Mom saw the Oncologist

[Treebywater]

Hi! I am new here. I'm trying to make the transition from the 'welcome' board to the board at large so I have posted this both places. I know I'm ridiculous.

My mom just called after her appointment with the oncologist. He was apparently pretty upbeat and hopeful about mom's prognosis... as well as fairly non-committal. He said mom has a possible Stage II. That depends on the PET scan that they will do in a couple of weeks (more on that in a moment). He thought that the spots on the liver might be harmless cysts. 1 lymph node looks like it MAY be involved. Again... we'll wait on the PET scan to determine that. AND the results from yesterday's MRI were good. It appears that there is nothing in mom's brain. (She would say.... 'No suprise there!' ). Nothing appearing to be cancerous or cause for concern anyway according to the doc.

So she is encouraged, and I am encouraged too. And now they are headed my direction to spend some time with us before they do the PET scan. That worked out well because they can only schedule those at the hospital she must work with every other Wednesday and they were full up for tomorrow. I can't wait to see her and give her a big hug!!

So that is what we know now. Of course, if things slide the other way, we will deal with that too. Can anyone give me any information about what the course of action may be if the spots in the liver are cancerous?

Mom's coming! Yay!!!

Edited to clarify and reframe my question.

[john]

In general I don't think surgery is done after a response to chemo for stage IV cancer.

It is often done for Stage IIIA, sometimes but I think less likely IIIB.

Sometimes there is resection of metastasis if there is a solitary brain met and even bilateral adrenal tumor resection.

Here is a case of liver metastasis resection resulting in long term survival.

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=15242087

I am not a Dr, so discuss your questions with the doctor. One thing to keep in mind with the PET scan is that it is about 90% accurate and may not detect everything. And on the flip side sometimes there are false positives.

I *think* a medianoscopy will be more accurate in finding lymph nodes that are cancerous, but it is invasive vs non-invasive.

We might want to ask the Dr about clinical trials, even for stage II and ask about neoadjuvant (chemo before resection) vs adjuvant (chemo after resection) for stage II

There have been recent studies that indicate chemo after surgery for early stage lung cancer may increase survival

I personally think it is important to know the mitotic rate of the cancer and how differentiated the cancer is or isn't. This will let you know how aggressive the cancer *might* be. If the cancer is aggressive than consider more aggressive treatment.

Again, I am not a Dr, but these are some questions you might want to ask the Dr.

[Treebywater]

Thank you for the information and the heads up about what line of questions we can ask. For the moment, I think the best I can do is simply focus on being encouraged by what the doctor said in the meeting. It gave us all a bit of a lift to find out that this might not be as bad as we were all anticipating... and even if it isn't as encouraging as these 'maybes' we will find a way to take action.

We're all new to this so I don't even have a basic grasp of the 'lingo' involved here. (Translation: Speak in smaller words until I catch up, please ). I don't have any idea what you're talking about regarding the resections, etc.

From what I understand about what happened today we are still just in the information gathering stage... We don't have a good idea just yet of what the doctor has in mind or what direction he may want to try to take things... I'm sure he will give us a better idea of that after the PET scan. Until then, we'll hold on to this information and enjoy the time we have together while they visit.

Also, wanted to interject that I am in Washington State and they are in Illinois.... so I will not be able to be involved in very many doctors visits. I will pass the information on though.

Never mind my question. I think I will delete it. I was getting ahead of myself.

Again thank you for the assistance about what questions we might want to ask when the opportunity again presents itself.

Val

[karenl]

Hi Val

Sounds like a really positive doctor's visit. I agree that you should take what the Oncologist has said about it being a possible stage II, and just enjoy, rather than worrying about what the implications are if it is not. You will have plenty of time to research and worry later on if need be!!

I don't know what your Mom's doctor is like, but in our experience, they tend to be pretty negative, and present worse case scenario, so I would be encouraged by the fact that he is perhaps leaning the other way.

Have a great visit with your parents, and don't forget to look after yourself and that precious cargo you're carrying!!

Karen

[Andrea]

I *think* a medianoscopy will be more accurate in finding lymph nodes that are cancerous, but it is invasive vs non-invasive.

To follow up on the mediastonoscopy issue, what the surgeons at Cedars Sinai in California did on my mom was a mediastonoscopy after the PET showed the cancer confined to her chest. A lymph node did light up on PET, but sometimes they are false positives. The advantage of doing the mediastonoscopy is that they can go in, test the lymph nodes right there and if negative, they keep going and remove the tumor right away. Otherwise, as was my mom's case, they biopsied the tumor, closed her back up b/c the lymph was positve, sent her home for a few months of chemo and then she went back for surgery.

It is more invasive, but the benefits we were told was possible immediate removal of tumor.

[cindi o'h]

Hi val.

With me, they did a biopsy of one of the two main lung tumors, which showed malignancy.

Then they went to a mediastinoscopy to detect any involved lymph nodes...(metastases to there). The surgeon was hoping to find it all clean in there so he could flip me over to remove my lung. For me, that was not the case. He found some malignancies in the lymphs on both sides of my trachea/esophagus, so he just but a little tape over his incision and then I ate a big meal cuz I was so hungry.

Then I had a PET to see if there were distant metastases. And there weren't. So I had locally advanced disease and with lots of chemo, radiation, prayers from friends and strangers, I find myself giving you encouragement today.

A good medical dictionary was a big help. There was a library of sorts at the hospital where I could look things up too.

Mostly, keep coming back and asking questions. We will help you through all of this.

Cindi o'h

[stand4hope]

Hi Val,

All in all, it sounds like your mom got a pretty good report to start off with. As far as possible liver mets, my husband had one liver met, and they just continued with his chemo and now Iressa. That met has been stable the past 3-4 months.

By the way, congrats on her brain MRI. We call that "empty-headed". So, we are all thrilled that your Mom is empty-headed! LOL!

Keep us posted, Val.

Love,

Peggy

[Treebywater]

Mom is here. That is very good. It was so wonderful to finally hug her.

It is hard though too as I can see with my eyes now how weak and tired she is. I wasn't as ready for that as I thought I was. I'm hoping after some rest to recouperate from her 30+ hour car trip she will perk up a bit.

It's hard to live so far away...