86 year old - active lung nodule but surgeon won't biopsy - radiation treaments? - 1289640

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ladyhlh
86 year old - active lung nodule but surgeon won't biopsy - radiation treaments? - 1289640

My 86 year old frail mother had a PET scan because of a thyroid nodule, when they did the scan the thyroid nodule was inactive but they found a very active 3 cm lung nodule. She went to a lung surgeon who said that because of the location of the nodule he would have to remove 1/2 her lung to even do a biopsy and he doesn't recommend it because she would then be on oxegyn for life because she has a bad absorption rate. He is trying to set-up an appointment with a radiation oncologist but the scheduling person said it might be denied by her insurance and/or the radiation oncologist because of the lack of biopsy. My mom has multiple other medical issues, I'm not even sure of all of them but I know that she has hypertension, delayed gastric emptying, mild diabetes, completely collapsed arches and arthritis. She also can barely walk now even with a walker because her one knee keeps giving out and it really needs to be replaced. I just wonder about doing radiation oncology on someone who is not in good health at all. My mom wants to do the treatments but my sister and I aren't sure it makes sense. Also my sister and I live in other states, she is in an assisted living facility with only our useless alcoholic brother as local family support.

JimC
Hi ladyhlh,

Hi ladyhlh,

Welcome to GRACE. I am so sorry to hear of your mother's situation. Decision-making can be very difficult in the case of an elderly, frail person, as the side effects of either surgery or radiation may outweigh the potential benefit.

I think the first question I'd want to ask is whether the appearance of the nodule makes this highly suspicious for lung cancer. If she hasn't already seen a pulmonologist, a consultation may be in order. Depending on the characteristics of the nodule as seen on the scan, there may be the possibility that it represent an infection or inflammation with another cause. Given how difficult surgery or radiation may be for your mother, a wait-and-see approach may be in order, possibly with a course of antibiotics to see if that helps. A cancerous nodule would be more likely to grow over time.

Another possibility would be to get a second opinion from another dedicate thoracic surgeon, preferably at a research hospital, to see if you get a different opinion about the feasibility of a biopsy.. Also, although it's true that doctors (and insurers) don't like to proceed with surgery or radiation in the absence of a biopsy confirming cancer, at times there is no other choice, and it can't hurt to check out all options by consulting with the radiation oncologist.

I hope that you can have some good, frank discussions with your mother's medical team, weighing the benefits and risks. Of course, the final decision is hers assuming she can make it in an informed manner, and some patients with a strong will can overcome significant odds.

Please keep us updated and let us know if you have more questions.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

ladyhlh
My mother went to see the

My mother went to see the head of thoracic surgery at a local hospital yesterday with my sister who was in our hometown for the holidays. He didn't think a biopsy was feasible because the location of the nodule meant he would have to remove 1/2 her lung, it is also near an artery and the windpipe. He was the one who referred our mom to a radiation oncologist, so he must have thought that the PET scan of the nodule was indicative of cancer even minus a biopsy. He did mention the possibility of waiting and seeing what happens with the nodule over the course of a few months as a possible option. If the radiation oncology appointment is approved, I will be going down to stay with my mom and to take her to the appointment. My mom doesn't have dementia but her reasoning skills are definitely on the decline. If the radiation oncologist thinks that treatment would make sense for my mom, I will have to make sure that he outlines all the possible side effects.

JimC
Yes, I agree that a complete

Yes, I agree that a complete discussion, including details of what post-radiation life might be like, as well as the possibility that this isn't cancer, will be essential in order to allow your mom to make an informed choice.

As far as the appearance of the nodule, if it was a straight PET scan (not a combination PET/CT), it may be harder to judge what the nodule looks like; a CT is much better at showing its shape and other characteristics. This subject was discussed by Dr. West in this post. Perhaps you can discuss these issues with the radiation oncologist.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>