What stage would this be?

[nikkala]

my grams report reads"Abnormal subcarinal lymphadenopathy and right hilar lymphadenopathy, enlarged lymph nodes in pretracheal space. 5.5 cm mass in right infrahilar region with abnormal mediastinal and hilar lymph nodes as well as a malignant effusion. Appears to be a left adrenal metastatic lesion" My gram has decided she does not want to even have a biopsy, she has lived a full life and is prepared to be with my gramp. Can you give me any input as to what stage she would be in and what kind of time she will have left. Do you know how she will die with having no treatment. ( that sounded a little cold) I am worried about her living alone and what will happen. Any input is appreciated and I understand it is only input. Thank you.

Lisa/32

lung nodules/awaiting next ct scan

lost mom to LC 7/13/95

[john]

It could be a number of different stages. (Stage IV, IIIA, IIB, or IB)

I think more tests need to be done to stage more accurately. I'm not a Dr, so oncdoc has to answer

She is either T4N2M0 or T4N2M1. T4 because of the malignant pleural effusion.

If the effusion is not malignant then it is T2N2M0 - Stage IIIA

If the lymph nodes are not cancerous then it becomes T2N1M0 or T2N0M0

(Stage IB or IIB)

It depends if the suspicious adrenal lesion is really a met that makes it Stage IV or not. That changes the M0 to M1 (distant metastasis). There are certain times when a isolated adrenal met is resected, but I think the lymph nodes have to be clear?

If there is no biopsy I don't think they can say 100% that the enlarged lymph nodes are cancerous.

I think if the effusion is exudative (very leaky) and bloody it strongly suggests a malignant vs non-malignant effusion. But without testing the fluid I am not sure how accurately it can be deemed malignant

No one can say with too much certainty how long she has without treatment.

But I think it would be important to get the biopsy. There probably is some chance it might not be cancer.

Oncdoc can give a more complete and better answer.

[teresag]

First, only a biopsy could show definitively whether the adrenal mass is malignant. But, unfortunately, both the malignant effusion and the adrenal mass signal Stage IV in non-small cell lung cancer. If your Gram doesn't wish any more diagnostic testing, she can still have palliative therapy. Talk to her onc doc and see what would work best; radiation is often proposed to limit symptoms and improve quality of life.

Talk to the doc now about hospice care, too. I can't guess how long she has to live, and honestly even the physician's estimates are often imprecise. The referral criteria for Medicare hospice in the U.S. state that the prognosis must be 6 months or less.

A common misconception is that hospice only provides respite care and counseling. Actually, their most important service is expert symptom control at the end of life. With good symptom management, your beloved Gram can be comfortable and die peacefully.

I don't wish to sound grave. There are many people on this board who are surviving Stage IV lung cancer. It can be done. It sounds as if your Gram is finished fighting, though. I wish you and her peace. - Teresa

[nikkala]

My gram is going next Thursday to have the pleural effusion drained. Can you tell me what this procedure is called? They will use ultrasound and insert a tube thru her back. The Doctor believes it is malignant by the scans. Does the fluid just build up again? Her main tumor is the size of a racketball and the mets to the adrenal gland is pea size. The dr is not planning a biopsy. He thinks the fluid will tell the story. Will she be able to be staged with this alone. She may need to apply for hospice but can only do so if she is considered terminal. Any input is appreciated.

Lisa/32

lung nodules/next ct scan 12/30

Mom died of LC 7/13/95

now my gram too

[kimblanchard]

That procedure is called a thoracentesis and may (not always) tell if the fluid is cancerous. If that is the case, it would make her inoperable although it would not technically completely stage her cancer (if fluid is involved it would be stage 3B, if adrenal gland involved it would be stage 4). The fluid usually does recur after it is drained but sometimes stays gone for long periods of time.