Hello - 1245906

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Hello - 1245906

My mom has a 1.9 cm nodule in the extreme upper portion of her lung..x-ray..two CT's, bronchcoscopy and then PET/CT. The nodule but nothing else apparently lit up.They were to do a thoractonomy(sp?) and try to remove the nodule but when they biopised some of the meditasinal lymph nodes they detected cancer. Adencarcinoma... I am letting out some specifcs but not on purpose. I can get them but my questions are these: I know this is possibly quite controversial and I absoultely do not like asking questions in a very/highly insinuating manner about which something I have not one grain of expertise/knowledge...except being a 'WebMD'...but...I have seen and read ..of course..on the web that doctors have proceeded with surgically removing nodules and even multiple nodules along with affected lymph nodes with patients that are Stage III a and Stage III b..... my mother has one known 1.9cm nodule and if the information was correct two affected medtisnal lymph nodes. Basically..why did he stop? I have read and with just very...very general layman knowledge that chemo/radiation is normally used as treatments but not always. Also if the cancer spread might increase with an attempted removal how much more and or faster does aden or other lung cancer spread if removed at this stage. I just don't understand the rationale.
Also...I will be very honest since we are at the doorstep of beginning an aden cancer treatment program and from what I have read from the links provided by the moderator that this would likely be the time to seek a second opinion...has anyone here done this...seen this or recommend this?
I just do not want to 'kick the can' and re-start the entire process and waste obvious very valuable time.
In other words...if I collected all pertinent medical records, test results and such and attempted to have her seen at John Hopkins or the University of Penn medical system or a very large academic/research based hospital would they proceed w/treatment & or surgery? Th

Reply To: Hello

Hi dkm, Lots of people get 2nd opinions. Did you read this post? http://cancergrace.org/cancer-101/tag/second-opinion/

The reason for not continuing with the surgery after finding the involved mediastinal lymph nodes is because it doesn't hasn't shown a better outcome. Patients have shown do as well or better without the resection when mediastinal lymph nodes are involved.

Below is a quote from the blog/post from Dr. Pinder with an explanation of the mediastinal node involvement.

She states, "Most commonly, patients are classified as stage III because of involvement of lymph nodes in the mediastinum (a space in the middle of the chest between the two lungs). If the involved
mediastinal lymph nodes are on the same side of the chest as the lung tumor
(ipsilateral nodes), this is classified as N2 and is considered stage IIIA disease. If the involved
lymph nodes are on the opposite side of the mediastinum (contralateral nodes), these are
considered N3 nodes, and the cancer is stage IIIB. If a patient has involvement of
supraclavicular lymph nodes (just above the collar bone, or clavicle) on either side, these are
considered N3 lymph nodes, and the stage is likewise IIIB."

A second opinion will certainly help answer your question about whether your mom is getting the best possible treatment. Obviously what your mom thinks is the most important piece to judge the decision on.


Reply To: Hello

I did read the "2nd opinion" post but maybe I do not remember one of the aspects that prompted my question...do the medical facility and or doctors from which one is seeking a 2nd opinion must run and or prefre to run their own round of tests and procedures before analayzing the most recent data which was just recently aquired from the the initial DX? Or if they do give their opinion from the most recent data and not their own will they draw a treatment plan based on the findings given to them or will they insist on running another set of set of CT, PET/CT scan(s), MRI's before they would give a treatment plan..OR would it be possibly better for them to run another set of tests before they would give and or start a treatment plan?
Are large academic/research facilities normally the only institutions that perform clinical trials?
We live in central Pennsylvania...would John Hopkins and or the University of Penn offer clinical trials?
How does one enter one and how are clinical trials normally paid for?
I thought I did clinical trials. I will check it out but any specific, personal input if applicable would be greatly appreciated.
Also do you know what might be a an excellent instituition for clinical trials...I assume what I read John Hopkins and Penn would be very good ones? Any specific knowledge of these two?
Are affected lymph nodes normally surgically removed after chemo/radiation? Along with the nodule if reduced in size?
One last for now...what is the indicator(s) / test after chemo and or radiology plan is administered that signals that cancer is starting to get beat or on the path to NED? I read on hear that CEA is not a good indicator? I assume from what I've read on here that constant vigilance and repeated CT's, PET/CT and or biopsy are the good ones to signal a cancer is getting beat? Or are there others? Again..thank you very much. I apologize for the somewhat 'scatter brained' flow of my emails..I am trying my best. I have so much going on.

Dr West
Reply To: Hello

It's really not possible for the faculty here to address a long list of big questions. I can say that it's absolutely considered optimal to not proceed with immediate surgery in someone who has several mediastinal lymph nodes involved if that can be identified before surgery. It's true that there are doctors who do surgery for very extensive stage IIIA or even stage IIIB disease, but the vast majority of these cases ultimately turn out to be a quite poor decision, I'd have to say, either done because the doctors

1) don't know or don't care that what they're doing isn't a very good idea, or

2) are cajoled into doing a surgery that they have significant misgivings about because they feel pressured into it because the patient and/or family is hell-bent on it, despite it not being the wisest choice

In neither case does that make the most aggressive avenue the optimal decision.

To address another big question, most places that do second opinions shouldn't need to repeat the vast majority of tests. Sometimes a scan wasn't done, sometimes a test wasn't done the way they'd want it to be, or sometimes a long interval has past and it's important to reassess whether things have changed. But in most cases, little or nothing new may need to be done to get either the reassurance that the first opinion was a good one, or else that a different approach may be a better alternative.

You may well have other questions, and we'd be happy to try to address them, but try to prioritize your most important question or two at one time, rather than submitting a list that is infeasibly long for us to tackle here in a remotely timely way.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education