Bone mets and enlarged lymph node 5 years later - 1266924

Tue, 11/04/2014 - 05:52

Good morning all. My question is: if you knew then what you know now, what question do you wish you would have asked during your second opinion visit?

My 88 year old mom was Dx with stage 1a nsclc adenocarcinoma in 2002 and again in 2009. Both times she had a lobectomy performed in her right lung at Sloan Kettering . The tissue from 2009 showed a k-Ras mutation. No chemo or radiation after either surgery and she was NED up until last month. Her last lung CT scan was in May 2014 and it was clear

After complaining of recurring leg pain and back pain which was getting worse she had cat scans, a MRI and a pet scan.

1. A biopsy confirmed a single met in her left hip.
2.The MRI confirmed a single met of 1.3 cm to T8 in her spine
3. The pet scan confirmed a 2.5cm enlarged lymph node in her right lung. (No biopsy as it was too close to a vein).

Her brain and liver and other soft tissue are clear.

Aside from this she is a very active 88 year old and is a holocaust survivor and a fighter

We are heading back to Sloan Kettering for a 2d opinion as to treatment (she now lives out of state)

I am putting together my obvious list of questions as to the pros/cons of radiation, chemo, palliative care. I am trying to be as thorough as possible

With the benefit of hindsight and experience is there is there something you wish you would have asked during your second opinion visit that others might find helpful?

Thank you and God bless everyone on this board.

Kmc

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JimC

Hi Kmc,

I'm very sorry to hear of your Mom's recurrence.

I'm not certain there is much that could have been asked which would have changed what happened. If at some point she had been given PET scans to search for metastases, and those came up clean, the standard of care would have been surgery and no adjuvant chemotherapy. There is relatively new research seeking to determine the level of risk of recurrence for early stage patients, but it's still being tested and wasn't available when decisions were made about your mom's treatment: http://cancergrace.org/lung/2012/01/28/pinpoint-molec-assay-lancet-201/

As far as the current situation, these discussions may help you in deciding which treatments to pursue:

http://cancergrace.org/lung/2010/09/29/quoix-ifct-0501-asco-doublet-vs-…

http://cancergrace.org/forums/index.php?topic=1519.0

http://cancergrace.org/lung/2011/09/25/stage-iv-non-small-cell-lung-can…

http://cancergrace.org/lung/2011/11/20/challenges-of-managing-elderly-p…

Good luck with whatever choice is made.

JimC
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kmc63

Jim

Thank you so much for your incredibly thoughtful and thorough reply

Dr West

I think another key question, and perhaps the most important one, is whether the pace of the disease now suggests that a "less is more" approach might be very fruitful. We don't want the treatment to be worse than the disease, and that's a particular concern when you have clues like a very long interval between last seeing the cancer and its reappearance. It's also a real risk when a patient is elderly, which tends to track with having other potential health threats and often experiencing more side effects from treatments than younger patients.

See here:

http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

http://cancergrace.org/cancer-101/2013/01/16/progression-rate/

I hope this helps.

-Dr. West