What to expect - 1265087

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rick3401
What to expect - 1265087

Hi
I apologize if this post is too detailed, I don't want to violate any forum rules. Just looking for what to expect next. Had a pet scan done 3 weeks ago and scan revealed an 8cm x 6cm left apex tumor. Suspicion is high for malignant pancoast.. The tumor is encroaching on the sub clavian artery, a few upper vertebrae, and esophagus. The report indicates the mass almost completely fills the left apex. The highest SUV value was 10.03 and also showed at least 1 hylar node lit up but not sure of the SUV value on that. Biopsy is scheduled for 07/30. If anyone familiar can give me an idea what the next steps may be I would be much thankful.
Peace and best regards to all.

JimC
Reply To: What to expect

Hi Rick,

I'm sorry that you are dealing with this, and the uncertainty that goes along with it.

At this point, the next steps will be determined by the results of the biopsy. If it is positive for cancer cells, then treatment will be recommended, either surgery, radiation or systemic treatment such as chemotherapy or targeted therapy, or some combination of these.

If the biopsy does not reveal cancer cells but also cannot confirm the presence of something else (such as infection), then your doctor will recommend further workup in order to determine what this represents.

Good luck with your biopsy.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: What to expect

Yes, the biopsy is typically the next step. In addition, we'd almost always complete staging with a brain MRI, which is hopefully not going to show brain metastases, but you wouldn't want to presume anything.

If the cancer is limited to the places you described, it's most common to initiate chemotherapy and radiation concurrently. If surgery is feasible, which is a question that needs to be deferred to the most expert thoracic surgeon within striking distance (and not a general surgeon who says that they also do some lung surgery between gall bladder and appendix surgeries), surgery is often done after about 5 weeks of chemo and radiation. If surgery can't be done safely, then chemo and radiation are typically done for a little longer -- more like 7 weeks. Sometimes additional chemo is done after the surgery or the concurrent chemo and radiation, but that aspect gets much more variable, on a case by case basis, depending on how the patient and their cancer are doing.

Here's a bit of general information on Pancoast tumors:

http://cancergrace.org/lung/2007/10/12/pancoast-tumor-intro/

http://cancergrace.org/lung/2007/10/15/pancoast-trimodality-rx/

Good luck.

-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

rick3401
Reply To: What to expect

Thank you Dr West and Jim for the rapid replies. Dr West I have read many of your posts on pancoast tumors and appreciate that you took the time and detail. MRI of the brain may not be feasible as I have a pacemaker implant. A recent CT of the brain did not cause alarm with the radiologist so hopefully no MET there. I intend to be very proactive in my treatment process and perhaps get into a clinical trial somewhere. So far not many of the Drs I have spoken with are familiar with Pancoast and I may need to look for experts outside my area.
I know that pet scans can light up infection and still hopeful that may be the case however my Pulmonologist and radiologist seem pretty certain it is not infection given the Findings thus far. I await the biopsy and go from there. Thanks again.

Dr West
Reply To: What to expect

A CT of the head is a reasonable substitute when people can't get an MRI, especially if you aren't having neurologic symptoms.

Yes, the biopsy is what confers proof of the diagnosis.

Finally, as I emphasized, a Pancoast tumor is one where experience and expertise really matters. Even if you get treatment close to home, it's helpful to get input on what that plan should be from the best regional experts you can find.

Good luck.

-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