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BlueWolf6457

What's Going On With My Sister?

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My 61 yr old sister received several heart stents in May of 2009 and immediately after she would have occasional pain in her left upper chest that she thought was "stent pain" since one of the stents that they placed was fairly large.

In January of this year she complained of a more constant "stent pain" and also that she had pain in the left shoulder and upper left arm as well.

She went for a complete heart exam in February and was told the only thing they saw was some "scar tissue" which the heart doctor attributed to the stent placement and sent my sister on her way.

The pain increased and she then went to her Rheumatologist (she has severe rheumatoid arthritis) and he shot her with cortisone in her left shoulder and elbow. This did not help at all.

Last week she caught my bronchial cold and was finally given a chest x ray to look for pneumonia. No pneumonia but there is supposedly a pear sized mass in her left lung. Until she caught my cold she never coughed and even now with the cold there is only yellowish sputum and no blood. This is the news we got Friday late afternoon and that she would be set up with a CT scan.

She had a very quick CT scan with no contrast dye yesterday morning and now we are waiting.

Has anyone heard of lung cancer affecting the shoulder, back, and/or arm before?

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Not sure if I can help with this one or not but have shared to my Friends from here on social media to respond if they can ASAP.. My wife had LC and had pain in the shoulder but it was attributed to Arthritis and cortisone did help her for that pain.... She did develop a sudden cough and a loss of voice due to her tumor pressing on her vocal cords however.. that was basically how we caught hers. she thought it was laryngitis and went to see our family doctor and things went from there... Hope we can get some answers a little better for you ASAP....

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I had chest pain and arm pain so I went to the clinic. On the phone they were worried at 50 I was having heart problems. At the clinic the labs and EKG were fine. They did a chest xray and found a tumor in the apex of my Right upper lobe of lung pressing on the pleura ( lining of the lung ) and pressing on the nerve going down my arm. I had a Pancoast tumor.

I hope they do all the tests to be sure they know what it is. Keep us posted.

Donna G

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My Brother had pain in his back and shoulders for 2 years. They finally discovered that it was cancer in his throat. Like Randy mentioned, it was around the vocal chord. I would mention it to the Doctor.

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CT scan results show "an orange size mass in the upper left lobe pressing against the chest wall" a "nodule" in the right lung" and a "nodule" on/in her thyroid gland". It's been 6 yrs that she's complained of pain in her chest area. They want to do a CT scan assisted biopsy but because she's on blood thinners she may have to stop taking them for 5 to 7 days before she can have that done.

I am so mad right now that shes been complaining about this pain for all this time and not one of her doctors (PCA, Heart, Arthritis) ever thought to x ray her chest. You'd think the heart doctor would have caught it.

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Thanks for the update. Glad they are planning a biopsy. I had that too. Keep us posted of the results and what her plan will be. Pray all goes well.

Donna G

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keep us posted on biopsy results.... can help with support for both caregiver and patient also!! let us know about treatments and can help with side effects and suggestions for care!!!! Hang in there...

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I will do that. I'm a breast cancer survivor and she is all set to see my Oncologist on October 10th. He taught at Northwestern University for 25 yrs so he really knows his stuff. How do they typically treat a pancoast tumor?

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As you can see on my profile I had Cisplatin and VP 16 with daily radiation then the xray showed shrinkage so I had surgery and as planned from the beginning I had more of the same chemo after surgery.

They have new chemo drugs now so that most likely would be different drugs.

again keep us posted.

Donna G

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Oddly my husband didn't really have any symptoms that he told me about anyway. The only thing that really stood out before diagnosis with him was fatigue. I imagine everyone is different. Hoping for some good news on your sister and will be checking back for updates. ((hugs))

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I will keep everyone posted and thanks for your replies. The only other experience I have had with lung cancer is our father who either refused treatment or was never offered any back in 1995. He lasted one month after diagnosis. but he was 10 yrs older than she is now so....

My sister has other health problems as well. Namely the heart disease for which she received 5 stents and severe Rheumatoid Arthritis. It's always so hard to tell what is causing what pain with her, which is probably the reason this went on for as long as it did.

They say that there is a possibility of lung collapse during biopsy (though lessened because her tumor is near the chest wall) or bleeding into the lung. The biopsy will be for sure a day long affair and might require an over night stay.

Thanks again everyone.

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She had her lung biopsy today and is in a lot of pain. Anyone know how long this biopsy pain lasts and what to do to make her feel better? This is all still like a bad dream to me. Her O2 sat rate was 97 throughout her 4 hour hospital stay and other than the pain there was no lung collapse or bleeding.

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I am SO VERY sorry that you, your sister and family are facing this!! I was also Dx with a Pancoast tumor. They are high up in the apex / apical / tippy top of the lung and the various things / nerves they encroach upon cause Pancoast syndrome / Horner's syndrome which explains the shoulder and arm pain along with some perspiration issues and minor eye issues that include a droopy lid and tiny pupil. All are easy enough to Google and not the worst thing when it comes to side or after effects.

I am glad she came through the biopsy well and I hope that the post-op (biopsy) pain won't be long lasting. (If my experience is any clue it won't be) Odds are she will also need a PET scan and maybe a mediastinoscopy ( a surgery where they go thru the bottom of the front of the throat to scope the mediastinum [area between the lungs & around the heart] to see if there is any evidence of cancer hiding in there) before they are done staging and can let you all know how far along the illness is.

