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Not sure what to do...T1a tumor but no lymph nodes taken.


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Hi, I have been lurking around and wondering how to explain my situation.

I was DX'd with Squamous Cell Carcinoma, Poorly Differentiated (Histologic Grade G3) on July 10th 2007 after having a wedge resection done. No nodes where removed for diagnosing by pathologist. I don't know why. They staged my tumor as T1a (1.8cm...no large or small vessel invasion observed) but can not formally called it that because of not removing any LN. Now they want me to go back in and have the remainder of my right lower lobe removed just so they can check out my LN as they feel that is in my best interest. No chemo or radiation is being offered Has anyone gone through this?

I DO NOT want to have surgery again but I also want the best prognoses I can get with my lung cancer. I am very upset and afraid of having to go through another surgery because I also have moderate to severe COPD and a portion of my lung is stuck to my body because of scaring from having radiation for prior Breast Cancer and will require some repair to allow my lung to move freely. This makes the operation a bit more encompassing than the first one. I also have had some prior problems with anesthesia. These problems make it very hard for me to come to a decision as to what I should do. I feel emotionally overwhelmed.

Has anyone had a lung resection done. Had their tumor stage T1a with no nodes removed and decided to not have further surgery to have the remainder of their lobe removed. If so, how is your LC doing now?

Thank you for any help you can offer me as I said I am at my wits end coming to a decision.

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To be honest, I've never heard of lymph nodes not being being resected and checked...but I know very few people who have had wedge resections. Perhaps LN resection is not part of wedge resection. I am pretty sure that if you go on and have the lobectomy and have any positive lymph nodes, you would be evaluated for radiation and/or chemo. I guess my key question would be why they are asking you to come back for a second surgery, rather than having done a lobectomy in the first place. That would help to guide my thinking if I were in your shoes.

Best of luck - please keep us posted.

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Was the first surgery more like a biopsy than a treatment? In other words, did you have a biopsy done prior to your wedge resection?

If you feel very strongly about not wanting more surgery, perhaps you could get chemotherapy to be sure that all the cancer if not taken out is at least killed.

Donna G

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Your situation is curious and your questions are valid. If your current medical team is not giving you answers or explanations; you should definitely get a second opinion. You should get the report of the surgical procedure that was performed as well as records from your surgeon, oncologist and/or pulmonologist. You should also get copies of all the imaging reports from any PET/CT scans or xrays. Good luck and god bless.

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From the information below it does not seem like it is possible to do a full dissection during a wedge resection. Only N2 nodes can be reached and not N1.

There is a much greater survival rate for lobectomy.

10 uears I read were 70% vs 35%

I think a lot of the research says full dissection of the lymph nodes are best. Size of lymph node does not always indicate that there is no cancer in they lymph node.

The higher rate of local recurrence with more limited resections seems somewhat intuitive when one considers the lobar anatomy of the lung and the prevailing lymphatic drainage patterns. Ishida et al[18] demonstrated that 5% of patients with tumors between 1 and 2 cm and 12% of patients with tumors greater than 2 cm will have N1 (hilar) nodal disease proximal to the primary lesion. Although it may be possible to remove most N2 (mediastinal) nodes at the time of a wedge resection, removal of N1 nodal tissue, which is often intraparenchymal at the hilum, requires a lobectomy.Sublobar resections would, by definition, leave behind pathologically detectable tumor in 5% to 12% of cases since intraparenchymal lymphatics proximal to N1 nodes cannot be evaluated.

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I agree, this is sort of an odd situation. Maybe the explanation you were given was too sketchy for you to have a good understanding of all the factors.

Lots of us could "manufacture" scenarios that might make sense, but we'd have to make some assumptions that may or may not be valid. For example, I might offer that perhaps the resection was done with a minimally invasive scope procedure (video-assisted thoracoscopy) for diagnostic purposes only, pathology confirmed cancer and also concluded that some cancer probably remained in the lobe, your team believes that removing the lobe is now advisable, and at the same time that's done the lymph nodes can be evaluated for more accurate staging. That scenario might be totally off the mark, but it's probably less of a stretch than their wanting to remove the rest of the lobe "just so they can check out" the lymph nodes!

So essentially I'm hitchhiking off of Donna G's post, and I agree with Tom K's recommendations. You deserve a full explanation of what they've done and why, plus all of your options from this point forward. If they can't or won't do that for you, get a second opinion -- true, that can be a hassle, but it's your life we're talking about. And never forget that these guys are working for you, not the other way around!

My best wishes and Aloha,


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I'm sorry you find yourself in this quandary and want to offer my best wishes for some resolve. I have no knowledge of this situation, but I think you've been given some great advice by the others. If you can't get solid answers from your current team, consider getting a second opinion.

Good luck and keep us posted. It's best to be very pro-active and putting your concerns down on a post is a big first step forward. More surgery has huge implications for you with your other issues. It's good to weigh all the options -- but better to know what those options are!

God bless,


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I can't be a huge amount of help to you here, but do want to agree with some of the others before me that maybe a second opinion or another visit with the doctor is in order.

