Hello everyone,
My wife has been diagnosed with an adenocarcinoma in her right lung. It is about 6 cm in diameter. She also has an adenocarcinoma in her left lung that is about 1.7 cm. Both are located in the apex of the lung. PET scans showed no nodal involvement and Brain MRI was clean. Oncologist feels it is 2 primary tumors vs metastatic due to lack of nodal involvement. The tumor in the right lung is large and is against the chest wall. We have just completed week 4 of a 6 week program of chemo (carbo/Taxol) once per week and radiation daily. The symptoms of pain in her right shoulder have greatly improved. The plan is to complete the neoadjuvant therapy, then do resection on the right lung (lobectomy). Then we will come back early next year and decide what to do about the left lung tumor which is smaller and less active. The PET SUV on the right lung was a 13.9.
My questions:
1. What is the probability that the two tumors could be metastatic vs. two primaries?
2. What is the probability of the pleural involvement on the right lung becoming an issue for full resection?
3. How successful are resections of two bilateral primary tumors historically?
Thanks so much for all of the help we have already gotten from this wonderful site and bless all of you.
Jim
Reply # - September 26, 2015, 08:02 AM
Hi Jim,
Hi Jim,
I don't know that probabilities can be stated for either of your first two questions. There are imaging features of the tumors that can point toward two primaries. As Janine pointed out in your previous thread, if both are spiculated that suggests two primaries, while if one looked rounded with smooth edges that would tend to indicate a metastasis. And as you've been told by your doctors, the lack of evidence of cancer anywhere else is also a strong factor in favor of two primaries.
As far as the tumor on the right being near the chest wall, it is possible that if a lobectomy is performed part of the chest wall may be removed as well as the affected lobe. But we can hope that the current therapy will shrink the tumor enough that chest wall resection will not be necessary.
If these are two primaries and neither has metastasized elsewhere there is a good chance of cure, pretty much in the range of typical cure rates for stage I-II lung cancer (for each tumor).
Good luck with the treatment plan.
JimC
Forum moderator
Reply # - September 27, 2015, 07:05 AM
If surgery is to be
If surgery is to be considered then you want a thoracic surgeon that is experienced in the pleura. I had a recurrence of a tumor that was 5.2cm and spread into the pleura. I chose Dr. David Sugarbaker as his experience is in mesothelioma which involves the pleura. He is now at Baylor in Texas if you want a second opinion. The right lung would not be a resection but a complete lobe removal. If they did decide to do the left side, it might be a resection or again a complete lobe removal. She would have to have a pulmonary function test before surgery would be considered for either side. Why not think about doing SBRT on the other smaller tumor? Are you in the US?
Take care, Judy