recurrence after lung lobectomy - 1270780

Hi muge,

Unfortunately this could be a recurrence. Normally it wouldn't be considered such a big deal to worry about but the size and since she just had nsclc in that lung it does make it more possible than if neither were true. That doesn't mean it's not something else. A biopsy is the only way to know for sure.

I sincerely hope it's something else and best of luck to your sister.

Janine

P.S. I very sorry for the delay in answering. I'll be faster next time if you have more questions.

Hi my older Sister had small cell 2.5 years ago. They removed her upper lobe and she did chemotherapy after. Shortly after another nodule showed up in middle lobe. Surgeon went in and did a wedge resection. The testing came back that it was infection thank God! So stay positive there is a chance it could not be cancer returning.

THANK YOU TAHOE! It's so important to hear the stories with happy endings. I'm sure somewhere you've read that most people who've smoked have lung nodules so best to you and congrats to your sis.

Janine

Dr. West:
Having read your discussion of the “precocious metastasis,” my wife and I request your advice regarding her situation: she had her right lung upper lobe removed in June of 2011 due to adenocarcinoma. This NSCLC was classified as Stage IB because the CA had infiltrated the pleura. For four years all of her scans (CT, MRI and PET) came out negative until 3 months ago when a single 4 – 5 mm growth was seen on MRI in the left frontal lobe of her brain. The radiology report stated “suspicious of metastasis,” but the neuro-oncologist said it was too small to either measure accurately or determine whether it was a met. The same result came back 2 months later (now 1 month ago) but we also learned at that time that a radiologist had reported a “shadow” in the same location on a 9-months prior MRI. As you can imagine, these developments have been very unsettling and frightening for both of us, especially after a 4-year period of clean scans, so we’re requesting your opinion as to whether or not to treat at this time. If yes, how, and if no, why not? We wonder, if Jimmy Carter was diagnosed and is being treated for brain lesions as small as 2mm, albeit that they are not lung mets, why would my wife’s doctors and radiologists be so less certain of what she has? Our major questions: What is the standard of care and; what are the treatment approaches that should be considered?
Some important background information is that my wife participated in the GSK MAGE A3 trial and likely received the active vaccine, as she developed significant side effects and was therefore taken out of the study after the 8th injection, rather than receiving the full course of 13. She also has a meningioma that we are told is virtually insignificant and has not changed over many years. (My wife’s sister also has a meningioma that grew very large over the course of many years and has left her quite disabled.)
Michael

Hi mstel,

I'm very sorry your wife is going through this. I can imagine what a scare it is for you as well. Waiting for the other shoe to drop has once again taken up residence in my psyche.

Brain mets are a common harbor for lung cancer however that doesn't mean this is cancer, especially since it's been 4 years and your wife has comorbidities. However every case is individual and type of care is given individually. That's why our faculty wouldn't be able to provide recommendation to your wife's specific case or JC's. A couple of differences in JC and your wife is JC is in the process of being treated with other metastatic spots, he didn't have a primary diagnosis prior to biopsy of brain met so there was reason to suspect cancer and to look further at what type of cancer he had and the brain tissue answered that question.

In the links that follow the first one explains the types of treatment given to solitary brain met. Surgery is often done to confirm cancer if it's in doubt. Stereo tactic radiation (a single dose of radiation to just the one spot) is given to one or very few brain mets. And whole brain radiation (WBR) can be given but usually when there is worry about more mets to come.

It's a difficult decision process especially if there are no symptoms. One alternetive that isn't mentioned in the first post is to wait and see. To do this there must be close observation and a plan of action to put into place if symptoms arise. A good alternative if it's what the patient wants. If waiting is worse that doing something then that's good enough reason to move forward with a plan.

The first post following is probably the best place to start. It explains the importance of being sure it's cancer,

http://cancergrace.org/radiation/2011/08/17/treatment-for-solitary-brai…

The first couple of these videos should also be helpful. http://cancergrace.org/lung/category/lung-cancer/general-lung-cancer-is…

Another good option is to get a second opinion. It's never a bad idea to get another head or 2 involved. Dr. Weiss has written an excellent post on the subject and I think an important read for all of us. Since our faculty are highly regarded specialists in their fields they see many second opinions.

http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…

I hope this will give you and her food for thought. Please let us know what further questions you have.

Janine

Dear Janine,
Thank you very much for your concern, your suggestions and the links. I'll reply further once I've had a chance to review everything. Was the description of the 53 y/o man with stage 3 squam your husband? If so, we are even more indebted to you for finding in your heart to help us.
mstel/Michael