Husband With Lung Cancer, Need Advice

[LynnRH]

My husband, age 67, is a lifelong smoker who finally quit last May. He was diagnosed with COPD/emphysema. Last month he had a "routine" chest CT w/contrast but the results were a shock. They'd known about a 5 mm nodule, unchanged for years. This time there was a "new left apical 3.4 cm pleural based mass" and a "new right middle lobe 1.0 cm bilobed nodule." There is also a new 3 mm nodule, lower left lobe. Old 5 mm nodule and changes from emphysema remain stable. (He has moderate stage COPD, hadn't been bothered terribly by it.)

His PCP sent him immediately to a pulmonologist and we met with this doctor the other day. He pointed to the mass on CT film and he believes it's cancer. As he has experience and good credentials, we didn't argue. I asked if there was any other possibility, and he said yes, but it seemed remote. He's ordering a PET scan to investigate further, was already talking about surgery if indicated.

I was treated for breast cancer in 2002 so I'm pretty well up on that, but as I lost my father to lung cancer years ago, I have little knowledge of it. His was diagnosed very late and treatment was of no help.

What kind of doctor will we need for a second opinion after we hear again from the pulmonologist, this after the PET scan is done? If this doctor recommends surgery, do we want a second pulmonologist's opinion? Do we want to interview surgeons? Oncologists? What specialty do we need here? We're comfortable with this doctor and the group in which he works, but there's no room for error.

We're in the suburbs of New York City, can check out Sloan Kettering if needed though my husband hates going into the city, prefers our nearby community hospitals.

Thank you in advance.

Lynn

[ernrol]

Lynn,

Going to Sloan Kettering would be a very good place to get a second opinion. That is where I went. I was very happy with my doctor in Naples. My doctor recommended that I go to Sloan Kettering for the second opinion. It is very reassuring to make sure that you are getting the best treatment. You are very fortunate to be so close to New York. My second opinion only took a few hours.

Stay positive,

Ernie

[RandyW]

Unless surgery is recommended would not worry about that. Surgery is not always doable because of locations, sizes,numbers of tumours. Will probably go to Oncologist for Chemo I think. I am not an expert though so don't quote me on that. the important things are type Of Lung Cancer Small Cell or Non Small cell. type of treatments available. Radiation. Stage of cancer of course. Types of Chemos available for treatment options. You know that do not worry about the You have this long of course being a Breast Cancer survivor. I think almost every one has beat that odd right now here. We have a wide range of Lung Cancer survivors here. Both types, Many treatemnts, some on Clinical trials. this is one of the best sites for info and support about LC. welcome to the Boards here. Sending Prayers. Also read Survivor stories for a little comfort and positive reinforcement. Keep us posted.

[MsC1210]

Hello Lynn and welcome,

I am a little confused here. Has your husband had a biopsy to confirm that he does have cancer? If not that would be, at least in my opinion, the very first thing that needs to be addressed.

If I am missing something here and he has had a biopsy and it is confirmed to be lung cancer, I would think that an oncologist would be the wisest choice for the next step in order to get a treatment plan in place.

I wish you and your husband all the best and please keep us posted and let us know how we can help you further.

Christine

[Welthy]

Hello Lynn and welcome to the community,

I agree with Randy. It sounds like you are traveling the right path via the lung specialist. If your husband's PET does light up, the pulmonologist may do a bronchoscopy to try to get tissue to determine the exact type of cancer or whether it is even cancer. (Sarcoid was the alternative we had hoped for.)

We went through all the above and we decided to do a wedge section biopsy by a surgeon recommended by the lung specialist. We scoped him out beforehand via the internet and he had tremendous credentials.

If curative surgery is not an option and you move directly to an oncologist, the most important issues in this scenario are finding someone that will treat aggressively, think outside the box, and that you are comfortable with. The treatment options for each type of cancer (ext-SCLC & NSCLC-IV) are pretty standardized, especially for first line treatment. Again check out recommended Oncologists credentials. We were fortunate to have excellent quality Doctors and didn't feel the need for second opinions. (Although we were ready to make the trip to M.D. Anderson, until we realized that it wouldn't make a bit of difference in how Tony would be treated.) We were all about getting treatment started to halt the spread as quickly as possible. Each person is different, and I'd never say never get a second opinion, but they are not always a necessity -- especially living in a large metropolitan area. My husband's situation was pretty much black and white, while there are others with many shades of gray that may require second opinions.

