Benefit of surgery to treat BAC/AIS - 1253625

Sun, 02/10/2013 - 09:43

I am faced with the question of surgery for 3 lesions (GGO) now thought (after CT 3 scans) to be BAC now called AIS. If pathology after surgery reveals BAC/AIS, and the treatment is to do nothing and continue to scan, is there benefit in taking the lesions out vs. the risk of the surgery itself? Is the knowledge of the exact diagnosis needed here? Or is the benefit of knowing what they are worth the risk because the lesions (or cells) could actually be something else (worse)? I am a healthy, non-smoking 50 year-old woman. This was found on a CT scan of my abdomen by accident.

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catdander

Hello rubydoo, Welcome to Grace. Not the place you want to need to be but certainly the best place on the web to get a good understanding for the tough decisions you're facing.
First of all, I'm very sorry you're in this position.

It sounds like you've not had a pathologic diagnosis (dx), which is the final step in having a cancer dx. A needle biopsy is usually the procedure of choice and not a thoracotomy. Like you suspect, it's a big deal surgery and not to be taken lightly.

Have you read up on work up to dx? or the latest on BAC from Dr. West? It sounds like maybe you have. But I'll link you to some of the literature just in case. An FYI about our search feature. It's excellent though you may need to log off first depending on the type of browser you use.

Another thought is do the doctors believe that if it's cancer they will be able to cure with surgery. That would be the only reason for surgery. You're right that watching and doing as little as possible is really the way to go for as long as possible.

With that said, I'll leave you with links and I'll ask a doctor to comment on your questions. You should hear back within the day.

All the best,
Janine
forum moderator

On work up and staging, http://cancergrace.org/lung/2010/05/12/general-work-up-and-staging-of-l…

On BAC, http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/
http://cancergrace.org/lung/2011/11/29/bac-today/
http://cancergrace.org/lung/2010/03/02/watching-ggos-over-time/

Note the further reading options at the end of the blog/posts.

Dr West

The second link that Janine provided really summarizes my perspective on exactly this situation. If there are a few minimally changing nodules, there is no clear incentive to doing surgery at all, and certainly not earlier vs. later. Moreover, I'd say that the exact diagnosis under the microscope is less important than what the nodules are doing or not doing over time: if they aren't changing at any appreciable rate, doing surgery just for the sake of removing stable nodules isn't of any clear value. The potential danger is that one or more of these will become more solid and faster growing over time, but that's the kind of thing that you can watch for with repeat scans every 6-12 months. The dubious value of intervening just for the sake of intervening needs to be weighed against the permanent loss of lung tissue from surgery and the small but real risks of a serious complication from the surgery itself, as well as the shorter term challenges such as pain, etc.

Good luck.

-Dr. West