My question is should I have an open lung biopsy on a tumor less than 2 cm? How do you know when to wait and see, especially if the doctor is really pushing the surgeon?
Background: Jan 2010 diagnosed with NSCLC stage 2 and had right lower lobectomy with mutation EGFR exon 19 detected. I was declared cured with no further treatment and quarterly/biannual CT scan follow up reviews.
In Sept 2015 a 9 mm tumor was detected and my medical oncologist prescribed Tarceva 150 mg based on my previous occurence. The tumor reduced in size/stablized until Aug 2016 when 2 small perifissural nodules 5 mm and 6 mm as well as a 5 mm mammary lymph nodule.
Progression to Jan 2017 when all nodules are still less than 2 cm and my oncologist wants a biopsy or removal. The tumors are situated such that it cannot be easily radiated or biopsied by pulmonologist. My impression from the surgeon is that finding tumors that small is very difficult and it will have to be an open biopsy using his hands to feel for tumors that small. Because the oncologist wants it and doesn't want to wait further, the surgeon is willing to do it. I don't have much confidence, especially reading some of Dr. West's talks about Adenoma In Situ and the potential over treatment of lung cancer.
How do you know when to go with or against the oncologist? Is it worth it to have an open lung biopsy on tumors that small when even the surgeon is hesitant?