Tom Galli

Nur, Welcome here. To reinforce Lou's point, we are not doctors. Sometimes we can answer a question about medical terminology and perhaps words common to a radiologist's scan report but we certainly can't assist in diagnosis. I understand your mom is frail and two attempts at using a flexible bronchoscope did not yield a biopsy. Lou mentioned a guided needle biopsy and that is a less stressful way compared to a surgical biopsy. But, a biopsy is required to determine the type of lung cancer before treatment can begin. So basically you are left with surgical methods. Here is some information about the type of biopsies used in diagnosing lung cancer. The two surgical methods cited are a Thoracicoscopy/VATS and perhaps a Mediastinoscopy. You might want to ask your mom's doctors if these procedures can be performed on your mom. These are less aggressive than a full opening of the chest (called a thoracotomy). A thoracotomy would indeed be challenging for your mom given her complicating medical conditions. Another important criteria for treatment is the stage of lung cancer. Staging defines the number, size and locations of nodules or masses in your mom's lungs or other organs. Do you have insight into your mom's lung cancer stage? Here is information about lung cancer staging. If, for example, your mother's cancer is small and situated in a single lung, surgery might be an effective treatment method. What should you do? If it were my mother, I'd help her understand that a biopsy is necessary before treatment can begin. The biopsy yields the type of lung cancer and each type has differing treatment methods. Here is information on the types of lung cancer. I'd tell her about the medical risk implied in a surgical biopsy and help her make a decision. Then I'd support her decision. I hope this information is helpful. If you have more questions, ask away. Stay the course. Tom

Today, I celebrate 18 years of life after diagnosis with lung cancer. Normally, I'd paint my toes and post. Of course after 10 years, I had to invite more feet to the photo-celebration. But, on this day, indeed, in this week my hometown is ice-bound and my planning skills have waned because my celebratory bottle of Lungevity blue nail paint is exhausted. So, no photo this year. There are so many lessons I've learned during my diagnostic, treatment and survival journey. Two among them bear mention: The objective of treatment is life; do something you enjoy with the extension. And, if I can live, so can you. Indeed... Stay the course. Tom

Jason, Welcome here. Unresolved spiculated lung nodules, 47, good health, and concern, I completely understand. Learning your PET result adds apprehension and perhaps confusion. The benign lymph node biopsy is comforting, but might your lymph node SUV be the result of an infection. And might your lung nodules be lung cancer? Any SUV above 4 is an indicator of metastatic disease but infections can also generate high uptake. Diagnostic grade blood biopsies are medically down the road so I'd be inclined to disregard the lack of cancer markers. Lung nodules occur for many reasons and most of them are not cancer. Here is my go to resource on pulmonary nodules. But your nodules are deep in the lung and distant from mediastinal and hiller nodes. Of course, I'm not an expert on lymphatic system connections, but all this is to say I share your concern. Your nodules are small. Perhaps the 1 cm nodule could be a target for a needle biopsy, but there is a lot of pulmonary plumbing in that area making a needle biopsy tricky. Waiting 3 months is maddening, but it is also a pretty standard situation in our community. I suggest adding a medical oncologist to your team, and let this doctor review the test results. I'd ask your medical oncologist if a second PET can be administered after your infection is resolved. That might remove your concern. Again, welcome here and I hope your time with us is short based on a definitive nodule determination. Stay the course. Tom

Saskgirl, I don't know of treatments or trials to control or stop pleural effusions. Their cause is irritation between the exterior of the lung and the interior tissue of the pleural space. This irritation is driven by cancer's presence and the only way I know to stop effusions is to treat and eliminate tumors and metastatic activity. Immunotherapy can be effective and you've only been on this treatment for 4 months. I hope it takes hold and eliminates your lung cancer. Stay the course. Tom

Czechag, Many of us get an internal drain installed to deal with pleural fluid. Thankfully, I didn't need to have one but did experience several accumulations and drainage. Inflammation of the pleural space is indeed the cause but what causes the inflammation in my case was an open question. Your guess of Imfinzi is likely a good one. Welcome here. I do hope Imfinzi continues to control your lung cancer. Stay the course. Tom

Minh, So very sorry to learn this. Treatment plan is a good one. Thoracentesis will immediately give your relief. Oncologist should (must) order pleural fluid test for malignancy. Likely you'll spend about a week on antibiotics. The thoracentesis will be over in less than 30 minutes. Stay the course. Tom

Minh, I completely understand your situation. In fact, I've experienced many treatment delays because of other medical complications. Just try and get some rest. You might ask your doctors for a sleep aid. That might help with your exhaustion. Stay the course. Tom

