Lymph Node Biopsy - 1274187

seanmullingart
Posts:6

Hi, I was wondering if you could help. I have had a biopsy that has confirmed the presence of lung cancer in a mediastinal lymph node. I have tried to look this up and have found that Lung cancer often spreads first to lymph nodes near the tumor. What I do not understand is that my CT scan was clear but the node was picked up as suspicious on a PET scan. So where could the original tumor be? I have ben told that chemo will be started in the next few days, but if no tumor is showing, how will we know if it has gone? I just don't understand this. I cannot find any information on this anywhere. I hope you can help.
Sean

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Reply # - May 31, 2016, 08:10 AM

JimC
Posts: 2753

Hi Sean,

I'm sorry to hear of your diagnosis, and the added uncertainty caused by the inability of the CT to image the primary tumor. It’s unusual for the primary lung cancer tumor to fail to appear on a CT, but by no means unheard of, as you can see from this comment in a post by Dr. Pennell:

“If the primary tumor is fairly obvious such as a big lung, colon, or breast mass, then most of the time we have a good idea what it is before we even get the pathology report. But it isn’t always immediately obvious where the primary site is located. Some patients come in with metastases to the brain, bone, lung, and/or liver, but with no obvious primary, and then we really rely on that biopsy to help us decide what type of cancer this is.” – http://cancergrace.org/lung/2009/04/04/dx-of-primary-tumor-with-oligonu…

Chemotherapy is the treatment of choice for lung cancer which has spread to the mediastinal lymph nodes when surgery is not an option. In the absence of a measurable primary, it may be difficult to judge the efficacy of that chemotherapy, but if after your chemo you are feeling better (if you have any symptoms now), and a follow-up scan shows nothing new, that will be a good indication that chemo is having its desired effect. Otherwise, you would likely see further spread and eventually enough growth in the primary tumor that it would become visible on a CT.

Good luck with treatment, and let us know how it goes.

JimC
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Reply # - May 31, 2016, 10:01 AM

seanmullingart
Posts: 6

Thank you Jim, would a biopsy from the node be good enough to ascertain if a targeted drug would be effective or would this need to come from the primary tumor?

Reply # - May 31, 2016, 01:51 PM

catdander
Posts:

Hi Sean,

It should be fine as long as the node is accessible. Those who are involved should be able to say which mass is the option for biopsy for mutation testing. There needs to be enough cancer cells in the tissue biopsied for testing. Note that for diagnosis there doesn't need to be as much tissue taken.

Hoping for the best,
Janine

Reply # - May 31, 2016, 02:23 PM

JimC
Posts: 2753

Hi Sean,

I would just add one comment to the helpful information Janine provided. With any biopsy, there is the possibility of a false negative, since it's not unusual for some cells to bear the targetable mutation while others don't. So although a positive result can be relied upon, a negative result might just indicate that the limited sample provided by a lymph node biopsy simply may have missed the sought-after cells. That's true with any biopsy, there's just a greater chance with smaller samples.

JimC
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Reply # - June 1, 2016, 06:26 AM

seanmullingart
Posts: 6

No one had mentioned targeted therapy to me yet, I just thought that it does become an option then I would rather have some understanding of the process. Thank you for passing me the information, I feel better prepared.
Sean

Reply # - June 3, 2016, 02:01 PM

cards7up
Posts: 636

Wondering what they staged you at? Did the PET light up anywhere else? Most mutation testing depends on type and stage. If you have squamous cell, they don't automatically do a mutation test. But if it's adeno and you have advanced stage cancer, then they will. Did you have a brain MRI also?
Take care, Judy

Reply # - June 4, 2016, 02:24 AM

seanmullingart
Posts: 6

Hi, I am staged at limited. As far as I know, the node was the only thing to show evidence of a tumor. I am still
Worried that the cancer has spread as I believe the nodes are paths to other organs. I try not to think about it and just accept the fact that there is no evidence of disease spreading at this point in time.

Reply # - June 4, 2016, 04:03 AM

cards7up
Posts: 636

If you have limited, that would be small cell lung cancer and it's not tested for mutations. Mutations are found in NSCLC. Did they do a brain MRI? It's very possible there are other cancer cells not showing up on a scan as they're too small. But having chemo which is systemic will go throughout the body. Wishing you the best.
Take care, Judy

Reply # - June 4, 2016, 04:31 AM

seanmullingart
Posts: 6

Thank you Judy, that may be why my doctor didn't mention targeted therapy. He told me not to get hung up on stage or outcomes as the cancer behaves so differently in different people and responses are just as varied too. At the moment my main concern is the fatigue from treatment. I start on Monday and I have been suffering with bad fatigue for months, I don't know if I can handle it getting worse. I have had a lot of blood tests and although my red cells are a bit low, sodium a bit low and platelets and potassium just on the right side of low, I am good to go. I forgot to ask if the borderline blood results were due to the cancer or something else or just my natural norm. I was just pleased that the next part of the journey will start soon.

Reply # - June 4, 2016, 01:08 PM

seanmullingart
Posts: 6

Hi Janine, I have not started chemo yet, big day is Monday! I am a bit worried as my levels are a bit low to start with as I expect chemo to knock them a bit. I will take one day at a time though. Thanks for thinking of me.

Reply # - June 4, 2016, 03:24 PM

cards7up
Posts: 636

Actually it can be caused by small cell lung cancer, it's called SIADH. Look it up. They will keep watch on your counts and do what needs to be done. Most chemo for SCLC is cisplatin and etoposide. If you find you have tingling in hands or anywhere else and ringing in the ears, ask if they'll switch you to carboplatin. It's still a platin drug but with less harsh side effects. Stay hydrated!
Take care, Judy

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