How to get second pathology opinions

[kdaru]

Hi, all. Saw surgeon yesterday. Dad's pulmonary function testing was good, but his cardiac stress test was problematic - he couldn't walk far enough on the treadmill and did not respond to the drug they usually use to bring up the heart rate. So the surgeon is covering his butt with a cardiology consult. We're upset, but I see his position. Surgery is tentatively scheduled for the fourth of January, pending cardiac clearance. The surgeon is planning to do the whole thing in one fell swoop - mediastinoscopy, bx of left lower lobe lesion, and if all is well, resection of the right upper lobe.

Because of some things oncodoc and others have said, I want to get a second opinion on the pathology, to make absolutely sure we're dealing with cancer before we cut out half my Dad's lung. How do you arrange this and where are the good places to send it? Oh, and how long did it take? I don't want to delay surgery if I can avoid it.

[john]

You can try the afip (armed forces institute of pathology). I think the problem is that your surgeon is trying to determine if the LLL is cancer or an infection.

Since your biopsy is not from the LLL, but right side, the 2nd opinion would only validate/invalidate the right lesion.

The surgeon (I am guessing) is trying to figure out if your dad is stage VI (nodules in left/right side) vs Stage I/II (nodules in the right side only)

I think what he is doing makes sense (your best bet is resection)

Post this and ask oncdoc for his opinion

Was anyother test run after the chemo to see if there was shrinkage/change in the 3 spots?

http://www.afip.org/index.html

[kdaru]

Thanks, John. You summed it up in a nutshell - we are trying to determine the exact stage, depending on whether the AP node and LLL lesion are cancerous or not. A repeat CT done after one cycle of chemo showed no significant change in the RUL lesion and lymph node, but significant progression and cavitation of the LLL lesion, which intensified suspicions that perhaps it was not cancer.

I'm all for the surgical plan (heck, I pushed for it), but I want to make ABSOLUTELY sure that that RUL is cancer before subjecting my Dad to a lobectomy. The original path report was somewhat vague - just said NSCLC, poorly differentiated. Given Dad's history of TB exposure, and atypical mycobacteria in the sputum, I want to make sure we're not dealing with some weirdo reaction to an infection.

[ken f.]

Thanks, John. You summed it up in a nutshell - we are trying to determine the exact stage, depending on whether the AP node and LLL lesion are cancerous or not. A repeat CT done after one cycle of chemo showed no significant change in the RUL lesion and lymph node, but significant progression and cavitation of the LLL lesion, which intensified suspicions that perhaps it was not cancer.

I'm all for the surgical plan (heck, I pushed for it), but I want to make ABSOLUTELY sure that that RUL is cancer before subjecting my Dad to a lobectomy. The original path report was somewhat vague - just said NSCLC, poorly differentiated. Given Dad's history of TB exposure, and atypical mycobacteria in the sputum, I want to make sure we're not dealing with some weirdo reaction to an infection.

hi,

so sorry to hear of you father's situation. i did have a comment of caution based on your reply to john.

as i understand your posts your father is 82 and he was unable to physically complete a heart stress test. you also indicated that you were pushing for surgery.

i urge you to be certain that your father is completely on the same page as you about undergoing chest cavity surgery. i'm 58, in robust health, and had a 4 hour lung surgery a couple weeks ago. this has been a very trying process even in my situation where the substantial risks all along the way that something might not turn out 100% were completely avoided.

after watching my experience, i know my 84 year old mother wouldn't even consider undertaking such a surgery no matter what the foreseeable outcome and even if she could be assured that surgery could be 100% curative. i would suggest that you get a view from your onco doc and surgeon that there is some reasonable chance to expect a curative outcome before your father is subjected to something that will in all events take a while from which to heal.

best of luck to your dad and to your whole family.

love, ken

[kimblanchard]

Just ask your doctor to request a second opinion. It is commonly done and no big deal. Usually each pathology department sends their slides to a certain center. For example, we send all of our slides to the Mayo Clinic due to proximity (plus the fact that their pathologists are pretty darn good). At my previous practice, we sent them to Stanford because that's where our pathologist trained. We only send tough sarcoma cases to the AFIP.

By the way, you will probably get a bill for the second opinion, not generally covered by insurance when requested by the patient. It is usually not terribly expensive, around $150.