mediastinoscopy and bronchioscopy - 1254124

mickey61
Posts:26

Hi Dr West, I have a question please, but I am scheduled for a mediastinoscopy and bronchioscopy on monday morning and I am really scared. I have a 1.3cm nodule URL, pet/ct only lite up on nodule, had a needle biopy (which had a lung collapse a week ago) which showed NSCLC andiocarcinoma. surgeon sent me for stress, echo and cartoid all turned out ok, says he needs to do this before offering surgery because eventhough nothing lite up pet/ct scan this is the first place this cancer spreads to and it would not be good to do surgery and then find it was in the lymph nodes. Says he will check my airways first (wondering how they do that if you have a breathing tube) then he will take put a cut and simp out all lymph nodes on boths sides and I will put under general anesthesia. I'm worried because of my first lung collapse with needle biopsy and can you tell me how much this is done before surgery is an option. I'm really scared and wanted to know how you get by with no lymph nodes if they are all taken out.

Surgeon gave me all the risk just really worried and looking for the worse.

Thank you in advance, can only find a handful of people who have had this done.

Thanks
Mickey

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Reply # - February 22, 2013, 08:11 PM

catdander
Posts:

Hi Mickey, I'm very sorry to hear about your diagnosis of cancer and hope it is contained so it can be taken out.
I am a little unclear about having both the broncoscopy and mediastinoscopy. Of course I could be wrong but I thought it was normal to do one or the other not both before a thoracotomy.
I could be wrong. One of our faculty will help clear that up for me.

Until then I've pasted a link to a discussion of the reasoning for doing them. It is normal to do them before a more extensive surgery. As far as a breathing test. It's done to make sure you have enough lung function to withstand a surgery and is not done as part of the other procedures but is done in a pulmonology dept.

I hope this helps.

http://cancergrace.org/lung/2008/03/30/ebus-intro/

Reply # - February 22, 2013, 08:23 PM

double trouble
Posts: 573

Janine, I had both when I went under for my right pneumonectomy. They did the bronchoscopy first. During the mediastinoscopy, they found a subcarinal node to be positive for adeno, so I was deemed inoperable and the pneumonectomy was cancelled.

I think they do both because neither procedure can reach all nodes.

Mickey, I did fine. The incision hurt some but the pain medication they gave me worked really well. Good luck with the procedure. I hope it goes as smoothly as mine did.

Debra

Reply # - February 22, 2013, 09:57 PM

Dr West
Posts: 4735

Mickey,

The mediastinoscopy, as well as the bronchoscopy, are very appropriate staging studies that a good surgeon would do. Though some surgeons don't, this is really a shortcoming -- the best trained and most thorough surgeons favor this, and it's considered a mark of higher quality care.

Though it's invasive, the risks are really quite minimal when done by someone well trained, and I definitely consider it not only appropriate but very preferred before surgery for anything but the lowest risk cancers. Some of the smartest lung surgeons I work with favor mediastinoscopy before ANY lung cancer surgery, and I respect that thoughtful opinion, even if some good surgeons don't feel it's necessary for the lowest risk lung cancers.

Good luck.

-Dr. West

Reply # - February 23, 2013, 06:08 AM

follansbee
Posts: 44

Mickey, my husband, who was 73 years old at the time, had a mediastenoscopy a couple of years ago, and he did fine. He didn't have much pain and was completely recovered in less than a week. He also has COPD. I think you will do fine!

Reply # - February 23, 2013, 10:06 AM

mickey61
Posts: 26

Thank you Dr West, now I feel a little more at ease, still scared, but you have made me feel better. Thank you again.

Catdander, I already had a pulmonary test, ct, pet/ct, needle biospy, stress test, echo and cartoid scan, wheeeew, now I'm going for the other two mention above. My surgeon did say, he will check the airways on the bronchioscopy and then do the mediastinoscopy he said before he offers or considers surgery he does this because this is the first place it goes to if it spreads. So please says prayers for me.