Arm yourself with as much knowledge as possible before talking to surgeons, oncologists, or radiologist so you can ask the right questions and know that you are selecting the "right" Doctor. And... there is nothing to say that you can't change Doctor's anytime you are not feeling like they are on the same page as you.

Last bit of info is to find out who the local Doctors send their family members to for surgery and treatment. That will give you a good idea of the best doctors in your area. Best of luck to both of you in your journey. Keep in touch.

Regards,

Welthy

[wendyr]

Hello Lynn & welcome. You'll find a lot of supportive & knowledgeable people here who will be able to answer most of your questions. I agree with everything said so far. Once a treatment plan is in place for your husband it would be well worth the effort to get a second opinion at MSK especially since you say you live in the suburbs. If MSK concurs with the treatment plan then you can go forward with confidence in the local doctor. I just am a firm believer in second opinions, especially from a major cancer center. Good Luck & God Bless

wendy

[LynnRH]

Thanks, all. To answer a question, my husband hasn't had a biopsy yet, no. The lung specialist wants the PET scan first, has already tested my husband's breathing via a Pulmonary Function Test (PFT). He said he needed to know how much surgery my husband could withstand, dependent on his lung function.

I may be jumping the gun, asking about second opinions. If the lung specialist recommends any sort of surgery, even for purposes of biopsy, should we just go along with his recommendation? That's what we'd usually do and, to be honest, it's my breast cancer buddies who are so concerned about which doctor we use or don't use. I feel satisfied with the doctors we know already but understand second opinions can be valuable.

Lynn

[RandyW]

If the surgery is an option and you are comfy with that, go for it. make sure your hubby gets some follow up chemo to make sure everything got taken and gets a good taste of the chemo. Get a second if YOU AND HUBBY are not comfortable with first opinion. Good Luck and again, keep us posted.

[ztweb]

I have no answers for you really, but I can say that I truly believe in second opinions. We went with Mayo for ours, and it has prooved a very good choice. We decided that if we went with the "A" team, we wouldn't never wonder what if.

There are so, so many docs out there who are amazing. Be comfortable in what you decide.

Blessings,

Jen

[chloesmom]

I would think that your next stop should be a surgeon. That would be the person to determine whether surgery is feasible or not.

In my case, I went right from the CT that showed a mass to the surgeon who ordered the PET and did the surgery. He still is the coordinator for my care related to this.

Cindy

[Maryanne]

If the biospy comes back as cancerous and they recommend surgery, then you are lucky. As only 1 in 4 are candidates for surgery.

You will find out all the information if and when you see a thoracic surgeon. If you want to get another opinion with another surgeon then that is up to you. But you may just feel very comfortable with the 1st opinion and may not want a 2nd.

We ourselves only went to one surgeon, who I found on the internet who had great credentials.

Keep us posted.

Maryanne

[Judy-OK]

Actually since your husband has COPD it could well be the Pulmonologist that will make the determination as to whether surgery is an option. If his lung function is already greatly compromised by COPD then removal of a lobe may not be a good way for him to go. Radiation and chemo therapy have worked well for many folks. I think if you like your doctors and truly trust them then the second opinion is up to you or your husband. Let us know what they find out.

[Muriel]

If you do end up having surgery, the big issues (I think)are (1) how many surgeries of this type has the surgeon done and (2) how many are done at the surgeon's hospital each year. You want people (Dr. and nursing staff, etc) who do a lot of this - a whole lot of it. Good luck!

Muriel

[LynnRH]

Thanks, all, for further answers. My husband's PET scan is scheduled for tomorrow morning and then we'll see the pulmo doc again to discuss the results. This doctor was already talking about directing my husband to a thoracic surgeon, intends to do nothing more, himself. If surgery is not advised, of course it would be an oncologist instead.

I think I jumped the gun a bit on second opinions as we don't have a first opinion yet and will have to take it from there.

Lynn

[MsC1210]

Lynn,

I will be thinking of you and your hubby today. Praying for good news with the scans~

I don't believe you are jumping the gun when thinking about a 2nd opinion. It is never a bad idea to have that option in mind, as well as a 3rd or more if you are not comfortable with the doctor and/or the treatment plan(s) they set up.

Please keep us posted.

Christine

[chloesmom]

Just FYI, in terms of the pulmonologist doing nothing further after the PET scan report, I have never even seen a pulmonologist.

