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I was diagnosed with COPD (severe emphysema) in 2014. Had a routine CT scan done 11/26/17 where a 9mm left apical speculated nodule was seen. PET/CT recommended. PET impression read, solitary speculated left apical nodule is hypermetabolic and likely malignant. Tissue diagnosis recommended. I was given the PET results at the end of the year and due to an insurance change had to find a new pulmonologist to order the biopsy. I am scheduled to see him on the 20th and the waiting is driving me mad.

I have been researching types of biopsies and there is very little I could find about the additional risk due to having COPD. Not sure which type would be best for me. Also, are the scan results positive it is cancer and the biopsy is for identifying and staging purposes? Hoping someone can give me some guidance. I am pretty scared.

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Hi Tamara,

Welcome.  I am not an expert on biopsies, but I can tell you about my mom's experience with them.  My mom did (past tense) have COPD, the majority of it was in her right, upper lobe (her upper right lobe was removed as part of her cancer treatment).  This was also where her nodules were.  She had a regular needle biopsy (there are a couple of different types of biopsies) - she had no issues at all besides a sore throat for a few days.  Initially her pulmonologist was worried about her breathing during the procedure just because she had COPD and was severely overweight, but all went extremely well and she was in and out in a matter of a few hours. There are always higher risks for folks with COPD in any situation where they are sedated, but good pulmonologists and anesthesiologists are used to dealing with the challenges of COPD.   

As far as scan results being positive it is cancer - all that the PET scan is telling you is that there is a something there and it is "active" - nodules can be active and not be cancerous.  The only way to know for certain if a nodule is cancerous is through a biopsy.  As far as staging goes, all aspects of the possible cancer situation is taken into consideration - size, area, has it traveled elsewhere, etc.  The nice thing about biopsies is that they can be tested for a variety of mutations that can lead to more options for treatment - immunotherapy, etc.  

I am so sorry you have to wait for your biopsy, especially due to the ridiculousness of insurance :(  The waiting seems to be the worst part, especially in the beginning.  I am sure you will hear from others very soon who will be able to better share their wealth of knowledge about the topic. In the meantime, you can check out what lungevity has to share about biopsies and staging: https://www.lungevity.org/for-patients-caregivers/lung-cancer-101/diagnosing-lung-cancer/biopsies   and   https://www.lungevity.org/for-patients-caregivers/lung-cancer-101/lung-cancer-staging

Take care,

Steff

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Tamara,

Steff's information on biopsies and staging is spot on.  

I completely understand your fright.  My diagnosis and treatment were very frightening times.  That said, in 23 days, I will celebrate my 14th year of survival with advanced stage, metastatic non-small cell Squamous cell lung cancer.  I relate that fact because if lung cancer is confirmed by biopsy, if I can live, so can you.

You are most welcome here and we are happy to address any questions you may have.

Stay the course.

Tom

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Hi, Tamara, and welcome!  I don't have any input on the issue of biopsies (I went straight to surgery and cancer confirmed during surgery, resulting in upper left lobectomy), but you'll get good info from the other folks here.  I know how tough the waiting is--hang in there!  The good news is that your nodule is still pretty small, which is always a good thing.

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Hi Tamara

My husband has severe COPD and was able to have a needle biopsy without any problems.  These type of patients have higher risks but the team at the hospital was great and everything went well without any issues.  Hopes this helps

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Met my new pulmonologist yesterday. After reading through my file and looking at the scans he determined the nodule needed to be removed as soon as possible. It's location, the upper tip of the left lung, is hard to get with a needle and with the condition of my lungs he would not recommend it. He said there is only about 1% chance that it is not NSCC. Therefore, it would need to be removed anyway so why attempt a risky procedure. Let's just get it out of there before it spreads to the Lymphatic system. I see a Thoracic surgeon Feb. 1st and will find out more then. Has anyone had a wedge resection? I would like to hear about your experience, if you care to share it. Thank you all for your information and encouragement. It helps a lot to have some one to talk to.

