Surgery for adenocarsinoma in situ 22mm left lower lung - 1290169

Tue, 02/21/2017 - 20:51

Has grown from 6mm to 22mm in five years. Surgeon can not biopsey because of location. He is 95% sure it is BAC fried egg shaped. I am 70 years old. He stated that if I were 80yrs old he would not recommend surgery. But feels he can get it all with left lower lobectomey. What are your thoughts? Should I get it removed?
Thank you
Frank

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JimC

Hi snowshoe46,

Welcome to GRACE. The growth rate you describe is quite slow, which is typical for many instances of BAC. Often it is so indolent that the real risk is in over-treating it. Dr. West has created an algorithm for treating such cancers, which you can access here: http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

JimC
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catdander

Hi Frank,

Jim posted while I was sitll writing but I’ll let this stand. I think this shows that decision making is rarely straight forward and is best done when more than one head is in the game. A second opinion by a dedicated thoracic surgeon would help in your situation.

Welcome to Grace. I'm sorry you are in this situation and hope you do well moving forward. We aren't able to tell someone what they should do. We provide information about standards of care and the thought processes oncologists go through when making decisions.

When a lung cancer shows it will outgrow you and it's resectable it's ok to think about resection. You're only 70 (the new 50 :) ) and have lots of life to live so yes resection should be on the table. Dr. West is one if not the leading oncs in BAC treatment so has written quite a bit on the subject. In this post about BAC myths and facts he talks about surgery, "If there is one spot of cancer, taking it out is almost always a great idea as long as a patient can tolerate it." http://cancergrace.org/lung/2015/06/01/gcvl_lu-aa02_bac_myths_misconcep…

The most important piece of information I can give and has been mentioned too many times to count by our faculty is to use a dedicated thoracic surgeon. A surgeon who only does thoracic surgeries minus cardio. A cardio-thoracic surgeon does mostly cardio surgeries a general surgeon does lots of different types of surgery. A dedicated thoracic surgeon does only thoracic/lung surgery, every day and practice makes perfect. Personally I sometimes lament that if I'd insisted my husband had his surgery by a dedicated thoracic surgeon he'd have less pain issues today, so I usually make this part longer and with redundancies.

Lots more about BAC, http://cancergrace.org/lung/category/lung-cancer/core-concepts/bronchio…

I hope you do well with whatever decisions you make. Keep us posted.
All best,
Janine