There was never one in my treatment team except for the pulmonologist who read my pulmonary function tests and sent the report to my surgeon. I never laid eyes on him.

I also don't suffer from any breathing problems, so maybe that's why there isn't one involved. I don't know, I just wanted you to know that it isn't unheard of for a pulmonologist to bow out because there is no need for one in a treatment program.

And yes, I think you're right in saying that you need to get all of your first opinions before you start getting second opinions.

Cindy

[Don M]

Hi, welcome to lchelp. I think I would pursue a biopsy regardless of what the PET scan says. Sloan is always a good place to go to for a second opinion. But you might consider going to a facility that has a new technology called "SuperDimension Bronchus". Apparently they don’t have it yet at Sloan. It is a new system that uses bronchoscopy techniques to navigate the entire lung to find suspicious masses and take tissue samples. Until now, bronchoscopys were often inconclusive because they could access only about one third of the lung. Now they can go anywhere. With the various areas of concern in your husband’s lungs, the SuperDimension Bronchus may be the way to go. They have the technology available at St Vincent’s Comprehensive Cancer center in NYC. Here is a link.

http://www.svcmc.org/body.cfm?id=1218

Don M

[marym]

I would look for a thoracix oncologist.

Mary

[recce101]

[cynical_angel] I don't believe you are jumping the gun when thinking about a 2nd opinion. It is never a bad idea to have that option in mind...

If you don't know the surgeon, you might even consider telling him up front (before he lays out his plan) that you'll likely be seeking a second opinion. The way he reacts to that could give you some useful insight. Some bring up the subject from their side, saying you are welcome to get an opinion from another surgeon. That, I like!

Aloha,

Ned

[Welthy]

In your husband's case, as well as my husband's, the lung specialist will probably always be in the picture. COPD issues are still going to be there and possibly exacerbated by some of the treatment, whether it be chemo or radiation. Ours has helped Tony stay on top of his game with his breathing problems. SOB lives with us permanently.

Best of luck with the scans!

Welthy (Debi)

[LynnRH]

Thanks again to all. The second appointment with the pulmonologist is coming up Friday, March 9, and we'll get the results of the PET scan then. After we hear the details and recommendations, we'll know better where to go from here. I'm so glad to have suggestions and information from you who've been there. I'm scared stiff, to be honest, absolutely petrified. I'll do my best to act calm for my husband's sake.

Lynn

[Mary Cer]

I also think you should go for the second opinion after the results are in. My PCP and the pulmonologist encouraged me to go to Moffitt Cancer Center in Tampa, Fl. I was not operable according to them and they new I would get better and more updated care at Moffitt.

Good Luck and keep us posted. You are in my prayers.

Mary Cer

[LynnRH]

We got the results and my husband didn't "light up" on whole body PET/CT scan. The wording is "no significant FDG uptake (maximum SUV 1.7) is identified within this mass." That's the 3.4 cm lesion that worries them. It's further described as "a soft tissue mass in the medial aspect of the left apex, which has broad contact with the pleural surface. There are calcifications seen at the periphery of this lesion." Elsewhere there are "no areas of increased radiotracer uptake." IMPRESSION: 3.4 cm pleural-based mass in the medial left apex which has no significant FDG uptake. However, given the interval appearance of the mass since 12/27/06 which now occupies the location where a previous bulla was seen, consideration to biopsy is suggested."

The pulmo doc seemed hopeful, said this couldn't be a fast growing cancer,if it's cancer, and thinks my husband is a candidate for surgery. He recommended a thoracic surgeon and my husband has an appointment March 19 to consult with him. So, for now, I guess we wait and see what we think of the surgeon. He seems to be well qualified from what I've read about him on the Internet and the pulmonologist seemed very sincere in his assurance about him.

And, yes, I'll ask about the latest methods of surgery/biopsy. Already know he does VATS. I'm worried about my husband's emphysema as they see a lot of damage from that in his lungs.

Thanks, all, again.

Lynn

[enyaw061032]

Hello, Lynn:

I think the first thing to determine is whether or not in truth and in fact your husband has lung cancer, and if so, what type it is, how big it is, and what his options might be.

I think before getting a second opinion, you really need a definite diagnosis from the other physician. Sometimes whereas things look to be a certain way, they may be a different way.

Let us know when you find out for sure what your husband has, and the details.

Regarding a second opinion, I do think that after you get the definite opinion, it is wise to get a second opinion in most cases.

Barb