Minh, Normal and lung cancer are words I hesitate to use in the same sentence. That said, you might indeed have a pleural effusion, but until it is drained, you won't know if is malignant or not. When your effusion is drained, the pathologist will look at samples under a microscope and determine malignancy. So, yes you could have a pleural effusion, and yes they do occur after lobectomy, but no one can predict malignancy until after your effusion is drained. I know, peace after lung cancer is a hard thing to achieve. But, you've been through a lot already in your treatment. Give yourself a break and relax a bit. Try not to worry until the test results are in hand. Stay the course. Tom

Lizzy, I’m happy treatment is proceeding without adverse side effects. Let’s pray for good results! Stay the course. Tom

Lizzy, Stay the course! Tom

Lizzy, Walter Reed—The Army Medical Center? In my active duty tenure, I spent more time than I care to remember at WRAMC. Since then, I think they closed the Army hospital in DC and rebadged the Navy hospital in Bethesda as Walter Reed. Either way, you are in good hands Stay the course. Tom

Lizzy, I'll add my welcome to Robert and Lou. I do hope your biopsy sample is being sent to a laboratory for bio marker testing. (I linked an informative article describing this very important testing). Certain types of adenocarcinoma display driver mutations that can be exploited by targeted therapy. If your tumor has the indicated bio markers, you could experience remarkable results from these new treatments. Moreover, this testing also discloses the likely suitability of immunotherapy treatment as a treatment method. Again, this new regime has remarkable results. From your description, your cancer will likely stage at IV. I had a stage IV progression during treatment. I'm alive nearly 18 years after diagnosis. I offer this information because if I can live, so can you. Stay the course. Tom

Justin, In my chemo-radiation treatment, both my red and white cells dropped dramatically. I had injections of Neulasta and Procrit each week and these two drugs allowed me to keep on therapy schedule. Stay the course. Tom

Lisa, Well said and well done. I specifically endorse removal of social media apps from the phone in preference for checking one's computer for updates. That is a key suggestion to avoiding overload! Stay the course. Tom

Lana, Welcome here and I am overjoyed to learn of your treatment success. Seven years is indeed a significant period and I hope future scans continue to reflect good news. Stay the course. Tom

Judyb, Welcome here. Your's is a great good news story and I am so happy you've found us. Regardless of lung cancer flavor, any form of lung cancer is the elephant in our room forever. Unfortunately, we are all in the same boat, but I am so pleased to hear your boat is still sailing. Stay the course. Tom

Karen, Welcome here. If your question about fluid removal involves draining a pleural effusion, then yes I’ve experienced it. I had a local anesthetic and a long needle was used to withdraw the fluid from the pleural space. My discomfort breathing was immediately relieved. I admit, I was concerned when I saw the rather large needle, but I didn’t feel a thing. Does the fluid come back? Sometimes. The fluid results because the lungs are experiencing irritation. Judy reports her Tagrisso stopped the fluid and mine never returned when I started chemo. I do hope you have but one drain session and results improve with Tagrisso. Stay the course. Tom

Justin, I also find your nurse's communication odd. In my 18 years experience with lung cancer treatment, a nurse never explained scan or test reports or suggested treatment. In the United States, these functions are performed by a physician. But the UK National Health System might operate by differently. I do hope you are able to see a physician to gain understanding of your test results and future treatments. I don't know what radical chemotherapy means. Turning to a dictionary, the word radical contains the definition of "relating to or affecting the fundamental nature of something; far-reaching or thorough." Perhaps the nurse's descriptor of radical implies thorough treatment. Thorough could mean treating cancer throughout the body in several or many locations. Indeed, this is the benefit of chemotherapy; its ability to address cancer throughout the body. Normally one receives a chemotherapy plan that involves the discrete drugs to be used and the interval of use (say Taxol and Carboplatin, 1 infused dose once every 3 weeks.) But, to formulate a chemotherapy treatment plan would presume the type of lung cancer is known (from the biopsy test) because the type of chemotherapy used is keyed to the type of lung cancer one has. You've described your cancer locations "in the right upper lung" and involving lymph nodes. Depending on the extent of lymph node involvement you might stage at IIIA or IIIB. The latter might take surgery off the table as a treatment modality. And, a PET scan identifying another metastatic site in another part of your body would point to a stage IV diagnosis. Here is more information on lung cancer staging. Some stage IIIB and all stage IV disease are not treated surgically but rather with chemotherapy and perhaps radiation. So, and this is an educated guess, your nurse may have been trying to communicate you had stage IIIB or stage IV disease by using the words radical chemotherapy. I am trying to offer you an explanation of the nurse's words radical chemotherapy. It is an odd term in my understanding. It would have been far better to have a complete discussion of all your test results with a physician, hopefully a medical oncologist, who would explain test-by-test what is revealed and what the appropriate treatment possibilities are. I do hope you get that kind of diagnostic explanation soon. Stay the course. Tom

