Adrenal Mass Change with Chemo - 1263141

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Adrenal Mass Change with Chemo - 1263141

Hi – I’m glad to have found this site today – there is so much information I’m finding useful to read. I wished I had started looking up all this info online earlier Have left it to my oncologist to make the calls at this stage, but still very thankful for finding this site so I can learn more in the meantime.
A little about me:
60 year old female. Diagnosed July 2013 with stage IIB NSCLC Adenocarcinoma. Surgery to remove (5cm tumor) left lower lung in August – no lymph node involvement, clear margins.
16 weekly treatments of Cisplatin/Vinorelbine completed December 2013
CT Scans done in July 2013 & Dec 2013.
Masses visible on adrenals gland in July Left 5.2cm x 2.4 cm in Dec 4.4cm x 2.3 cm
Right 4.4cm x 2.3cm in Dec 3.9cm x 2.3 cm
My oncologist has taken a wait & see approach to these adrenal masses, is this the recommended protocol? The change after chemo has me concerned.
I am cautiously optimistic; the tumor was found when doing a CT for kidney stones, as this was discovered relatively early. I don’t want to have the adrenal masses left untreated, if this will endanger my long term outcome.

Reply To: Adrenal Mass Change with Chemo

Hello and welcome to Grace. I'm glad you've found us and so sorry you've got these adrenal masses to worry about.

It seems that the masses were there before surgery so I'll take a guess and say they didn't show uptake in SUV from a PET scan? I say that because normally surgery is reserved as curative treatment and tests are done beforehand to make as clear an understanding as possible that there is no other cancer (metastases).

If you will let us know what type of work up was done for surgery and what the surgeons and other doctors thought about the masses, I'll ask a doctor to comment further.

And yes a wait and see approach is often used when there is no immediate concern of cancer becoming too advanced for treatment.

Hope to hear back from you soon,

Reply To: Adrenal Mass Change with Chemo

Thank you for responding so quickly. They did do a PET scan prior to surgery, but I don't have the results, so I am going to assume that they didn't show an uptake in SUV ( not sure what that is). Lung biopsy and lung function done prior to surgery as well.

Dr West
Reply To: Adrenal Mass Change with Chemo

SUV is "standard uptake value", basically a numeric measure of metabolic activity. The size of the adrenal nodules is concerning, though it's not uncommon to have benign adrenal nodules/masses (basically the same thing, but a nodule graduates to a mass at a certain size, generally 3 cm). A PET scan would be critical before surgery to clarify the probability that those adrenal masses are benign vs. metastatic spread. If there were any uptake on the PET that put the adrenal lesions into an ambiguous range, many centers would favor a biopsy before doing a surgery for what should be recognized as metastatic disease.

At this point, I think the bigger concern is that they are behaving like metastatic disease and that the surgery was really futile when the cancer was metastatic from the beginning. Knowing that you'll be followed regularly, the risk of leaving them "untreated" for a bit of time is actually quite small; even with metastatic disease, most people don't actually need to be on active cancer treatment every week of their lives. It's always reasonable to take breaks, even if someone is known to have metastatic disease.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

Reply To: Adrenal Mass Change with Chemo

When you refer to 'the surgery', do you mean the lung surgery?

Reply To: Adrenal Mass Change with Chemo

Yes the lung surgery. You can read here about lung cancer basics, you can move down to the staging portion where staging and treatment standards for each is described.