Bronchoscopy vs. 2 month followup CT - 1270603

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healmymom
Bronchoscopy vs. 2 month followup CT - 1270603

Everyone says it, but I will say once again -- this site it PHENOMENAL, and everyone should donate to it !

I am in Greece visiting my husband who is currently living here to care for his ailing father. My husband is 61, a 30+ yr. smoker (still smoking). A few weeks ago, he inhaled fumes from bleach + ammonia and next few days felt pain in his throat and chest from it. Then a tiny bit of blood appeared daily in his morning little bit of phlegm he coughs up. (never had any trace of blood prior to this) Took 9 days of methylprednisolone (32 grams tapering down to 4mg) Helped but still little smear of blood in phlegm. Had CT scan, but as it's in Greek, I couldn't read it. What I DID see on it is a 2.3 cm measurement and another measurement (looks like an area defined) ie. 2cm x 3 cm x 8 cm)

The drs. over here are not like drs. in the U.S. -- they don't go over all the details with the patient. So, pulmonologist only said he should have Bronchoscopy done this Tues. (in 2 days) -- He had bloodwork and gave a sputum sample on Friday.

QUESTION 1 -- is it more logical/prudent to put off the Bronchoscopy now, and do a repeat CT scan in 2 months to see if any change to whatever it is they see ? and THEN if change is seen to proceed to Bronchoscopy?

Since my mother's lung cancer surgery seeded the cancer thru her pleura and outside body on left rib, I am now nervous about if they do a biopsy during the bronchoscopy, it could spread the cancer if it is cancer, as I have read a lot more cases and opinions that say poking/cutting/biopsying any tumor runs the risk of spreading it, so I only want him to get it done if absolutely necessary.

QUESTION 2 -- IF the sputum testing shows cancer cells, would they still need to do a Bronchoscopy/biopsy?

It would be difficult, but if need be he can come back to U.S. Ias has insurance) for bronchoscopy or other treatment.

healmymom
*** added note to below info

*** added note to below info -- now my husband just told me that when he went for bloodwork, the pulmonogist told him they will also do XRAYS of his head when he goes into hospital for bronchoscopy. Am I correct in being much more concerned now, because those would be to look if anything has spread to his brain? Does that make the bronchoscopy more urgent ?

JimC
Hi healmymom,

Hi healmymom,

I'm sorry to hear of these concerning scan findings. Because you don't have an actual radiologist's description of what has been found, we don't have much information, and in any event it's always tough to second-guess the choices made by local doctors who have the patient and all of his medical information available. I would be inclined to find someone who can translate the report for you. Perhaps if you called a local university and explained the situation, they might be able to help.

If the report is describing a mass that is anywhere near as large as the dimensions you note, and since your husband does have symptoms which could be related, I don't think watch and wait would be a viable option, as much can happen in two months. Although I understand your concerns about seeding, especially with your experience with your mother, seeding is not a common occurrence and a bronchoscopy is not as invasive a procedure.

I do agree that if the sputum test shows identifiable cancer cells, the bronchoscopy may not be needed. If so, surgery may be part of the treatment plan, depending on the results of brain scans and a PET scan or other scans to check for metastases. Brain imaging is routinely ordered as a part of the initial workup of a cancer diagnosis, although an MRI is the modality of choice, as it is better at imaging small metastases than is a CT.

Best wishes for good test results.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

healmymom
Thank you, Jim, your comments

Thank you, Jim, your comments are appreciated.

IAssuming IF it turns out to be cancer that my husband would come back to the U.S. for treatment, what would be needed with regard to the biopsy. Of course the CT scan(s) + report in English, but I'm thinking ACTUAL SLIDES with cells on it, actual piece of the biopsy if that's even possible ?

Is it true that a piece of the biopsied tissue itself can be needed for varying tests -- possibly like the slides, then the major markers test and then possibly genetic testing ? How is the biopsy tissue handled in the u.s. ?

My mom had the biopsy, We had to provide the orig. slides for ea. diff. onocologist/hospital we went, but I don't remember any requesting actual tissue sample, even to do the test for ALK, EGFR or KRAS. Could you clarify what might be needed so I can tell the pulmonologist here in Greece BEFORE they do the test.

JimC
Hi healmymom,

Hi healmymom,

Tissue from the biopsy is used for testing, and what is not used tends to be preserved, as Dr. West has noted, as "formalin-fixed paraffin-embedded (FFPE, the basic way that tumor tissue is routinely stored after surgery everywhere)".

If your husband comes back to the U.S. for treatment, he will want to bring the slides and any FFPE-preserved biopsy tissue for any testing that may be done upon his return. What you'd prefer is that the minimum amount of tissue be used so that enough remains for further testing, but the bronchoscopy may not yield much tissue.beyond what is needed for diagnosis and initial testing.

You should probably advise your husband's doctors in advance that your plan would be to return to the U.S. and that he will want to bring his slides and tissue with him. They may be able to arrange for shipping of these materials directly to a cancer center here.

You and he will remain in our thoughts.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>