Latest scan results - 1251564

tinkeast
Posts:12

Often read, always sending good thoughts to you all, rarely posted, but wanted to share the latest scan results for my husband (two years into a Stage 4 NSLC journey, previously treated in 2010 with carboplat/taxol, radiation to lung and adrenal, avastin in 2011, 4 spots on brain treated with knife, 2nd round of 12 radiation treatments to adrenal tumor in November). We go back to see our oncologist in January to decide if he's up to more chemo. And I should add we love and adore our oncologist. Thanks in advance for any thoughts.

CT Scan Impression (changes from last scan 10/1/12)
1. Slight interval increase in size of large left adrenal mass. Mass legion abuts the spleen.
2. New satellite lesion left kidney 3.1 cm.
3. Linear consolidation left upper lob adjacent to major fissure, new from pior exam, which may represent atelectasis.
4. Small left pleural effusion and small pericardial effusion, also new.
5. Stable right hilar/right mainstem bronchus lymph node.

He also had a brain MRI which showed no issues.

Thanks,
Tinkeast

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Reply # - December 19, 2012, 07:42 AM

tinkeast
Posts: 12

ps., here are the details on the scan result

Chest: There is a small right pericardial effusion, minimally increased from prior exam (10/1/12). There is a small left pleural effusion, which is new from prior exam. No central pulmonary embolus. Infiltrative, partially calcified soft tissue anterior to the right mainstem bronchus region of the right hilum is unchanged when accounting for differences in technique and slice selection. Calcified left hilar lymph node. No axillary lymphadenopathy, supraclavicular lymphadenopathy, or internal mammary lymphadenopathy.

Emphysematous changes are seen. Scarring & volume loss seen within the left upper lobe adjacent to major fissure, increased from prior.

Upper abdomen: Wedge-shaped hypodense region of falciform ligament, more conspicuous on current exam likely secondary to bolus timing.
There is a large mass superior to the left kidney that measures 6.7 9.0 cm in greatest transverse dimension, previously 6.5 x 9.2 cm. There is faint rim enhancement. The mass extends inferiorly and causes mass effect on the left renal vein. In craniocaudal dimension it measures 9.3 cm, previously 8.8 cm. There is a second adjacent lesion more inferiorly that abuts the anterior interpolar region, which is new from prior exam. It measures 2.8 by 2.1 by 3.1 cm. There is increased perinephric stranding and thickening of Gerota's fascia when compared to the prior exam.

Reply # - December 19, 2012, 02:32 PM

cards7up
Posts: 636

Does he have adenocarcinoma? If yes, was his tissue tested for mutations? I would hope this latest scan was discussed with him and then he was told to take this time off and decide if he wants to try more chemo. Take care, Judy

Reply # - December 19, 2012, 05:11 PM

tinkeast
Posts: 12

Thanks Judy. Yes that is diagnosis sorry. They did the mutation testing and it didn't result in any extra options. We were together with the oncologist yesterday to hear the news and that's what we agreed to take the holidays and then reconnect with our oncologist in the new year. I could have also mentioned he had bleeding into his adrenal gland from the large tumor in Oct and so he was in the hospital for two and a half weeks in two admits working to get his pain under control and as part of that they also did a celiac (sp?) block.

Reply # - December 19, 2012, 07:25 PM

cards7up
Posts: 636

I'm sorry to hear this and what he's went through in October, it sounds painful. What about a clinical trial?
How is he feeling overall? Would you mind providing his age? Wishing you the best.
Take care, Judy

Reply # - December 19, 2012, 09:15 PM

Dr West
Posts: 4735

It sounds like the progression of the adrenal mass and left kidney lesion do represent enough progression that a change in treatment would be at least a strong consideration. In the setting of multiple areas of known metastatic disease and at least a couple of areas of progression, I think starting a new systemic therapy is a far more appealing treatment approach than attacking it with another round of radiation that won't do anything to control the more systemic disease process.

Good luck.

-Dr. West

Reply # - December 20, 2012, 02:29 AM

tinkeast
Posts: 12

Thank you Judy and Dr. West. He just had his 62nd birthday. He was on a trial briefly this summer but the cancer grew thru it so he was dropped and then had the big bleeding event so we are just now at the point of being able to start another treatment. The discussion for Jan is try another round of chemo or not - oncologist suggested with this progression it was a couple month benefit vs the side effects which would be more challenging this time given his status (low weight, reduced activity level etc). Earlier decisions were easier than this one. Thank you for helping us think this thru.

Reply # - December 20, 2012, 09:22 AM

catdander
Posts:

I'm so sorry your husband is feeling this bad. I hope he was sent off for the holidays with ample options for pain control. No one here especially me knows where your husband stands by way of whether he should have more treatment in January or move to hospice care. There are so many "it depends" in cancer care, everyone is an individual case.
I'd like for you to know as much as you need to about the hospice care option. So many places, the US is notorious, don't understand the benefit of hospice care. For one thing you can come off of hospice care if you decide to go back on treatment.
You need to find the right "fit". I've not had experience so not sure of specifics but I assume I'd want what I read about on Grace and will look for that. (birmingham has 2 options I think)
They take care of all your needs in the home or will point you in the right direction.
Dr. West discusses hospice here, http://cancergrace.org/cancer-treatments/2012/08/12/hospice-is-help/

And of course there are other systemic therapy options. Tarceva is a pill that targets the egfr mutation and is found to be a good 2nd line treatment for those without the mutation. It is considered a good option for those who are frail and doesn't lower blood counts like standard chemos can. Alimta is a standard chemo for non squamous like your husband. Many people do very well on it. Taxotere is another chemo that has shown good efficacy but maybe has a bit harsher toxicity profile than the other 2. Here is a discussion on 2nd line treatment I really like but can only find the pdf file, let me know if you can't open it. http://cancergrace.org/lung/files/2009/12/brahmer-second-line-therapy-t…

Hope this helps,
Janine

Reply # - December 20, 2012, 09:43 AM

tinkeast
Posts: 12

Thank you Janine. I appreciate all the time and thought you and others have taken to help us with information and support. We have the pain under control thank goodness - so all is good there. That made the scan news all the harder because he was finally starting to be able to just get thru the day without fear of hurting eclipsing all other thought. He had a celiac block (spelling?), and is on oxycontin, hydormorphone and gapobentin (spelling again). The trial he was on this summer was Alimta and his adrenal tumor grew steadily thru it so it was stopped. Taxotere is what he was going to go on next before his big bleeding event and that is what our oncologist recommended if he does decide on treatment. I will ask about Tarceva.

I have read every post ever written on this site including all the great posts by Dr West on hospice and showed several of his posts to the doctors I encountered in my husband's two inpatient experiences trying to get his pain under control. I went thru this journey with my dad many years ago and didn't get into hospice soon enough (thinking about it in retrospect) but personally saw the huge benefit... I need to do the homework for the new area we are in to find the right one. Just stressed to figure out the right next step, wanting him comfortable as long as possible.

Thank you all....

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