My 79 yo uncle was just diagnosed with NSCLC Adenocarcinoma. Waiting for an oncologist appointment set for July 19th, in the meantime here is his PET/CT and biopsy. Any help would be appreciated, specifically:
- What is the significance/likelihood that he indeed has mets in his posterior acebatum while nothing else lights up and he has no pain? All things being equal, does it really reduces chances of his survival?
- What should we look for/discuss with the oncologist in terms of treatment - he lost a lot of weight - 20-30 lb recently, has heart condition and diabetes. I know surgery is not an option. Any help/advise would be hugely appreciated.
LUNGS: FDG avid (SUV 13.7, image 75) approximately 9.0 x 8.0 cm irregular
centrally necrotic right upper lobe perihilar mass invading the
mediastinum, including superior vena cava, innominate and subclavian
vessels. Low-grade FDG avid patchy airspace opacities in surrounding right
upper lobe and superior segment right lower lobe, probably
infectious/inflammatory; new since CT dated April 27, 2018.
THORACIC NODES: FDG avid right mediastinal and hilar adenopathy. For
example, 2.0 x 2.0 cm right anterior mediastinal node (SUV 5.6, image 93).
BONES/SOFT TISSUES: Focal FDG avidity (SUV 2.6, image 234) in right
posterior acetabulum without CT correlate, possibly marrow metastasis.
He had transbroncheal needle biopsy and they did not get any malignant cells in the lymph nodes.
The subsequent CT needle biopsy of the tumor showed the following: histologic and immunohistochemical findings support a diagnosis of primary adenocarcinoma of lung.
Immunohistochemical stains (Block A1):
POSITIVE: TTF-1, napsin, cytokeratin 7.
NEGATIVE: Cytokeratin 20 (rare single cell positivity), p40,
chromogranin and synaptophysin.
Histology subtype/Predominant growth pattern: Acinar and solid
Anatomic location of biopsy: Right upper
Sorry for long post, we are a bit desperate and want to be prepared.