Hi: Was told Dr. West is here who is a BAC specialist. I know I cannot substute website answer from Dr. visit, but want his/other Dr. opinion none the less. Will help firm my opinion for follow up care.
Background: Wife had been diagnosed (6 weeks ago) with Stage IV adenocarcinoma with BAC feature. RUL 5.5X2.5 cm mass biopsy confirmed adenocarcinoma. RML: 4mm nodule with GGO to 1cm no biopsy. LUL: 4mm nodule with GGO and biopsy showed atypical, suspect malignancy. EGFR possitive with exon 19. PET scan show no mets to other organ and brain MRI clear. RUL shadow had been there for many years on X-ray, all were judged to be scar/pneumonia/prior TB exposure etc. Start to have chest pain on the right side.
Dr. want to start tarceva, but I read that for bilateral stage IV, surgery still could give good result if no mets outside of both lungs. We want to have this operation while still can and save the Tarceva path for later. She need all the weapon possible. We have found a second Onc/thoracic surgeon who agree that we can have this window for surgery. First will be in days, RUL lobectomy and at the same time RML wedge. Second operation in 4 to 6 weeks, LUL wedge.
My dilima: I still believe strongly to go through the first operation. The mass is big and pain had started. Also want to get this source of cancer out so it does not emit cancer cells all over. I start to have doubt on weather second is necessary. Here's why. If she go through both operation, will she be on adjuvant Chemo or Adjuvant Tarceva? Dr. said and I have read that BAC is not responsive to Chemo, If she is on adjuvant tarceva, would the second operatoin be wasted? Thanks for reading and your wisdom is appreciated.