Still a candidate for surgery? - 1261452

I have recently been diagnosed with BAC in my lrl. So far I have had a brain Petscan,MRI, Lung Function test, a biopsy of the lrl which confirmed my cancer. I have multiple nodules on both of my lungs that have been followed by my pulmonogosit for the past 2 1/2 yrs with no growth until recently. All my nodules in my lungs are smaller than 1 centimeter except for the recent biopsy which was 2.2cm and grew in 8 months to 2.9cm. My surgeon that my pulmonogist has sent me to has ordered another biopsy of one of the larger (still smaller than a centimeter) in my ull. My question is if that nodule turns out to be cancer as well will I still be a candidate for surgery to remove the growing nodule in my lrl? I assume then it will be multifocal cancer and I am sure they are going to test for the mutant genes too. Would this make me stage lV? and inoperable?
I am just trying to understand all of this. I was completely blindsided as I have no symptoms. I am 56 yrs. old and an ex-smoker. I stopped smoking 30 yrs ago.
Thank you to anyone who can help me try to understand or at least help me ask all the right questions.

Unfortunately if cancer is found to be in both lobes it would be considered stage IV those surgery and radiation would only be used for palliative reasons. Dr. Weiss describes it this way,
"Extensive Stage disease: The cancer cannot be encompassed within a single radiation field. It is not typically curable, but is treatable, with the goals of therapy being better quality of life and longer duration of life." http://cancergrace.org/lung/2010/04/05/an-introduction-to-lung-cancer/
Note the links within and after the post provide additional information. Am important aspect of your post is that you may have BAC which can be very indolent meaning many people live a long time without much intervention.

I hope this helps get you started,
Janine

It is sometimes reasonable to consider a right lower lobe (RLL) cancer and the left upper lobe (LUL) cancer to be two separate primary cancers.
In this setting, we may give patients the benefit of the doubt and treat them as if they are two separate small cancers.
For example, patients may receive a definitive lobectomy for the dominant growing lesion, and monitor the other lesion. If the other lesion is positive for cancer, or shows signs of growing, then it can get stereotactic radiation or wedge resection at a later date. It depends on the context.

Thank you Webmaster Mark, catdander and Dr. Creelan. I am still trying to wrap my head around this whole thing and appreciate your time and advice. My biopsy is scheduled for Monday to find out if the other lung has cancer as well. Hopefully all will prove that the node is benign and I can have surgery to remove the cancer in my LRL and we can keep a watch on the rest.

Hopefully all will move forward as planned and all cancer can be removed.

Good luck,
Janine

Since it's already confirmed this is BAC and says there are multiples nodules in both lungs, isn't it already stage IV and why would surgery still be an option? Sorry, but still like to learn the differences with LC and treatment options. Take care, Judy

Had my biopsy yesterday of my ULL. Now the waiting game begins on whether it is cancer or not. I have multiple nodules in both lungs as I stated above. I guess I will find out my staging and what treatment options are available for me soon. The waiting is the worst.

One step at a time. I think the important thing is to know that there will be a good plan for whatever the outcome of the biopsy is.

Good luck.

-Dr. West

Okay got the call from the surgeon today that the biopsy of the ULL was also diagnosed with BAC, so I am considered stage lV multifocoal BAC and surgery will not be an option at this time. They are sending me to an oncologist and the surgeon said he thinks the treatment will be Chemo. They are testing both of my biopsies for mutant genes in the meantime. I can't say I am surprised at the outcome because I was kind of expecting it. I only hope that the treatment that is in store for me will let me live my life with quality for whatever time I have left on this earth. I will be seeking a second opinion just to make sure all that is being done is the best for me. I know life will never be the same for me again. Both of my parents died of lung cancer my mother about 30 yrs ago and we never thought to ask questions but I am assuming she had small cell as she was a very heavy smoker. My father passed away about 3 yrs ago he was 90 had adenocarcinoma. So for me this has become the self fulfilling prophecy. I always knew in my mind this was going to be my fate as well. Sorry for being Debbie Downer but I am in the middle of a pity party right now.

I'm so sorry. I can certainly see why you're debbie downer and not such a happy camper today. It's very possible that you can keep the cancer in check for a very long time. Maybe until you're 90.

I will keep my hopes high and you will join me too when you can.
We'll be here to move through this with you.
Janine

Thank you Janine for your encouraging words. They are greatly appreciated!!!!

Marian

If you read much on the GRACE site, you'll know that I don't tend to glad hand with stories of rainbows and unicorns for everyone. I try to be realistic about the positive and the negative things we might anticipate.

With that context I'll just say that there is a huge variability in how lung cancer can behave -- very aggressively in some, and far more on the indolent side of the spectrum in others. Because of that, I wouldn't paint your cancer with the same brush as those of your parents'. It will be very important to see how quickly or slowly the cancer progresses independent of treatment, and then also how it responds to treatment. But if you have a slow-growing cancer and/or it's very responsive to treatment, you could do extremely well for a very long time.

I'll invite you to check out some of the boat load of links on this website that I've written about management of BAC over the past several years.

Good luck.

-Dr. West

Update on my quest to get the right treatment. Yesterday I went to see an oncologist who was so very nice. She also told me that she, my pulmonogist, surgeon and I don't know who else was going to be reviewing my case at a tumor board today. The consensus was to do surgery of the lrl and then closely watch me to see if anything else grows. I think I would rather have done than have to go on chemo or radiation right now. I was hoping that Dr. Creelan (who already said this is possible) and Dr. West could give an opinion if they think this is the way to go.
Thank you.

Marian

Hi Marian,

Essentially what Dr. Creelan said is that surgically removing the dominant lesion while watching the smaller one is sometimes a good option. That "sometimes" is what makes it impossible for the GRACE faculty to tell you whether your case is one in which it is the proper course of action. Your doctors have access to all of your medical information, including scans, and have had an opportunity to examine you. As he said, it depends on the context.

Good luck with the treatment path you choose.

JimC
Forum moderator

I really can't comment on your specific case, not being directly involved, but here is a link that really describes my view on the matter, which really should apply to your situation:

http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

Good luck.

-Dr. West

Thank you Dr. West! Information is what I am seeking in order to make an intelligent decision.