about the invasive procedure of a biopsy.
If the fluid builds up to a point where symptoms are an issue it can be drained. The fluid sometimes has cancer cells in it.

Can you say whether the repeat scan showed progression or shrinkage? With the exception of "cancer can do anything" cancer doesn't shrink without anticancer treatment. If the nodule shrunk that's a sign that it is inflammation or infection. If the nodule grew then there is still concern of that it is cancer. It would depend on how large it is and how much how fast the nodule grew whether a doctor would want to chance another biopsy. If you can provide that info one of our doctors may be able to provide more input here.

If your dad isn't losing anymore weight there shouldn't be a concern about the 5 lbs he lost when sick.

All best,
Janine
forum moderator

Hi devia13,

I will just add one point to the excellent information Janine provided. At your dad's age, the question arises as to what his doctor would do if he knew that it was cancer. If your dad had a tough time with the biopsy, how difficult would it be for him to handle surgery, radiation or chemotherapy, the standard treatments for cancer? If the tumor appears to be slow growing, would it cause him more harm than good to try to treat it?

A great deal depends on your dad's overall physical condition - does he have other medical issues that might make it tough for him to tolerate treatment? If his doctor doesn't think he could handle treatment very well and wouldn't recommend it, then it might not make sense to do a repeat biopsy.

You can read Dr. Lilenbaum's discussion of these issues here: http://cancergrace.org/lung/files/2011/10/dr-lilenbaum-on-treating-lung…

I hope your dad continues to feel well.

JimC
Forum moderator

Devia,

I'm afraid that it's really not possible to say what to recommend in this situation. There are many huge unknowns here, without knowing with certainty that it's cancer there, but as Jim said, it's appropriate to ask whether any intervention against the cancer is advisable if there's a question of whether a repeat biopsy would be safe and feasible. It sounds very concerning for likely recurrent/metastatic cancer, but the value of chemotherapy in someone over 80 is something that needs to be individualized based on the pace of their disease and other characteristics of the cancer, as well as their overall health, and of course their personal preferences about aggressiveness of care.

Good luck.

-Dr. West

CT scans are much more appropriate to follow lung nodules. Our faq section has several discussions on this common question. http://cancergrace.org/faq

Cancer isn't likely to return after 30 years unless the larynx is very different I think Dr. West may have missed that piece. If this does represent cancer it is probably a primary lung cancer. I understand the position you're in trying to learn an expert's level of information in a very short amount of time. You're asking the right questions. We have an extensive library that covers they basics such as the link in my and Jim's posts above and the faq section. We also have an excellent search function though you may need to log off first. Our cancer info tabs are also a good place to search.

Janine's exactly right. I didn't see the 30 year interval, and with that long a time range, it's probably most appropriate to presume that the prior cancer is completely cured and not a relevant factor at all. In that situation, the current nodule should be interpreted as a completely new and likely totally unrelated finding. The key question is whether it would be feasible and appropriate to do any aggressive interventions now if it were found to be a lung cancer, or possibly a cancer from some other site. If a primary lung cancer, it could potentially be treated with an approach like stereotactic body radiation therapy (SBRT), but that would only make sense if it appeared that, if confirmed as cancer, the cancer is also felt likely to be a significant threat vs. other medical issues over the next few years.

Good luck, and thanks to Janine for clarifying and inferring my oversight correctly.

-Dr. West

Hi devia13,

It's not a question of whether surgery is possible for any 83 year old man, but your dad in particular, given his current health, his doctors' assessment of how well he could tolerate the surgery and the potential benefit of the surgery considering his age and other aspects of his health.

JimC
Forum moderator

Recurrence of vocal cord cancer 30 years later would be extremely unusual. While only a biopsy can prove what something is, the greatest concern would be for a new lung cancer; of course, other cancers and noncancers (inflammation, infection, etc) can cause a spot on CT or PET/CT. 83 years old vary in terms of what they can tolerate and benefit from. Some 83 year olds are extremely fit and can tolerate and benefit from the same things as younger patients while others have a tough time with treatments. Sometimes a geriatric consult can be helpful in assessing the strengths and weaknesses of an individual patient. Consultation with experts who are comfortable and experienced with older patients can also be helpful.