Today we learned that the mass is malignant from 12/2/13 CT guided biopsy. Pathologist needed extra time to study because the sample had a lot of nonviable cells. Pulmonologist reiterated that this is a surgically curable case however instead of removing 2 lobes the entire lung may need to be removed because of the tumor location and cannot exactly tell if it crosses the fissure. This will be determined when they get inside as will collection of lymph node biopsies.
In response to my previous email, Dr. West stated that surgery is favored if patient is a good candidate. My husband is apparently a good candidate (PFT shows moderate COPD with FEV1 of 2.7 liters, 65% ratio, normal TLC, DLCO of 42% correction for volumes; no health issues other than TBI, NPH and <5 cm aortic root aneurysm). The team wants to operate as soon as next week because it is lung cancer, located near lymph nodes and no evidence of mets - so let's go in and get it out.
I understand that in the grand scheme of things, this diagnosis portends a favorable outcome with respect to prolonging life but what about quality of life especially if a mass is found in the left lung in the future. I accept that the surgical option is the best course but would it be advisable to postpone for 2 weeks or longer to get a second opinion about the surgical approach or locate a CT facility that has the capability to more clearly establish the location of the mass to rule out a total lung removal? Or, is it something that can only be determined once the surgeons get inside?
Thank you so much for listening and any guidance offered.
Best regards,
Lisa
67 yo husband, smoker; 4/13 Pre-sx CXRs clear. 11/8/13 CT for aortic root aneurysm shows lobular mass in rt posterior hilum, 3.5x2.4 cm straddling major fissure,11/21/13 PET/CT - rt posterior hilar/perihilar mass extending into lower lobe superior segment, SUV8.7 & proximal gastric mucosa appears thick, area not well expanded SUV8. Bronch nondx; CTGB,
Reply # - December 5, 2013, 12:31 PM
Reply To: limited stage adenocarcinoma TTF1 + NSCLC perihilar.
Based on your description, it seems reasonable to proceed with surgery. There's no way to be 100% sure of the extent of disease based purely on any imaging. The 'proof is in the pudding', when the surgeon actually performs the operation and sees the extent of cancer. Most surgeons will do a lobectomy or bilobectomy if it is feasible, but in many cases that is not possible.
If you have already had a PET-CT and CT scan, I doubt many other facilities will have special studies that will add much to what has already been done. I don't think pneumonectomy is something to be feared, providing it is used appropriately. If you read on Inspire forum, you'll see the story of a young lung cancer survivor who won a long-distance race despite having a pneumonectomy.
Reply # - December 5, 2013, 01:39 PM
Reply To: limited stage adenocarcinoma TTF1 + NSCLC perihilar.
Dear Dr. Creelan,
Thank you for your rapid response. I feel very fortunate to have found cancer grace.
Best regards
Lisa