Starting Lung Cancer Journey, Hx of Brain Disease & High Functioning Dementia - 1260745

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Starting Lung Cancer Journey, Hx of Brain Disease & High Functioning Dementia - 1260745

I don't know how I happened upon this site but I am so grateful that it exists. I fear that the speed at which we are moving may result in unintended outcomes & no time for 2nd opinion. See below for medical hx. Rt lung mass appeared on heart CT that wasn't on 2012 CT or pre-sx chest x-ray in 4/2013. Pet-ct and bronch done. CT guided biopsy on Monday. No dx yet but at consult pulmonologist states due to size & rate tx STAT. If NSCLC will remove 2 lobes by VATS. Chemo if lymph nodes +. No mention of target tx or DNA test. Husband made remarkable rehab from brain disease. He works but no driving. He plans to resume teaching college in Jan. He is unable to make medical decisions due to anosognosia but can participate in discussion. I believe in tx if + but worried that sx/anesth/chemo will plunge him into unmanageable dementia. I can't base decision on unknown but perhaps I can prepare with appropriate specialist on the team if one exists. What additional info is needed to decide if immediate surgery is the best option?

Thanking you in advance

67 yo husband - lifetime closet smoker; asymptomatic
2/2005 Traumatic brain injury - enlarged ventricles considered not medically significant;
5/2012 Severe Traumatic brain injury - enlarged ventricles & triad of symptoms - Normal Pressure Hydrocephalus - VP Shunt;
4/2013 Pre-sx chest x-ray clear;
4/2013 Endoscopic third ventriculostomy (ETV) sx (shunt inoperable and aqueductal stenosis);
5/2013 Subacute subdural hematoma with 14 mm midline shift;
11/8/2013 CT scan to monitor aortic root aneurysm shows lobular mass in right posterior hilum, 3.5x2.4 cm straddling major fissure, aneurysm stable
11/21/2013 PET/CT Scan - right posterior hilar/perihilar mass extending into lower lobe superior segment, SUV 8.7 and proximal gastric mucosa appears thick but area not well expanded SUV 8.2.
11/22/2013 Bronchoscopy - nothing communicated
12/2/13 CT guided biopsy

Dr West
Reply To: Starting Lung Cancer Journey, Hx of Brain Disease &

I'm sorry for your husband's neurologic condition and recent diagnosis. It sounds like the recommendation for surgery is very reasonable, and the question is really whether anesthesia or the other challenges of surgery will worsen his brain disease. I'd venture to say that no cancer specialist could do anything more than speculate wildly about that. An anesthesiologist may be able to offer some insight, but I think a neurologist with knowledge of his brain injury is likely to be the most valuable source of information.

Focal radiation like stereotactic body radiation therapy (SBRT) is an alternative to surgery that wouldn't require general anesthesia, but we generally favor surgery in patients who are good candidates for lung surgery.

-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

Reply To: Starting Lung Cancer Journey, Hx of Brain Disease &

Dear Dr. West
It is truly a day to give thanks. I greatly appreciate your response as it tempered my escalating anxiety developing over this holiday downtime. Both NPH neurosurgeons have indicated that they do not need to be involved. We really didn't develop a relationship with a neurologist because shunt was implanted while husband was in critical care for TBI. I will get to work on that.

When my husband came out of ETV surgery I felt he was the most oriented to place and time than other surgeries. I have the anesthesia data record that I plan to present to the anesthesiologist when the time comes. Hopefully he/she will be as compassionate and understanding as you have been today to me.

Once again, thank you.