Update on Biopsy - 1257170

Hi Judy, I was really hoping that this wasn't a conversation about you and you remained NED. I'm so sorry about the recurrence and that you had a tough time with the biopsy. D had a traumatic lung collapse with one of his biopsy tries.

I'm sure you know that radiation scarring is the issue here. It has been described as trying to cut through cement if the surgery is much more than a couple of months post radiation. So I'm glad you are traveling to have a major 2nd opinion on this. Since it all depends.

I'm sorry it has taken so long to answer your post I found myself in the country without access to the internet and a low battery on the phone. No problems on my end just helping out bil with egg business while sis is out of town on consulting business and with the computer. Bad planning on my end.

I'll ask a doctor to reply.

All the very best and of course, take care,
Janine

Judy, I'm also sorry to hear about these developments. I hope after you have heard from several experts that the right path will become clear. I know how hard it is to be faced with several options. Hard to know you're choosing the best one, but like you said, you've had 2 1/2 years experience, dealing not only with your own situation, but following and giving support to others. You're probably armed with more knowledge than you realize.

Please keep us updated, and know there are many here sending love.
Debra

Hi Judy:

I'm so sorry to read about this new cancer. . .but am quite hopeful that some really good options remain on the table for you. . .and that you will be back to your NED status before we know it.

I'm keeping you close. . .

Laya

Judy,

I'm sorry that you're no longer NED. In general, it often makes sense to locally ablate recurrent disease if on best imaging, there's really only one spot seen. The best modality is hard to address without all the details, including imaging. If the surgeon doesn't think that surgery is a good choice, other alternatives include RFA and cyberknife. For cyberknife, fiducials can be helpful. These are tiny flecks of metal (often gold) that are put in or very close to the tumor during biopsy that can help guide the radiation machine in its targetting.

Judy,

I'm sorry to hear about the recurrence, but happy that you're past the difficulties of the collapsed lung, and I'm hoping that you'll have good discussions with your doctors and formulate a good, effective, well-tolerated plan going forward.

As always, you will be in our thoughts.

JimC
Forum moderator

Judy,

I don't have the radiation oncology knowledge to offer a good comment here, but I'll ask Dr. Loiselle if he can offer any insights here.

Good luck.

-Dr. West

Judy, I am sorry to hear of this development, especially since you have been NED for an extended period of time.

Perhaps the long NED is suggestive that this is a 'slow' cancer since it has taken so long to come back (well, at least I would like to think that way).

Please stay strong.

Hi Judy -

Sorry to hear about this, but I would be optimistic regarding an excellent outcome with appropriate surgery or radiation to this area of recurrence.

First, surgery such as a VATS lobectomy is often feasible following prior radiation therapy. It does depend on surgical experience, but the thoracic oncology surgeons in our program will do this routinely.

In terms of re-irradiation, all approaches can have certain benefits or disadvantages, including linear accelerator based radiation, protons, or cyberknife. For recurrent lesions in close proximity to the vertebral column/spine, cyberknife is typically ideal.

I hope that helps.

CL

Judy,

I am sorry to hear that you've had a recurrence and had a lung collapse(Mark had that w/his biopsy). I wish you all the best as you scout other opinions and come up with a tx plan. I'm very hopeful that you will be back to your NED status very soon!!!!

I will be keeping you close in my thoughts,
Lisa

Hey Judy, I too am sorry about the recurrance I hadn't checked in on Grace in awhile but have been on Inspire a bit more. I'm sure you have a lot of the answers already and just wanting confirmation! I will pray for you to have a speedy return to your NED status with much more sucess this time! You have been such an inspiration to not just me but a lot of people not just here but on Inspire too! Actually you were the one who recomended me to join Grace! It has been quit the source of information and support! I hope you will keep us posted as to what is going on on your new Journey! Lorrie! :)

Judy, I've found this blog post on rfa for lung tumors linked to below. I'll also ask Dr. Loiselle to comment on your follow up question.

All the very best,
Janine

http://cancergrace.org/lung/2007/03/06/rfa-for-lung-tumors/

Judy -

For both effectiveness potential and toxicity concerns, I would favor radiation over RFA, unless for some reason radiation is not an option.

CL

Judy,
Very sorry to hear of your recurrence, small as it is. I hope you can sort out the best solution soon and be on your way back to NED and playing with the grand babies ;)

Hang in there and best wishes for getting through this quickly.

Jazz

Hello, Judy. I of course cannot answere your medical question but just want to let you know that my family will be thinking and praying for you and that you beat this sucker back into nothing again & get back to one of the greatest acronyms there is...NED..NED..NED..NED..NED...NED..NED!! Please take care and thanks again for all of your help over the past months for my Mom.

I don't mean to hedge, but this is a situation so far outside of the boundaries of evidence-based medicine that it falls entirely in the range of individualized recommendations based on judgment and specific circumstances. If there is a realistic probability of killing the last cancer cell for good with chemo, then it would be a reasonable consideration. If the strategy is to manage the cancer with as little intervention as possible over time, and there isn't a realistic probability of killing the last cancer cell for ever and ever, I think it wouldn't make much sense to do chemo when there's nothing even to treat, but rather to save it for another day, when it might be useful to fight cancer actually causing a problem.

Good luck.

-Dr. West

The waiting while figuring it out is probably pure torture! Believe me I know! Your in my thoughts and prayers! Lorrie

Judy,

As a Stage IV afforded only systemic treatment, I try to follow radiation, ablation and surgical options just in case, but my knowledge is thin.

I do have a friend/mentor who is 9yr Stage IV NSCLC survivor. He has been NED for the last 5 years. He had ablation, radiation and surgery - long story. 5 years ago, he had a recurrence in the lung that was not radiated, and therefore don't know if his experience has any relevance to your case. But I wrote him to make sure I remembered correctly what he told me, and this is his response:

"The little tumor (1.5 cm as I recall) that popped up on my left lung was removed with laproscopic surgery. If it had a more official name, I don't recall it. It was a simple procedure involving just one day in the hospital. Went in, in the morning, woke up later that day with a 1 1/2" incision on my left side and a 1/2" incision for a drain. Went home later that afternoon. They got it all and I've never had any more problems since. Hope this helps."

There may be reasons it can't be as simple as my friend's experience for you, but I thought I would pass it on. If any patient is capable to weigh all the possibilities calmly and rationally once presented and choose wisely, it is you. I hope you will explain the option you choose and why so we can keep on learning from you. All the best.

Well. . .they have GK in Southern California near where I live - - which is a lot further from you than Boston. But, you are more than welcome to come out and stay with me :O)

xoxo,
Laya