I also wanted to ask you another question Dr West:

I have been researching squamous and andeocarcimoma. From what I found on the internet squamous is found 80% more in smokers and men and andeocarcimoma is found more in woman. So I was a former long time smoker. Is squamous found more in smokers? and I was reading where andeocarcimoma is found more in the lungs, prostrate and bladder. My father had prostrate and bladder cancer that were not mets, he was non-smoker, very healthy man until he got cancer, he beat the prostrate but then didn't survive the bladder cancer at 78. Could there be a genetic factor, eventhough I smoked and he didn't. I'm finding so many people who never smoked, or who stop years ago are getting LC. thats so sad when they say on cancer.org after 5 years your risk is that of non-smoker. I have found people that quit 10/20 prior to there diag.

Also is there a worse type squamous or andeocarcinoma, I also had a friend who a needle biopsy said squamous and after surgery the path report said andeocarcinoma, how can they come up with two different path reports.

Thanks as always Mickey

Reply # - February 23, 2013, 11:03 AM

catdander
Posts:

It's most common to find squamous cell nsclc in smokers or former smokers. Though it's very possible to be a never smoker and have squamous nsclc.
It's my understanding that it's more possible to get lung cancer if you are or were a smoker. A smoker is described as someone who smoked over one hundred cigarettes in a lifetime. As you may imagine the more one smoked the more likely one can develop lung cancer.

There are ongoing studies about gene mutations and heredity chances of developing cancer. I think a search of the terms will help you understand that better. remember you may need to log out to access our search engine.

You can have both adeno and squam in one tumor. Cancer can do just about anything.
I think the average squamous is considered to be more aggressive locally and adeno spreads to other organs more readily though everyone's is different. I'm having trouble with my computer so searching is difficult.

I fully understand you have many questions. This is complicated for our specialists so for us laypeople it is quite overwhelming. Remember to try to keep your questions specific and just one or 2 at a time so you get the best chance for piecing together an understanding. It will take time and we'll help you get there. OK?

All best,
Janine

Reply # - February 23, 2013, 12:39 PM

mickey61
Posts: 26

Thanks Janine.

So squamous does not spread as fast as andeocarinoma, well per your research anyway. The only other question I have is how they you can have two different pathology reports, needle biopsy says squamous and pathology report after lobectomy say andeocarcinoma. Not both, one says squamous and the other says the andeo one. this was in a non-smoker. Very very confusing, I know you can have both together but wouldn't it say that?, but this one clearly said one and then clearly said another, maybe its because when they do surgery there is a no longer time wait for the path report because they really pick it apart, who knows.

Thanks and I praying if that case with nsclc andeo has not spread. thanks

Reply # - February 23, 2013, 01:11 PM

catdander
Posts:

I don't do research, I just read mostly here on Grace. It's not that squamous isn't as deadly or difficult to treat. Squamous just has a tendency to stay in the chest area while adeno spreads more. They're both deadly and they both can do just about anything. This is just a statement of what's most common. Everyone is an individual case and you'll find most everyone has an oddity or 2 or 10 about her cancer.

When doing pathology (study under a microscope of biopsied tissue) you have just the tissue taken. It's possible they got tissue that held squamous cells in one and adeno cells in the other. As in the case of my husband. He's had 5 pathology reports. Only one held cancer cells at all. I think it would be fairly easy to find a doctor's input on this by doing a search on Grace. It's a fairly common question.

Reply # - February 23, 2013, 04:20 PM

Dr West
Posts: 4735

Janine's quite right about everything she said. What I'd add about the discrepant reports, one saying adenocarcinoma and the other saying squamous, is that sometimes the cancer can have different characteristics that appear mixed together, so sometimes a biopsy will show one kind of cancer that's actually only a small minority of the bigger cancer. Sometimes the more extensive pathology review will see and comment on even the small areas of a secondary cancer type (like if most of the tumor is adenocarcinoma but 5-10% is squamous), but sometimes the review after surgery might not comment on or even notice a small area that looks more squamous.

The other point is that sometimes cancers are pretty chaotic appearing. The assignment of histologic type is somewhat subjective, a matter of pattern recognitions, and in cases where the pattern is very subtle or largely broken down, there can be disagreement from one pathologist to the next about whether a cancer is adenocarcinoma, squamous, or some other type.

These are all common types of cancer, so I wouldn't presume a hereditary component.

Unfortunately, while risk of lung cancer does decline after someone quits smoking, it never drops to the risk of a never-smoker, and the more substantial drop in risk occurs after many years. The idea that the risk in an ex-smoker drops to that of a never-smoker after 5 years is definitely false.

-Dr. West

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