when to get a stent - 1262336

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ssflxl
when to get a stent - 1262336

In past 2 month, I have struggled with congestion and wheezing/cough - felt like rock in my chest. feeling is different from an infection. in past 4 days, I had severe left arm pain and tingling, esp when I get up or go up and downstairs.
I had chest CT done 2/14 which showed:
Increase in size of the LEFT apical lung mass measuring approximately 5.6 x 5.9 x 5.8 cm (AP x TR x CC) since PET/CT on 10/11/2013. Further compression of the LEFT upper lobe bronchi with complete occlusion resulting in lobar collapse. LEFT upper lobe pulmonary artery is also compressed to occlusion. No
extrathoracic involvement into the brachial plexus. Lingular nodule measuring 1.8 x 0.9 cm is compatible neoplasm. Limited comparison with PET/CT given the differences in slice thickness. Stable small LEFT pleural effusion. Other findings include LEFT renal angiomyolipoma and LEFT T11-T12 neural foraminal soft tissue.

I am scheduled for Carbo/Pem m on Thursday - 2/20. MY QUESTION IS: SHOULD I GET A BRONCHIAL STENT TO OPEN UP MY LUL? also should I ask about stenting for the pulm artery that is occluded. I believe that is the cause of my arm pain - there is less perfusion to the arm. Can the stenting be done safely? should I push for it or is it just minimally beneficial in my case?

thanks

ssflxl

catdander
Reply To: when to get a stent

ssflxl, How awful you must feel, I'm so sorry. With so much going on at the apex of your lung I can see how the nerves might get compressed near the brachial plexus even if there is no involvement. My husband certainly had a lot of pain into the arm as well. Though I'm just guessing.

As you probably know our doctors can't say what one should do. It's a big no no on the forums both legally and just because they don't have the information needed to make those calls. I hope you understand. I'll make sure Dr. West or Weiss sees your post.

Please keep us posted and know you're in my thoughts,
Janine

ssflxl
Reply To: when to get a stent

Let me rephrase this question when is a stent indicated ? under what circumstances is a stent indicated

Dr West
Reply To: when to get a stent

A stent is certainly a very appropriate option to consider here, and I think an interventional pulmonologist would be very helpful to enlist for consideration of whether this would be a good option. Less commonly, an interventional radiologist might stent a vessel. But since so many things -- bronchus, vessel, and nerves -- may be compressed by the cancer, a leading option in this setting is probably radiation, which is more likely to reliably debulk the cancer and decompress everything.

Chemotherapy is certainly an option as well, but it's less reliable than radiation in shrinking a specific area significantly.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

ssflxl
Reply To: when to get a stent

Dr. West,

thanks for your opinion. Radiation is not an option for me anymore since I already had radiation in this area twice in the past, so Rad Onc said no more radiation. I realize chemo is not the best option for this and even if it works, it will take some time. That's why I ask about stenting in the bronchus and pulmonary artery.

ssflxl

catdander
Reply To: when to get a stent

Thanks ssflxl for rephrasing. Sometimes it's the little things that become significant in this type of forum discussion. Thanks for understanding and making it work for you.
I sounds as though you're leaning toward a stent?
In the meantime I hope you're able to mitigate at least some or most of the pain. As I said before my husband's pain from the pancoast tumor was intense and for quite some time left undx. Pain killers and nerve pain meds (lyrica for D but some use Neurontin (Gabapentin) made an exquisite difference in his life before debulking treatment. I hope you don't hesitate to try something like that if you need a break.

ssflxl
Reply To: when to get a stent

dear all

my onc asked the pulm about stenting the LUL and we're told that it is very difficult if not impossible to stent the LUL (or RUL also) due to its anatomy and multiple bifurcations. So just fyi - upper lobe collapse - no stenting.
I will be getting my first dose of Carbo/Pem tomorrow so wish me luck!! I hope my cough/sob/arm pain subsides soon. I am sick of having these problems since I have already put up with them for over 2 months.
will post after I get chemo.
I just want to know how soon my counts will be down? I assume it will take a few days before that happens.

thanks

ssflxl

catdander
Reply To: when to get a stent

In response to a question about the chemo doublet carbo/alimta Dr. West stated, "I standardly have a complete blood count checked 10-14 days after the chemo is given, to test the nadir (low point) in blood counts," http://cancergrace.org/topic/stage-2-nsclc-adenocarcinoma-chemo-strategy...
(it's Dr. West's 4th response in the thread timestamped March 24, 2013 at 4:05 pm #1255097 .
If your counts are lowered by the first cycle it will be in those 10 to 14 day post treatment nadir period.

I hope that helps,
Janine

ssflxl
Reply To: when to get a stent

Janine,

Thanks. I hope to have symptom relief soon after the chemo!!! A new adventure for me!!

ssflxl

Dr West
Reply To: when to get a stent

Yes. And I am not surprised about the pulmonologist's answer. As I replied earlier, I wondered if stenting an upper lobe bronchus would be feasible, based on the difficult angles. The explanation that it isn't is quite believable to me.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education