Hilar Lymph Node Positive on Pet Scan - 1251794

koal
Posts:29

Had a 1b adenocarcenoma Cyberkinfed 18 months ago. No other treatment at that time. Clean scans until two weeks ago which showed a Hilar Lymph Node with a suv of 4.0 suspicious for cancer.
Recommendation by the radiation oncologist was to radiate the area and do chemo at the same time. Sent me to a medical oncologist who said that he did not believe that I needed chemo now, to wait and take chemo should it come back again.
From what I have seen on sites is that most people do both in cases like this.

What are your thoughts?

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Reply # - December 24, 2012, 04:49 PM

Dr West
Posts: 4735

There's no hard rules, as this is a situation that falls in between our well studied situations, but in such cases, I have favored concurrent chemo/radiation in patients who have a local or loco-regional recurrence after surgery and have no evidence of distant metastatic spread. Radiation alone would have a real potential to be curative, but I think many oncologists would consider chemotherapy, either administered concurrently or sequentially with radiation, could increase the potential for a very good long term outcome.

-Dr. West

Reply # - December 25, 2012, 01:28 PM

Dr West
Posts: 4735

We often do a biopsy in the setting of a first suspected recurrence, if there's room for doubt about the diagnosis, so yes, that's my typical approach, especially if there's been a long interval between initial treatment and the new finding.

As for staging, I don't see enough information on her post to comment on that, and I'd really need to defer to the people who are actually reviewing the films and know her case.

-Dr. West

Reply # - December 25, 2012, 01:56 PM

koal
Posts: 29

The PET also showed a new 7mm nodule (no suv uptake) in the upper lower lobe.
Isn't there a problem both with false positives in a biopsy of this type of lymph node as well as complications in trying to take a biopsy of it? Simply treating it being the prudent thing to do?

Reply # - December 25, 2012, 09:22 PM

Dr West
Posts: 4735

I don't think there's much concern about a false positive result. If the biopsy shows a lung cancer, that's what it is. The main concern would be a false negative result: if it doesn't show a cancer, it could be that there isn't a cancer, or it could be that the biopsy didn't sample the cancer. And there could be complications from a biopsy, but that's not very likely, and probably no more likely than the risk of treating a lymph node as cancer but that is actually enlarged and PET avid because it's just involved with an infection or inflammation. But this is all debatable, which is why I say that if there's a 99% probability that you know what the finding will represent, not everyone would favor the biopsy to raise it to 100% vs. just treating.

-Dr. West

Reply # - March 2, 2013, 07:08 PM

koal
Posts: 29

Ok, the lymph node and surrounding area has been radiated. Here is my current problem.
The first medical oncologist I went to thought I should just get radiation that I did not need chemo.
The 2nd medical oncologist I went to thought I needed chemo but to stop the radiation for 7 days prior to getting the first chemo treatment.
The 3rd medical oncologist I went to put me on Carboplatin, Taxol & Avistan. I refused the Avistan at my 3rd session (side effects too frightening) but his plan was to keep me on Avistan "forever". Don't know the total number of infusions planned.
I'm not looking for the best deal but three doctors and three different answers so far. What do you suggest I do?

Reply # - March 2, 2013, 10:06 PM

Dr West
Posts: 4735

I'm sorry, but this is really in the realm of providing a medical recommendation to someone who isn't our patient -- and that's something we're not permitted to do. You can read through the content on the site to help you decide among the different options presented to you, but I can only give medical advice to people I'm seeing in my own clinic.

-Dr. West

Reply # - March 23, 2013, 07:43 PM

koal
Posts: 29

I initially referred to this as a recurrence but the more I read the more unsure I am. From my lower left lobe to a hilar lymph node on the same side, is this a metastasis or a recurrence?
Is this still considered curable? I also see several conflicting writings some say curable and some saying not (regardless of recurrence or metastasis).
Thank you for your expertise.

Reply # - March 23, 2013, 11:42 PM

Dr West
Posts: 4735

You're right that it's a tough one to interpret. If it's just a hilar node from the same area, it's a local recurrence, and it may be possible to treat for cure. The key is whether it has spread to other areas. If not, cure is still a realistic possibility.

-Dr. West

Reply # - April 11, 2013, 09:51 PM

koal
Posts: 29

Completed 33 radiation treatments in February, completed 4 rounds of Carboplatin and Taxol 4 weeks ago. PET scan yesterday shows NED. Thank you Dr. West for your support.

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