Mediastinoscopy. - 1251090

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apra
Mediastinoscopy. - 1251090

Hello everyone,

As you are aware my husband has decided to try for another tissue testing option. The recent pet ct can sowed some new mediastinal lymph nodes lighting up so we thought we should do a biopsy by taking tissue from these mediastinal lymph nodes.
My question is, will tissue taken from these nodes be good enough for mutation testing. Although he is still on Tarceva, he is showing some progression so we want to keep ahead of the cancer.

How expert should a surgeon be to be able to perform such a procedure?

Thank you for listening

catdander
Reply To: Mediastinoscopy.

Hi Apra, I hope you and he are feeling alright. I will contact a doctor to give input.

You are right to question one's expertise in performing a mediastinoscopy. That person should do many of these and often.

Take care,
Janine

dr. weiss
Reply To: Mediastinoscopy.

Apra,

We haven't conversed in a while, but I hope that your husband is doing well. Please forgive my lack of memory, but has any molecular testing been done before? It's very rare to have more than one mutation. At any rate, I'll put that question aside and answer the question you asked: how useful mediastinoscopy is for getting tissue for molecular testing?

The mediastinal nodes are a classic place for lung cancer to spread to. Obviously, cancer needs to actually be there for it to be useful to get tissue from there for molecular testing. In addition to being hot on the PET portion of PET/CT, you'd like to see decent sized nodes on CT for this to be a good location to go after. Also, depending on the location of the nodes, you'd also want to be sure that mediastinoscopy is the best way to go after them. For many locations, EBUS with biopsy (if you're not familiar with this technique, I think that there are a few posts on it) can be effective and less invasive. Once the determination is made that there's likely to be cancer there, yes, getting cancer cells from the mediastinum can be an effective place for molecular testing.

For any procedure, you'd like a doc who's experienced in it and good at it. While mediastinoscopy is one of the easier and safer surgical procedures done for lung cancer, it's still surgery with plenty of associated risks. If possible, it would be best to be done by a thoracic surgeon (not general surgeon) who's done many of them. For a good surgeon, this is a "routine" operation.

catdander
Reply To: Mediastinoscopy.

Thank you Dr. Weiss. Apra's husband hasn't had any mutation testing. He's on tarceva now though it's just been 3 or so months and it may not be working as well as they'd want. I suspect she's asking about an ALK test. Is that right Apra?

apra
Reply To: Mediastinoscopy.

Thank you Janine, thank you Dr. Weiss,

Both your posts were so helpful. My husband has been having a relatively good period after the pets can. He is on 300mg Gabapentin twice a day. However he is suffering from leg cramps. I don't know whether this is due to the water pill he is taking daily or due to the cancer itself.
Yes, Janine, he has not had any mutation tests done and so we are keen to know whether he is a good candidate for Crizotinib. He has Adenocarcinoma with pleural effusion along with mild ascites now.

Dr. Weiss, I will go through the posts on EBUS and speak to the lung surgeon about this. And I will try to find out whether he is a thoracic surgeon. We were told that he is the doctor who deals exclusively with Lung Cancer, but we failed to enquire about his surgical specialty.

Always so helpful to hear from the wonderful people on Grace. May your tribe increase :)

apra
Reply To: Mediastinoscopy.

Today when we went to met he surgical oncologist he could not recognise my husband. He said he looked absolutely if and well he could not tell that he was the patient :)

We met an experienced Thoracic surgeon who told us that he performs about 15 mediastinoscopies per month. So we have decided to go with him.

As my husband seems to be responding somewhat to Tarceva, we are wondering whether it will be a good idea to ave this edastinoscopy as the lymph node may not even be cancerous.

We are wondering whether the diagnostic surgery would compromise his strength and health.

catdander
Reply To: Mediastinoscopy.

What high praise from the surgical onc. How great! What did they suggest? Will you wait until there is more positivity of cancer to catch? Anything invasive has the potential to do harm. He may show that he will do quite well on tarceva taking away any need to check for ALK. I know it isn't me or my husband and probably shouldn't say this but... well Apra we've corresponded so often that I will. If my husband was doing better than he had in a while and there was a likelihood that he may be responding, I'd wait. Like your husband he's had no luck in getting a biopsy the usual way and even had a pneumothorax and a 3 day stay in hospital the last time they tried. Is seems there are never easy answers in lung cancer tx.

Janine

Dr West
Reply To: Mediastinoscopy.

A mediastinoscopy is quite unlikely to be especially hard to tolerate, especially if your husband is doing well. However, it still makes very good sense to have a clear idea of the benefit of the intervention, so if that's not clear, there is good reason to question whether to do it.

-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