Very confused - 1266952

Tue, 11/04/2014 - 15:22

My dad has fairly recently been diagnosed with lung cancer. He was originally diagnosed due to symptoms from a lesion in his brain. - I am very stressed and confused because he has said the lesion in his brain is a metastasis, but he has also said that it is benign. Is benign ever used just as a descriptor of how aggressive something is - or does this diagnosis just not make sense?

His dr is hoping to do gamma knife treatment on both. If the brain lesion is a met, then is there any benefit in pushing for surgery on the lung (I think the brain lesion is too tricky to get to anyway)? (I think both are fairly small).

Thank you.

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cards7up

Benign is not cancerous and so wouldn't be considered a met. How does he know it's benign, have they biopsied the brain lesion? It never hurts to get a second opinion at a top rated cancer hospital. Do you know what type it is? Take care, Judy (Fellow LC Patient)

JimC

Hi ocean,

As Judy said, a metastasis from a cancer is not benign. It has the same characteristics in that it can grow without the restrictions that normal cells have.

Normally when lung cancer has spread beyond the lung, local treatment (radiation or surgery) to the lung tumor is not recommended because the cancer has entered the bloodstream and can appear anywhere at any time, so surgical removal can be an exercise in futility (and one that is not without side effects). There are instances in which local treatment is used when there is only one metastasis, but this is something that is determined on a case-by-case basis. Definitely something to discuss with his oncologist. You can read about this concept of a "precocious metastasis" in this post by Dr. West: http://cancergrace.org/cancer-101/2010/09/15/solitary-brain-mets-precoc…

JimC
Forum moderator

ocean

Hi Judy and JimC,

Thank you for your replies - they were both really helpful. - and thank you JimC for the link, that was also very useful.

I thought that would probably be the case (benign vs met), but wanted to get everything clear before asking my dad again (I think I have made him stressed asking questions). I dont live in the same country so it has all been over the phone....

I think there must be a break down in communication somewhere as he described the brain lesion as "small, benign and marginal", but then said yes that it was a met and also that the dr said they were linked and should be treated the same as they would react the same.

He has kind of already had a second opinion on the dx at least - as he was abroad when symptoms first appeared and had to go to hospital. - so they did scans and dx, then as that hospital were so slow sending copies of scans - everything was repeated at home.

He has not had a biopsy on the brain, only on the lung lesion (not sure what type). I am guessing that if it is too tricky to operate on the brain lesion, then the same would apply to a biopsy. So I'm wondering - how clear is it from various types of scans whether something is benign? Could the dr not know for sure?

Thanks again!

Dr West

You can't know for sure without a biopsy, but you can be 99% sure, or maybe more, based on finding a spot that looks extremely like a metastasis in someone with a cancer that is known to commonly spread to the brain. We don't consider it necessary to biopsy a brain lesion when the overall picture is exceptionally consistent with a brain metastasis from a cancer that started elsewhere, and which has been biopsy-proven outside of the brain to be cancer.

Good luck.

-Dr. West

ocean

Thank you for that Dr West.

It is good to know that it is possible to be pretty confident in the dx.

Just to clarify: when you say "based on finding a spot that looks extremely like a metastasis" - do you mean either that a met would appear differently on a scan than something benign - or just the fact that there is a further lesion in addition to the biopsy-proven cancer that the lesion would look like a metastasis?

Thanks again, your comment was very muc appreciated!

JimC

ocean,

It may be difficult to differentiate a benign vs. malignant lesion in some cases, but as you can see from this article, there are methods radiologists can use to try to distinguish one from another: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797474/ In addition, when a lesion appears in the brain in the context of an existing cancer diagnosis, without any other apparent cause, doctors can be confident that it is a malignant process.

JimC
Forum moderator

ocean

Hi JimC,

Thank you. Well obviously not the answer I would have hoped for, I can't say it was unexpected. It helps to know what is most likely going on - rather than the back-and-forth that has been happening so far.

Thanks again.

cards7up

Just to clarify, I was asking if the brain met was biopsied since they said it was a met but it was benign. I understand that they can tell from the MRI if it's a possible brain met. I also know they don't biopsy every brain met. Take care, Judy

ocean

Hi Judy,

Ok, thanks for clarifying - I didn't quite get your point before. I wonder if benign was just an unfortunate word choice by someone along the way - as my dad has also described the brain lesion as being of fairly low risk and the lung lesion as fairly inactive. (I think an old head injury was originally a possibility - so it could also have come from that...) I am now a bit wary of reading too much into any of this, so I'm sorry if that doesn't make sense...

Thank you for your advice.