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Mediastinoscopy and bronchoscopy


beachnut

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My husband has been recently diagnosed with a second primary in his left lung. He had a lobe removed from the right lung 2 years ago. We just returned from the surgeon and we are to have a bronchoscopy and a mediastinoscopy next week. Can anyone tell me what to expect with these two tests. We didn't have them the first time around.

Surgeon states that if there is any evidence of cancer in the lymphs from the mediastinoscopy then surgery is totally out of the question.

If they are clear and surgery is an option he only has a 50/50 chance of surviving the surgery. The surgeon also said that he had a 50% chance they wouldn't be able to remove him from the ventilator after the surgery also.

He does have some heart and circulatory issues that he had when he had the first surgery. He has atrial fibrillation and one carotid artery completely blocked. Also circulation in his legs is not 100%.

Doc said radiation would be his other choice.

How in the world do you make this kind of choice with the risks like that?

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I do not understand why your husband did not have those tests before the first surgery. I would seek a second opinion right away if I were you. Prayers

Carol

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Whoa Beachnut, It sounds like the immediate risks of surgery outweigh the potential. Your hubby could survive a long time without surgery. Do you remember what type of lc he had last time? If it took 2 years to return, it may not be extremely aggressive. Have they considered cyberknife instead of surgery?

Yes, this is definitely time to ask for referral to a cancer center.

I've had three bronchoscopies. The bronchoscopy requires major gargling and inhaling a very unpleasant numbing agent (lanocaine stuff). Lots of gagging. Then my doctor takes a giant Q-tip covered in white powder (cocaine I think) and sticks it down one of my nostrils - really far. It always burns and makes me very talk-a-tive.

Then they insert a tube down the nose and throat and into the lungs. They collect tissue, brushings and washings through this tube. I am usually half awake, half asleep. They have to tell me to stop talking. :) I hate the washings, as they spray a little water into the lungs and it makes me cough. It is inpatient...go in at noon and out by 5. They make you stay a few extra hours, because they always worry about bleeding inside the lungs too. If your hubby is taking heart meds, blood thinners etc, this could be real problem.

I've did not have a mediastinoscopy before surgery either. My CT's and PETs showed nothing in mediastinal nodes, plus I wanted "into" surgery and bad mediastinals would only keep me out of surgery. Plus it could cause complications and extra scar tissue. I decided to pass, although maybe not a good idea looking back....

I am sorry your hubby may have lc again. Did they find it with a CT? Have they done a PET?

Barb

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Your husband definitely sound like the ideal candidate for cyberknife surgery if there is no lymph node involvement. they should be able to cure him with very little risk as there is no actual cutting. It is a very intense and accurate form of radiation treatment. Go to this message board and talk to the radiation oncologists there.

http://www.cyberknifesupport.org/forum/

Don M

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My husband had NSCLC stage 1 before. It was a pretty small nodule totally confined with no lymph node involvement.

This second is not a met from the first - that lung is completely clear and we are told it is anoter primary.

It was found in his 6 mos. chest x-ray and did not show up in the chest x-ray 6 mos before. His pulmonologist sent us directly for a PET which did show uptake. He sent us directly to the surgeon who performed his first surgery.

The surgeon then sent us to have a CT scan with contrast and Pulmonary Function Tests and an ABG.

We had our followup with him yesterday and then what I had written is what we were told.

We are to have the bronchoscopy and mediastinoscopy next Thursday. The surgeon said they would do it while under general anesthesia.

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He did not give us those kinds of statistics with the first surgery - just said that it was much more dangerous for him now than with the first surgery. His heart docs have not been in the loop with his lung surgery. We do not have a thoracic surgeon here where we live so the surgeon is in Rome, GA which is 1.5 hours away from where we live. His pulmonary doctor here. His the one who sent us to the surgeon. Of course his heart docs knew that he was having the lung surgery and we visited with them when we were back from the first surgery. He sees his cardiologist every 6 mos.

The surgeon doing his lung is a cardiothoracic surgeon and does heart bypasses, etc. so he is extremely familiar with my husband's atrial fibrillation and carotid artery problem.

We are considering going to Mayo in Jacksonville for a 2nd opinion.

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You know I think it is hard to go to a new place for a second opinion, but in this case that sounds like an excellent idea.

Also, like Don M said cyberknife might be best solution.

Did your hubby lose much lung tissue on his last surgery? Sounds like docs are worried he could be left very short of breath?

Barb

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He lost 1 lobe of his right lung. This new primary is in his left lung upper lobe but deep inside the lung. The surgeon said he could not get this tumor without taking a whole lobe of this left lung which would be one half of the lung. His PFT and ABG are all good in numbers, but yes, the surgeone is concerned that he would be left a pulmonary cripple and we sure don't want that. He does get winded at times now.

Have you heard anyone say - when my husband has the mediastinoscopy next Thursday will we know then if there is anything in the lymph nodes or will we have to wait for a report of some kind?

Thanks for all the help. It helps to know that there are folks who know what you feel.

Shirley

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well I had one several years ago as my lymph nodes were enlarged and they wanted to make sure my cancer had not returned. I woke up and asked the surgeon and he said it looked good but had to wait for report. (about 3 days later) I think the surgeon can tell but they do not want to commit

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Shirley,

Barb and Don have given your great information so I can't add to that other than to say it sounds like there are so many issues that a second opinion from MAYO would be helpful. I'll be keeping you and your husband in my prayers.

Susan

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