Sister with stage 3B lung cancer

[Guest meinman]

I found this wonderful site while doing research on the internet. I have a 47 year old sister who went to the doctor with right shoulder pain back in October. She was originally diagnosed with pnemonia. However, the pain continued and she was referred to a pulminary specialist. The specialist did a broncioscope which was came back negative. A needle biopsy showed cancer. She has since had a pet scan that showed a tumor in her upper right lobe with lymph node involvement. The original surgeon she saw was willing to operate after chemo and radiation if her tumor shrank. However, he did not take her insurance. The new surgeon said that operating was not a possibility if there was any lymph node involvement. He wants to biopsy her lymph nodes. He told her that once he hit a cancerous lymph node he would stop. He also said that he would change her course of therapy to radiation alone. The only hope he gave was that her most recent CT scan showed normal lymph nodes. I thought PET scans were supposed to replace biopsies. He said it is considered major surgery and there is a chance that her lung could collaspe. Desperately need some feedback.

Mary

[Marlon]

Hi Mary,

My mom started off with shoulder and back pain. It sounds to me like you have got quite a difference in opinions from two different surgeons. My co-worker's mom also had lymph node involvement, but surgery was still an option for her. She did chemo, and the tumors shrank enough for her to undergo curative surgery. I'm not certain, but I believe it is the number and location of lymph nodes positive that determines whether a patient is a surgical candidate or not. They determine whether a patient is Stage IIIA(usually operable), or Stage IIIB(usually not operable at first) by the number of tumors and the extent of lymph node involvement. I would definitely seek another opinion.

A PET scan will show whether it is cancer or not, because it measures the metabolic activity of any tumors in your body. There are risks in every surgery, minor or major. In some cases, they need to collapse the lung in order to operate on the tumor, but they can re-inflate it. Please be aggressive with the doctors, and don't stop until you find someone who tells you what you want to hear. Especially when your research indicates other options. And visit this board often! It undoubtedly has played a role in my mom's being in remission.

[Guest]

Hi Mary,

Your sister's situation sounds a lot like my Dad's. He was diagnosed with Stage IIIA/B lung cancer in October 02. The PET scan showed that the mediastinal lymph nodes (in the center of the chest) were involved, however only a biopsy would confirm it 100%. The doctor gave us two options: to either go ahead begin chemo and radiation, or to attempt the biopsy, which could result in a collapsed lung. Dad wanted to try the biopsy, even thought there was only a 1-2% chance they were benign. If it meant he wouldn't have to undergo chemo/radiation, then he wanted to give it a shot. If the lymph nodes came back "clean", then surgery was an option to remove the tumor from his lung. If they were cancerous, then they are inoperable and chemo and radiation were the right course of action. Unfortunately, the lymph nodes were cancerous and he just finished his first round of chemo and radiation. He has tests at the end of the month to see how well the treatment did.

So, I think it depends on the location of the lymph nodes, some are operable and some are not. PET scans show "hot spots" and are very accurate in aiding the diagnosis, however I don't think they replace biopsies.

You and your sister will be in my thoughts and prayers. This nasty disease can be beaten!!!!!

Warmest Regards,

Amy

[Tiny]

Hi Mary,

Yes, it depends on where the involved lymph nodes are as to what stage the cancer is designated. My first CT scan showed no lymph-node problems, but the follow-up PET scan indicated a metabolically active lymph node "in the posterior right hilum". Because it did not show lymph-node involvement in the mediastinum, I was still a candidate for surgery. The post-op pathology report confirmed metastasis to 2/4 lymph nodes in the N-1 position. I was staged IIa (T1 N1 M0). Maybe you need yet another opinion or two. Be sure to ask for copies of scan reports, bloodwork reports, doctors' chart notes, etc., for you and your sister to keep and read and reread and refer back to. Ask for clarification of anything in them that you don't understand. Best of luck.

[Guest meinman]

Thank you for the clarification. My sister is going to do the biopsies. I'll let you know how it goes. She is very depressed as is her husband. I'm trying to lift her spirits with words of encouragement but she is very depressed. My father died of lung cance at 53, and she is in some ways very fatalistic. My three nephews are great kids but they are scared. Any suggestions on how to snap her out of it would be appreciated.

Mary

[Karma1976]

my dad got his lung biopsy and he said it was easy except for the fact he had to be still and he was a little uncomfy holding a position. they watched him for a while to make sure the didn't have to admit him for any problems resulting form the biopsy and he went home.

[Guest]

My husband has Stage IIIB/IV (no one has ever come to a conclusion) of the pleural lining of his left lung with a malignant pleural effusion. 58 yr, Non-smoker

His PET scan lit up like a Christmas tree but adrenal, lung, liver biopsies and bone scan were all negative. He has been a tough one for MD Anderson to figure out.