praisesgirl5
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Posts:5
My mother-in-law was recently diagnosed with stage iv adenocarcinoma nsclc lung cancer. She has a tumor/mass in the right upper lobe. The pet scan showed an SUV of 5.8 to the manubrium (sternum). The doctors have advised to go forward with chemo, without a biopsy manubrium. We are debating whether to delay chemo to have a definitive diagnosis of the manubrium, which would confirm stage four, or forgo the biopsy and begin chemo. Can you please advise whether the sternum biopsy would be prudent prior to chemo?
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Reply # - May 2, 2015, 05:12 AM
Hello praisesgirl5,
Hello praisesgirl5,
Welcome to GRACE. I am sorry to hear of your mother-in-law's diagnosis.
A biopsy of a solitary suspected metastasis is often done if the results will change the course of treatment, as in this case a decision between local therapy (surgery and/or radiation) and systemic therapy. But if everything her doctors see, including the PET scan results, points to a metastasis, her doctors may feel that beginning with chemotherapy is the proper course of action. That's something that would be impossible for someone on a website to be able to judge or second=guess.
If you have doubts, you may want to obtain a second opinion. Dr. Weiss wrote an excellent post on the topic of second opinions here.
Good luck with treatment. Please let us know if you have further questions.
JimC
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Reply # - May 2, 2015, 05:24 AM
Hi praisegirl5,
Hi praisegirl5,
I'm sorry it took so long to reply but of course I'm more sorry about your mother in law's diagnosis. It's always best to have biopsy confirmation of a metastasis that causes a change to stage IV disease because it can change the treatment plan. However bone can be difficult to biopsy. Your mother in law may prefer to get a 2nd opinion from a lung cancer specialist before beginning treatment. It can add the needed understanding your looking for. This is a link to an excellent post Dr. Weiss on the subject of 2nd opinions, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
Dr. Pennell wrote about getting the whole story before beginning treatment. In his post he refers to biopsying bone, "In addition, diagnosis and staging of NSCLC is a complicated process that takes time. After an initial CT scans shows a lung tumor, there is the necessary step of getting a biopsy by bronchoscopy or needle aspiration, then a PET-CT or full body CT followed by bone scan, often pulmonary function testing prior to surgery and perhaps referral to a cardiologist for “clearance” for surgery. Surgeons often need to perform a mediastinoscopy to confirm the absence of mediastinal lymph node involvement, and if that is positive then referral to medical and radiation oncology is a necessary step. Subtle signs on scans may need to be further investigated, such as a liver MRI for a suspicious spot or a bone biopsy of a spine lesion that may or may not be cancer." http://cancergrace.org/lung/2009/11/06/delays-in-treatment-for-lung-can…
Of course we can't say what your mother in law should do. It often seems to me there are more exceptions to the rules of cancer care than strict policies. I hope your family can get the answers you need. Please let us know if you have questions after reading these posts and discussing with family.
All best,
Janine
Reply # - May 2, 2015, 05:25 AM
Wow, Jim and I just had a
Wow, Jim and I just had a conversation the other day about how we often get to the forums at the same time even after being late to the game we show up at the same odd times. :)
Reply # - May 2, 2015, 09:04 AM
Is this the only site where
Is this the only site where metastases has been shown? And if it is, I see why you're questioning the whether this could be stage IV or not and if it makes a difference with treatment. If she's not already being seen at a top notch cancer center, then I'd think about getting a second opinion ASAP. If she is, then why not sit down and discuss your concerns with her doctor and get a treatment plan in place. I'm not a medical professional, just a long time lung cancer patient. Wishing her all the best. Take care, Judy