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New and have a lot of questions


ellen24

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Hi,

I am so very worried about my husband who has been referred to a thoracic surgeon for a growing lung nodule.  His Lung Rad score was a 4b.  His nodule was 0.9 x 0.6 in Feb'2015, May 1.1 x 0.6  and now 1.4 x 07.   His pulmonlogist won't be able to do the biopsy.  He said a surgeon has to do it?  The nodule is located in the right mid lobe in the right lung.  My husband is 66 years.  He has stop smoking these past 6 months.  However, he has smoke roughly a pack and half since he was 20!!!  I am so scared it is cancer.

The pulmonlogist said it might be better just to remove  the nodule instead of a biopsy?  We have an appointment on Friday. I am awaiting a appointment with a thoracic surgeon from Sloan Kettering.  I figure I live in NYC go for the best?  Any help and insights would be so helpful. 

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Ellen,

Are you citing millimeters (mm) or centimeters (cm) as units for your husband's nodule?  I ask because a Lung Rad score of 4B equates to a 15 mm or 1.5 cm nodule.  Regardless, you are still dealing with a very small nodule.  If the dimensions are cm they equate to a 9/16" by 9/32" nodule; if mm 1/16" by 1/32".  Either is very small and note the Lung Rad score suggests a probability of malignancy at >15% which is still low.

I think removing the entire small nodule would make sense.  A minimally invasive technique is likely with this small of a nodule.  Then a biopsy could be performed.  Read about thoracoscopy or video assisted surgery (VATS) here - https://www.lungevity.org/about-lung-cancer/lung-cancer-101/treatment-options/surgery

Sloan Kettering is a fine institution.  I'm sure you will attend his consultation with the surgeon.  As far as insight, I'd inquire if a consultation with an oncologist might be warranted.  If the nodule proves to be cancer, normally people have post surgical chemotherapy after surgery to ensure any individual cancer cells in the bloodstream are killed before they can become distant metastasis.  We informally call this type of chemo "dust-up".

It looks like your husband had a low dose CT scan as part of a program to find tumors when they are small and easy to deal with.  I believe your husband's nodule fits that category.  You'll likely have lots of questions and feel free to ask as you go through the various consultations and procedures.  After all, we are the lung cancer experts, at least in terms of experience.

Stay the course.

Tom

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Thanks Tom,  it was mm for the measurements.  I realize the nodule is small but I am just wondering why the pulmonlogist would recommend a surgeon and not just be able to do the biopsy? Is it the location?  I remember the doctor saying even though it is in the right lung it is near the heart??? Maybe a bronchoscope can't get down to that space?  

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Ellen,

OK, now understand your concern why a pulmonologist couldn't scope him and do the biopsy.  

On diagnosis, my pulmonologist tried to biopsy my tumor using a flexible bronchoscope. He couldn't and I now understand there are limitations to what can be safety biopsied with a flexible scope.  Therefore, I was referred to a thoracic surgeon who performed the surgery by making a small incision at the base of my throat (procedure called a cervical mediastinoscopy) and that required general anesthesia and day surgery.  Perhaps your husband's tumor is hard to access using a flexible scope.

I've had flexible scope procedures performed and the type of anesthesia is minimal compared to surgical anesthesia.  Perhaps this could also be a factor in seeking a surgeon and of course your point is equally valid - a difficult location.

Regardless, I hope the biopsy is easily performed and returns no evidence of disease or NED as we say.

Stay the course.

Tom

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Hi  yes that was what I was trying to get out. Question?  With my husband history of smoking they calculate it to be 80 pack smoker and being 66. Might it just be safter to just go in and that the nodule taken out?  Rather than have a biopsy?  I mean even if the biopsy comes back negative, it will still have to be watch with CAT scans so more radiation.   Just thinking out loud.  

 

Thanks again!

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Ellen,

I can't pretend to answer your question of nodule removal vice biopsy.  It is, however, a very good question for the surgeon and I'd ask it.  Sloan Kettering should have some very capable folks who can answer your question.

I wouldn't worry about the CT scan radiation at this stage.  It is essential to determine the nature of the nodule and one or even a dozen CT scans don't involve as much risk as say metastatic cancer.

Stay the course.

Tom

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