Question – Operation on adrenal metastasis

[Surveyor]

First of all, I’m sorry I have not posted in awhile – I just haven’t had anything worthwhile to contribute. Recently the CEA values & SUV’s on my pet scans have been increasing. It seems I’m one of the rare NSCLC survivors who had a tumor on the right lobe and a tumor on the left adrenal gland without spread to other areas (or perhaps the chemotherapy cleared up other small areas). For the last two years my scans have been clear except for a stubborn area on the left adrenal gland. I recently had a CT-guided biopsy on a left adrenal mass, 3 cm lesion. Diagnosis: “Metastatic moderately differentiated adenocarcinoma” (no change here). “Extensive necrosis and focal calcification present” (apparently the microwave ablation and two series of radiation therapy killed most of the cancer in the adrenal area). The biopsy comment was: “The specimen is extensively necrotic with only rare minute fragments of viable tumor tissue which forms glandular structures with cells having a moderate amount of foamy cytoplast consistent with adenocarcinoma. They also performed an immunohistochemisgtry (ICH) on the atypical cells and found: Strongly positive: TTF-1, CK7, CEA-monocional. Negative: Surfactant, CK20 and EGFR. (With negative EGFR, it confirmed that I would not benefit from Tarceva.)

I’m feeling pretty good and certainly feel blessed. Some fatigue, but otherwise a little fat happy being enjoying my occasional survey work in the hills of California. I’ve heard that an operation like this is pretty serious. What do you think? Should I have the operation? Have any of you had an operation to remove an adrenal metastasis or similar procedure?

Thank you,

Reily Smith

[Welthy]

Reily,

I have no experience with surgery of this nature. The only thing I can tell you is that my husband and I firmly believe that his brother might still be with us if his adrenal tumor had been removed. He had no other cancer left except that tumor. The docs watched and watched it. They kept saying that it was under 2 cm and too small to remove. Suddenly the cancer spread and he was gone. His health was good during this period. This was three years ago and we still have many unanswered questions about how he was treated (or not treated).

Warm thoughts and best of luck for the right treatment decision for you.

Welthy

[RandyW]

can not offer any personal insight But Sending Prayers and MAybe this Link May help a little in your Decision??

http://jtcs.ctsnetjournals.org/cgi/cont ... /130/1/136

[Littlegirl]

I don't know about the cancer angle but have done some research on adrenal surgery as my dad had one of his adrenal glands removed MANY years ago due to a microscopic tumor (Pheochromocytoma) and I recently thought I might have this issue as well.

From what I understand they can now do this with a keyhole surgery (laproscopically) which makes recovery much easier and quicker. Tumors on adrenal glands can cause hormonal issues/high blood pressure issues as well. Do speak to your doctor about this.

[ursol]

Reilly,

I have a small Adrenal Gland nodule that is active on PET Scan on my right adrenal. I was scheduled to have it removed laporascopically until two brain lesions were found and then my surgery was cancelled. My oncologist now tells me that if I show no new mets for a year they will reconsider removing the right adrenal gland. The surgeon that was going to perform the surgery made it sound fairly easy.

Lilly

[DrWest]

It is possible to have very long survival, so long people talk about it as a potential cure, after surgery to remove a solitary adrenal metastasis. The appeal of this approach is pretty much limited to a situation in which a single adrenal metastasis is the only site for metastatic disease. It is a significant surgery, which most experts would consider not undergoing if there are other areas of disease involvement. However, if that's the only area of disease, and if a patient has gone a long time without progression, it's something that is a strong consideration. Surgery for the "solitary adrenal metastasis" has been known as a potentially very effective treatment for a "precocious met" that may be the only area that got away.

-Dr. West

[Surveyor]

Thank you Welthy, Randy, Littlegirl, Ursol and Dr. West.

I was hoping you would see this post Dr. West. For over 2 years, my lungs have been clear per PET scans. For those 2 years, when my CEA rose, it would fall after treatment to the adrenal mass. I hope 2 years is a long enough base. After reading Welthy’s comment, I realized again that our cancers can become aggressive again anytime!

I have not met with the surgeon yet. Some of the questions I intend to ask are:

1. How serious is the operation?

2. What will the surgery involve?

3. How long in the hospital?

4. Recovery time (will the tissue heal after radiation)?

5. Time to full duty?

6. Do you think there is a reasonable chance you can get all of the necrotic area with scattered cancer cells?

7. Will you be able to get any margin?

8. Would you recommend additional chemotherapy after surgery? If so, what?

9. Could we schedule the surgery after April 19 (land surveyor’s convention).

10. Will you get “pre-approval” for the operation from Medicare & Blue Cross?

11. Have you performed operations like this before? How many?

12. If you think it is too risky, would you recommend another doctor or hospital?

13. I’m a little concerned about the “level of care” at Kern General Hospital (where she is chief of surgery). Do you think I need to be concerned with this?

14. Have you operated on areas that have had heavy radiation like mine? What do you expect to find?

15. Do you think I will feel better (when healed) after getting the dead tissue out of there? That is, perhaps less fatigue.

If anyone else can think of other things I should ask the doctor, I would be grateful for a “heads-up.” Naturally, any comments (been there -- done that -- medical knowledge) about my questions would sure be appreciated.

Thank you and God bless you one and all.

Reily

[Welthy]

I emailed you Reily.

[DrWest]

You may have already had this meeting and had the opportunity to ask your questions. They all seem very appropriate. It's a major surgery, and I wouldn't anticipate that you'd feel better for getting the metastatic tumor out, considering the extent of surgery. If it's done, it's usually done to try to achieve long-term survival, not to improve symptoms. I would interpret it as a significant investment now in hopes of doing well later.

-Dr. West