Tumor very close to heart with recent TIAs - 1265382

wantvictory
Posts:16

I've been diagnosed for 1 year 7 months with andeocarcinoma stage 4 KRAS.

Treated with Carbo/Alimta x4 then Alimta x10. Liver enzyme problems. Have been chemo free since January 28 2014. I have been waiting for enough growth for biopsy for OSU PDL1 trial.

I now have progression and have just found out that one of my mets in left lower lung is VERY close to my heart. This was told to me at OSU when they performed a new pet/ct on August 8th. After which I presented with double vision and sever neck shoulder pain over the weekend. Treating Onc in Ft. Wayne ordered MRI brain and cervical. It concluded TIAs and follow up needed. I followed up same day and Onc switched me from exarelto back to lovenox. That's all that was ordered.

I'm having core needle biopsy August 13 for trial prep. Onc at OSU now wants echocardiogram to determine if the tumor next to the lung could have caused TIAs. This is so scary.

I am so disappointed that my treating Onc never told me of this tumor's position. I feel betrayed because if I would have known I would have sought out a thoracic cancer specialist before waiting for progress. My treating Onc didn't warn me about this node knowing I was going on break. ARG.

My questions are,
How is a tumor in this position usually handled?
What symptoms should I look for if it does invade my heart, pericardium?
The FDG uptake was close to 8, is this an aggressive number?
Is 2 more weeks of --PDL work-up a risky amount of time to wait without treatment?

My treating oncologist does not read or look at the scans and the reports indicate placement of tumors by numbers. It would seem to me that someone should have raised a red flag in the scan report for that tumor placement.

Cancer always messes up my plans and this time I'm scared.
Hopefully knowing real information from you will help relieve some tension.
I handle truth well. I'm just so mad I was never told.

Many, many many thanks for your help.
WV

Forums
Full Archive

Reply # - August 11, 2014, 09:32 PM

Dr West
Posts: 4735

I'm sorry to hear about your tumor's location, but it's truly not as if your local oncologist has missed the appropriate treatment. There's really no clear best approach that is pursued in this situation of tumor close to the heart; it's entirely a matter of judgment with no consensus. We MIGHT consider whether radiation should be tried, but otherwise you just try the best systemic therapy you can.

I suppose it's possible that the tumor's location is contributing to the transient ischemic attacks (TIAs), but this is not a common or established association.

The standard uptake value (SUV) of 8 is really pretty much in the middle range we see for lung cancers.

Unfortunately, it's not possible for us to assess the right course to pursue with so many variables, and with us not being directly involved.

I think it's important to know that the development of the tumor close to the heart may well have occurred regardless of when you started the treatment. It's humbling to all of us that cancer can do what cancer wants to do, and it's a mistake to presume that had something been done a little differently everything would have been great. Advanced lung cancer pretty much always progresses, and it often causes complications along the way. It's not right to presume that these problems would have been obviated by pursuing a different course -- perhaps, but not necessarily. I'm not trying to defend your local oncologist, who I probably don't know, but I doubt your oncologist was trying to withhold something important from you.

Regardless, I hope your cancer responds to your upcoming treatment.

Good luck.

-Dr. West

Previous PostNext Post