Hi,
I'm seeking advice on what to expect and questions to ask as my mom faces upcoming surgery to remove a 3cm tumor (maybe 2, I don't have facts straight) from her cerebellum. The neurologist I spoke with briefly will be referring her to a larger hospital, to which she will be transferred today or soon.
I found this forum to be the MOST valuable support in 2011-2012 when my mom was diagnosed with Stage3B Lung cancer (adenocarcinoma). Gaining so much advice from this forum, she successfully went through removal of the lower lobe of her lung at UVA, chemotherapy (Altima), and radiation. The surgery was complicated and nicked the recurrent laryngeal nerve, which partially paralyzed her vocal cord, but reinnervation surgery helped. She recovered from treatments very well. Radiation was her big fear, and damage from that has caused substantial scarring that continues to accumulate and is problematic.
The intervening years have been full of vigor and health, gardening, and a very successful shoulder replacement.
This past year she had a breast cancer diagnosis (stage I ductile, very small) that was fully resectable via lumpectomy with seemingly effortless recovery and started chemo that would remove estrogen from her system. The breast cancer was determined to be separate from her lung cancer. It was found because she received scans twice a year.
She had a clear brain MRI at the end of 2016. Nausea and dizziness (that she attributed to the chemo pills) became so bad at Christmas that she couldn't eat and was bedridden. After the second hospitalization, the doctors ran an MRI and discovered the brain tumor(s). Via blood tests, they think it is related to lung cancer.
What should I be asking about the surgery? Is it OK for her to receive treatment at UVA, or should we try to get into Duke for treatment? Mom is very fearful of brain radiation treatment. What are the options?
Thanks for your help and support!
Reply # - January 14, 2018, 08:31 AM
Hi palmyramom,
Hi palmyramom,
I'm sorry to hear of your mom's latest troubles. In most cases, the discovery of a new tumor seven years after a previous diagnosis tends to indicate a new cancer, as the chance of recurrence after that interval is low (although not zero). Dr. West wrote about this subject here.
Possibilities other than a lung cancer recurrence or new lung cancer include metastasis from the breast cancer, a primary brain tumor or something that is not cancer at all. Although the treatment options include surgery and/or radiation, surgical resection of the brain lesion will allow the doctors to test the tissue and determine just what it is. Radiation oncologist Dr. Loiselle discusses treatment for solitary brain metastases here.
Both UVA and Duke have good lung cancer programs (one of our contributing experts, Dr. Craig L . Slingluff, practices there), and each should have experienced and highly capable surgeons and radiation oncologists.
Best wishes for successful treatment.
JimC
Forum moderator
Reply # - January 17, 2018, 03:36 PM
Thanks for the reply! The
Thanks for the reply! The brain met pathology shows the met is related to mom’s lung cancer, so although rare, it guess it does happen. I wonder if the fact that her lung cancer oncologist left UVA two years after her surgery, and her team did not connect mom with a new one, had an effect. She just followed up with the radiation oncologist and did he did not recommend that she take any maintenance chemo drugs.
Mom is on the successful side of the outcome of neurosurgery. They removed the single tumor and the MRI looks excellent. They got everything visible. Her pre-surgery symptoms have abated and she is home. Still a bit dizzy and tired and with a sore neck, but in good health and good spirits. (Just 2 days in the hospital after surgery.)
Next is SRS treatment. My question: which is better - gamma knife done in theee sessions that is less precise but more comfortable; or gamma knife in one day with a halo device that is more precise but more involved (need anesthesia with the screws in the halo). The surgeon didn’t see anything in the position of the tumor that would make him recommend one over the other. The radiation oncologist left the choice to my mom.
With the radiation on her lung tumor she formed massive amounts of scar tissue. She always forms excessive scar tissue from procedures. The radiation also damaged healthy lung more than expected. That damage became more evident over time. She wants to avoid problems from brain radiation ( necrosis, edema, cognitive or motor impairment, etc). She’s willing to do the method that will do the most good with the least harm. UVA has the Gamma Knife Icon machine, which I understand is quite advanced.
We meet with the doctor on January 30. What should we be looking into and what questions should we consider in making this choice??
Thanks ( so grateful for where we are right now).
Michele
Reply # - January 17, 2018, 04:10 PM
Hi Michele,
Hi Michele,
From everything you have said, the main question is choosing a procedure that will provide the maximum benefit while keeping damage to healthy tissue to a minimum. If the radiation oncologist doesn't have a preference between the two procedures, then it's safe to assume that he/she feels that either would be just as effective, but that the multiple days of treatment compensate for the reduced precision of the first procedure.
If those assumptions are verified by the doctor, I think the main line of questioning for her doctor centers on which procedure is less likely to damage healthy tissue. That being said, brain radiation is very precise, and the amount of radiation passing through any given area of healthy tissue is very small. Multiple beams converge at the site of the tumor, where the cumulative radiation dose is highest.
Wishing your mom good results from her therapy.
JimC
Forum moderator