I wish you the best in whatever treatment route you choose.


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Thank you all for your kind concern and caring thoughts. After reading all of your kind messages I believe that my best results will be from having the lobe removed, now all I have to do is figure out how to prepare myself for the operation, as I am terrified of having even the smallest of operations performed.

recce101...I might offer that perhaps the resection was done with a minimally invasive scope procedure (video-assisted thoracoscopy) for diagnostic purposes only, pathology confirmed cancer and also concluded that some cancer probably remained in the lobe,
...I don't think it was but it does seem to point in that direction doesn't it? If I remember what the surgeon said is..."he does not normally do that on a VATS wedge resection" If so, I wish I would have known that. He did say he looked around in the area and did not see anything unusual going on other than the scar tissue that was making it hard for my right lung to expand freely and did remove some of the scar tissue.

I hope I did not misconstrue any information about why the 2 doctors want me to have the lobectomy done. Not just to check out the nodes or for harvesting any more surrounding tissue but for the best possible outcome.. They both have mention that from what they have gathered from all the written information they read as to what is the best way to go with operable Lung Cancer is to have the lobe removed that has the tumor in it, over a VATS wedge resection. I thought I signed the papers to have a lobectomy done or a VATS wedge resection, what ever was indicated at the time of entry into the lung area. I never thought to think to ask about whether they would be taking any nodes with the wedge resection. I do know I did not get to have a epidural put in for the Lobectomy and that might have been part of the reason why no nodes where taken.

The Thoracic surgeon has said he has seen patients do well with just having the Vats done with a T1a tumor as well as having the lobe removed with nodes removed and that sometimes the "wait and see method can work" but would want me to have follow up chemo but my oncologist has said "NO". He feels it would be more detrimental than helpful.

It all comes back to ...do the nodes have any cancer in them? Since no nodes where removed, no one can even begin to know how to treat this Lung Cancer. I do not want to have surgery but I want every chance to survive like any one else but I feel I may not unless I have the surgery done. I hate being in this spot.

Before I had a Pet Scan done, I had a cat scan done and it did pick up the cancer but did not show any cancer in any Lymph Nodes but then again it could be so minute that they can not pick it up. I just had another Pet Scan done this past Tuesday and the results came back as NED. I will be seeing my oncologist on the 18th of September. I think I will leave this problem on the back burner for a few days. I need to get away from it over the Labor Day holiday and will go back to trying to come to a decision after that.

Once again...Thank You all for being there when I really needed to talk about this problem. No one can make a decision for me but what you all have mentioned can and will come into play when I do make one. I hope everyone has a wonderful holiday and please stay safe.

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I think the good news is - No vascular invasion.

It is a grade 3 tumor so it is more aggressive - maybe another reason to have a lobectomy.

Good luck with the decision. There are a lot of people who have a lobe removed and do ok. There was one person on here that had the all lobes removed on one side and is now competing in mountain bike races at a high level.

My mom had an epidural and a great pain management Dr, you can ask the Drs about this and maybe find out about what the Drs do for pain management and recovery. My mom recovered easily and was back to normal pretty fast.

Good luck.

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Hi John...Thank You for your reply. Please accept my condolences on the passing of your mother. I wish there was more they could have done for her. I too lost my parents to Lung Cancer. I know how you felt with her passing.

From what I read most all reports suggest having the lobectomy done. There are good reports out there with just having the wedge resection done also but as a rule they usually have more information to go on other than just type of LC. tumor size, grade of tumor and shows no small or larger vascular invasion.

They want to give me an epidural for the next operation but at the same time I have RA around that area of my spine so they may not be able to give me an epidural. I was suppose to have one with the wedge resection but they didn't give it to me. Although I have to say the Morphine worked very well.

I have no idea why I am so afraid of another operation. I just am. I am sure my Oncologist will be displeased with me if I don't have it done but he and my family need to think what I need too and right now it's a little more time to come to terms with having the operation done.

I will get back with you all as soon as I speak with my oncologist. The Thoracic surgeon wants me to have the operation before 3 months is up. So I should make a decision soon.

I hope everyone is enjoying a nice weekend. :D

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  • 2 weeks later...

I suspect the reason they weren't inclined to pursue a lobectomy immediately was that your COPD may have made them concerned that the risk of losing additional lung tissue may have been greater than the added benefit of a lobectomy over a wedge resection. Now, with the appearance under the microscope raising the concern because of the high grade (poorly differentiated), a lobectomy is a stronger consideration. This still needs to be weighed against the risk of another surgery if you're at higher risk for complications because of other medical problems. Radiation could be considered for the area, and potentially chemo (although if there is serious concern about your ability to get through surgery (either by you, them, or both), chemo likely won't be a cake walk.

There is also some evidence that older patients may do about equally well with a less extensive surgery compared with a lobectomy. The reasoning behind it is that if people have other medical problems, the lung surgery that is "good enough" may do as well as a more aggressive "best" lung surgery (which also isn't perfect, we are all saddened to say). You can read about this issue in a post at my website, OncTalk, if you're interested:


I hope that helps. Take care.

-Dr. West

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