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Tamara,

Many have had wedge resections.  Many have had VATS resections.  Let's get some input for you.  CALLING ALL Wedge & VATS resections!  Give Tamara feedback on your prep for surgery, hospital experience, and healing time and troubles.

I had an old fashion complete lung removal.  One thing I absolutely recommend is that you audition a wedge pillow for your bed.  You'll need to sleep elevated for perhaps 10 days to 2 weeks and the wedge will allow that.  You are looking for about a 12 to 15 degree elevation.  Many mattress stores stock wedge pillows.  I'd audition several in the store, not make and model, then buy on Amazon for better pricing.

Stay the course.

Tom

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Hey, Tamara, that's pretty much word-for-word what my pulmonologist and surgeon told me.  It was suspicious enough that it should be removed, period, and there was no real advantage to doing a biopsy.  I felt very confident about their recommendations, so I was on board with what they recommended.  

I had VATS surgery--the surgeon first removed a section of the lung with the tumor, and once the tumor was confirmed to be cancer (while I was still in surgery), he removed the affected lobe (which is the safest course of action--wedge resections are used for cancerous tumors without the full lobectomy only where lung function is not sufficient to remove the affected lobe (that's my understanding, anyway).  I don't know how your COPD will affect whether they will go on to remove the lobe if the nodule is cancerous--that's something to ask.  

The VATS was very simple.  The only prep was to fast the night before.  I  also had a PET/CT, which was very reassuring because the suspicious nodule was the ONLY thing to light up.  After surgery, I had a sore throat for a day or two (due to the breathing tube).  I was released two days later.   I did have a minor complication (not dangerous, but fairly uncomfortable) of a small air leak that caused my face/neck to swell up, and resulted in my being readmitted for a few days with a chest tube to be properly deflated.  I had relatively little pain--I only used the narcotic pain meds for a couple of days, and then nothing but ibuprofen.  I was able to drive once the chest tube was removed, and was out with friends for dinner and a concert less than two weeks after my surgery.  I was coughing for a while, which is normal, and may abdominal muscles got a bit sore from that.

It did help (as someone here recommended to me) to have a wedge pillow to sleep at night.  You have to do your breathing exercises afterward, too, which are probably especially important, given your COPD.  I felt almost completely back to normal within a very few weeks.  I was walking three miles a day about a month after surgery.  

My surgery was in July.  I have three tiny scars on my side/back, very slight numbness around the incisions, and a very slight twinge if I have a sharp intake of breath (like right before sneezing), but it doesn't qualify as "pain."  In short, I am scarcely aware of the fact that half my lung was removed--which I would never have believed.  Because my cancer was stage 1b, I had the option of chemo after surgery, but decided just to keep monitoring it--a decision with which my oncologist was perfectly fine.  I just go for scans a couple of times a year.

Teri

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Hi Tamara,

I also had a nodule that couldn't be biopsied by needle because of the location. I had a lower right lobectomy by VATs and my experience was not much different from LexieCat's, except that I was released from the hospital the day after surgery with a chest tube in place due to an air leak. It was in for t0 days. Lexie's advice about the wedge pillow. I was adviised to sleep with my upper body at a 45 degree angle. I tried to acheive this with pillows and ended up with an aching neck. The wedge was a reilief. A 12 inch wedge will give you 45 degrees.

My thoracic surgeon said  they couldn't do a wedge (no relation to the pillow!) resection because of the location of my nodule. A wedge resection would have cut off the circulation to a big part of the lobe below it, which would have then died. So they took out the whole lobe. My NSCLC was stage 1a. It was so small and slow growing that it didn't light up on the PET scan, but it looked really suspicious, so it had to go!. 

My surgery was in November 2016. I don't have any pain, not even a twinge and no shortness of breath.

If you have any other questions, feel free to ask.

Bridget O

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