Once they know where she is, they can assemble a team and tell her what is next.

In my case I had 2 chemotherapies and radiation at the same time in an effort to shrink the tumor in prep of surgery. I lucked out and it worked. I endured an 18 hour surgery to dig the tumor out of my spine and then take the right upper lobe of the lung and some ribs. Right now I am 3.5 years since Dx and 3 years 1.5 months post op - a/k/a cancer FREE!

Please take care of you & yours and let us know what is going on. I will pray that she has some awesome results and an amazing recovery! Please also let her know that she can find support here. There is also a way for both patients and care givers to find 1 on 1 support through this site! Many members are available to offer it via email and/or phone. You are lucky to have found this site early in the process.

Be well,

Mary

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Glad you got the results. Hope she is feeling better.

Now we need a plan. They will hopefully explain more during her appointment on the 10th. Please keep us posted.

Donna G

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A little light intro reading on this one!!!!

http://www.pathologyoutlines.com/topic/ ... izing.html

Nasal cavity, paranasal sinuses, nasopharynx

Nasopharyngeal carcinoma

Keratinizing squamous cell carcinoma

Reviewer: Abul Ala Syed Rifat Mannan, M.D. (see Reviewers page)

Editor: Songyang Yuan, M.D., Ph.D.

Revised: 21 January 2014, last major update January 2014

Copyright: © 2004-2014, PathologyOutlines.com, Inc.

PubMed Search: Keratinizing squamous cell carcinoma of nasopharynx

Advertisement

General

=========================================================================

Variant of nasopharyngeal carcinoma [NPC] exhibiting microscopic evidence of keratinization

Epidemiology

=========================================================================

Represents about 25% of all nasopharyngeal carcinoma

More common in men

Usual age at presentation is decades 4-6

Sites

=========================================================================

Lateral wall of nasopharynx (Fossa of Rosenmuller) is most common site, followed by superior posterior wall

Cervical lymph node metastasis is common

Etiology

=========================================================================

Weak association with EBV compared to other subtypes of nasopharyngeal carcinoma

HPV may play a pathogenetic role

Can arise de novo or as a radiation associated carcinoma occurring many years after radiation therapy for non-keratinizing nasopharyngeal carcinoma (Hum Pathol 2000;31:227)

Clinical features

=========================================================================

Similar to other subtypes of nasopharyngeal carcinoma:

Asymptomatic cervical neck mass is usually localized to the posterior cervical triangle

Nasal obstruction, nasal discharge, epistaxis, pain, serous otitis media, otalgia, hearing loss, and headache are other presentations

Higher incidence of locally advanced tumor (Am J Otolaryngol 1995;16:103), but lower incidence of lymphatic (Otolaryngol Clin North Am 1985;18:479) or distant spread as compared to other subtypes

Prognostic factors

=========================================================================

Overall 5 year survival is 20-40%

Clinical stage is the most important prognostic factor

Keratinizing NPC has a poorer 5 year survival rate due to higher incidence of deaths secondary to local disease and nodal metastases

Treatment

=========================================================================

Supervoltage radiotherapy (65→70Gy) is treatment of choice for all histological subtypes

Surgery is reserved for patients who fail radiation therapy

Gross description

=========================================================================

Varies from mucosal bulge to an infiltrative mass lesion

Micro description

=========================================================================

Invasive carcinoma demonstrating obvious squamous differentiation as intercellular bridges and keratinization

Can grade as well differentiated, moderately differentiated or poorly differentiated

A desmoplastic response is typically associated with invasive tumor

Micro images

=========================================================================

Well differentiated keratinizing squamous cell carcinoma

Positive stains

=========================================================================

Pancytokeratin and high molecular weight cytokeratin

Epithelial membrane antigen is focally positive

Variable positivity for EBV compared to non-keratinizing and undifferentiated NPC

End of Nasal cavity, paranasal sinuses, nasopharynx > Nasopharyngeal carcinoma > Keratinizing squamous cell carcinoma

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My sister saw my Oncologist today. He said T-3, N-0 and stage 2B but this is before the PET scan which I hope will be next Thursday (it was supposed to be on Monday but pre-auth for insurance didn't come in time so.....) . She gets a port placed next Friday morning and hopefully get the PET scan results Friday afternoon. 

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The PET scan confirmed she has Stage 2B non small cell lung cancer so his treatment goal is a cure. He stated that she was lucky it was caught this early. Next week my sister meets with the radiation oncologist and will hopefully be plotted for radiation during the coming week so that she can start a combination of chemo and radiation on Oct 27th.  The chemo meds they will use are called Etoposide and Cisplatin and it sounds like they will be used in tandem over a period of 36 days along, of course with the radiation. Then 4 to 8 weeks after that is over she will go to Milwaukee to have surgery. Has anyone had this regiment before? Doc talked about nausea and hair loss as side effects....any others? Any special precautions? How exhausting is this treatment? What is the surgery like? How long in the hospital and what is the recovery? Thanks for caring everyone.

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A plan is in place.  Great.   I had this plan.   ( VP 16 is Etopiside)    I am about to celebrate 17 years since diagnosis.

I wish her the same success.  Keep us posted.

 

Donna G

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My sister was plotted for radiation today after her consult with the radiation oncologist. Her port is in and she should be all ready to start her combo of chemo and radiation on Oct. 27th. What side effects did you experience from your treatment? and how long was your recovery time after the surgery?

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