Kris, EGFR results are important but I see no harm in having a radiation oncology consult. There are two disciplines who treat our disease: medical and radiation oncologists. Each brings different tools to the job and each has value. Glad your surgery recovery is going very well. Chest tube discomfort can be a "pain" but I found it leaves quickly. Stay the course. Tom

My CT was on August 30th but I needed to wait till today to get the results—from a new medical oncologist. He’s my kind of guy achieving undergraduate and graduate degrees in engineering before going to med school. We talked a bit on how things have improved since the dark ages of my diagnosis. I told him of my rabid scanziety driven by a 12-day dwell from test to results. He told me I’d not receive the same treatment if I was diagnosed today. I told him I was happy I was not being diagnosed today, or was I? I find inspiration when encountering stirring words while reading. An article about Joshua Chamberlain, a professor of languages and rhetoric at Maine’s Bowdoin College, told of his exploits as the country slipped into the Civil War. Chamberlain knew nothing about soldiering when Maine stood up its first regiment and declined the governor’s offer to command claiming insufficiency. But, he joined the cause as a lower ranking officer to learn how to soldier. He learned well. His leadership and commandership at the battle at Little Round Top during the second day of Gettysburg is still studied by current-day Army officers. For his courage, skill and character in that battle, he was awarded the Medal of Honor. On dedicating a memorial to Maine soldiers at Gettysburg, 25 years after the battle, Chamberlain asserted “it is character that tells.” Similarly, the tell in surviving lung cancer is character. Chamberlain said: “What I mean by character is a firm and seasoned substance of soul. I mean such qualities or acquirements as intelligence, thoughtfulness, conscientiousness, right-mindedness, patience, fortitude, long-suffering and unconquerable resolve.” A “firm and seasoned substance of the soul” that results in “unconquerable resolve” to survive. That essence is built day-by-day as we endure treatments, sometimes cycles of treatment, sometimes cycles-upon-cycles all with uncertain outcome. What was my scan outcome, you ask? All the typical magic nodules waxing and waning from scan-to-scan showed up. He laughed about me charting their location by spreadsheet. And we had the hypo-dense vs. hyper-dense liver lesion discussion, and a remark about that kidney stone that has been hanging around for 10 years. Then he told me he was reducing my oncology appointments to 1 time-per-year and changing up my scan to a low-dose CT chest type without contrast. He said that interval and type of scan is fully appropriate for one cured of lung cancer. I guess scanziety builds character! Stay the course. Tom

D, Oh my that is good news about your scan. A decrease from 1.2 cm to 4 mm is substantial indeed. And I'm quite certain precision radiation will eradicate that spot on your arm. A great report that is on the road to NED (no evidence of disease)! Stay the course. Tom

Welcome here. Lexie and Michele have provided excellent advice. On Social Security Disability, you might want to read this if you intend to apply. Note that Stage IV decisions are typically rapid and approved. Glad to have you out of the shadows. Stay the course. Tom

Kris, Wonderful news! Let us hope your September followup is without drama. Stay the course. Tom

Barb, How about that! A good news report on your surgery and all ready back to work. Good for you! Now please recognize the importance of future scans to check for new mets. Unfortunately, the thing that makes lung cancer so dangerous is its propensity to recur after NED treatment. I've had plenty of recurrences in and believe me, you don't want to go down that path. How frequent is recurrence after NED? Here is some relevant information. Stay the course. Tom

Bee, Welcome here. No problem understanding your English. Your writing is much better than my GI German. Let me sum up what you've told us. Your dad was diagnosed with SCLC in November 2020. His first line treatment was a combination conventional chemotherapy (common in the US is Cisplatin and Etoposide) and the immunotherapy drug Tecentriq. The addition of immunotherapy is a relatively new treatment modality in the US. Unfortunately, small cell has a disturbing tendency to metastasize to the brain. You mention 3 discrete tumors and this is far better than another common brain metastasis: many very small tumors throughout the brain. In the US, a form of precision radiation is normally used to deal with "brain mets" as we refer to them. There are many types but all are characterized with radiating a very small precise area of the brain, zapping the tumor, with minimal and perhaps no damage to surrounding brain tissue. Collectively these types are called External Beam Radiation Therapy (EBRT) but there are many forms. Some of these are SBRT (GamaKnife is a device name that delivers SBRT to the brain; there are other devices.), IMRT, IGRT and others. Here is some material on precision radiation used in treating brain mets. Your dad does have a very good chance or eliminating these brain mets with the aforementioned radiation therapy. However, with all lung cancer, especially small cell, recurrence is common. I've had 5 in my treatment history so I'm sure there will be continued monitoring in the form of CT scans for the body and MRIs for the brain in his future. I do hope his treatment eliminates his brain mets. Stay the course. Tom