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fauna13

Surgery vs biopsy

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Hello, 

A CT scan revealed a 5cm mass and 9mm lymph node in my mom's right middle lobe.  My mom had triple negative breast cancer 13  years ago.  The thoracic surgeon has recommended removal of middle lobe with no biopsy.  His rational is: PET scan is informative but not 100%, esp as to lymph node involvement, if it turns out to be an infection then you'll have had a potentially unnecessary surgery but if it is cancer then you'll be glad you didn't waste any time.  He thinks it unlikely it is breast cancer mets.  

Does this sound like  reasonable approach?  

With lung cancer, is it best practice to remove as much of the lung as possible (as it is often with breast cancer) or usually just a lobe?  

He is suggesting that he biopsy the central lymphs as first step of surgery.  Then it is unclear what he will do as I didn't quite understand him.  It sounded to me that if they are negative for involvement he would proceed with surgery but if they are positive then he would stop the surgery and we would go to a med onc to discuss radiation/chemo.  

So, in addition to all of the above, I am wondering if best practices/research dictate that she should have surgery after central lymph involvement of not.

It is so hard to even research this as we don't even know what we are dealing with as he is arguing for surgery first.

 

Thank you for any thoughts on this.

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Hi fauna and welcome. Is there a reason that the mass can't be biopsied without removing the lobe?  Generally a biopsy is a good Idea and generally standard practice, I think. Two ways of doing this short of surgery are by needle or by bronchoscope. I had a nodule that couldn't be biopsied either way because of where it was located. So I had the lobectomy and the right lower lobe was removed and it did turn out to be cancer, adenocarcinoma stage 1a. 

I also had a previous breast cancer as well as an advanced gynecologic cancer. It was a routine surveillance CT for the gyn cancer that found the nodule. It was very small, so they waited and rescanned in 3 months and it had grown. The oncologist, pulmonologist and surgeon all thought it did not look like a metastasis from my prior canccers because of its shape, but said they couldn't know for sure. The nodule didn't light up the PET scan at all, which apparently is not unusual for small and slow growing cancers.

I'm not clear from your post what the PET scan showed, or where the 9 mm lymph node is located..

I don't think it is standard practice to remove as much of the lung as possible, but rather to aim for getting clean margins while preserving as much lung tissue and lung function as possible. Taking out a lobe is common, but sometimes they can get it all with less than that. In my case it had to be the whole lobe because of where the nodule was located.  

I suggest that your mom and you get more information about what this surgeon is recommending and why. If you can't get an explanation that makes sense to your mom, she might want to look for a second opinion.  If you haven't already, I suggest reading Lung Cancer 101 on the main Lungevity website. Here's a link  https://lungevity.org/for-patients-caregivers/lung-cancer-101  This will give you reliable basic info about lung cancer, diagnosis and treatment.  

 

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Fauna,

Let me see if I can help but keep in mind I'm not a doctor.  I think what your mom's surgeon is suggesting is to gain entrance to the chest cavity with a small incision at the base of the throat and then to resect lymph nodes in the central area of the thoracic cavity and have them examined by a pathologist in real time.  He may use a bronchoscope to access the lymph nodes. This is a small incision and minimally invasive so if extensive lung cancer is found in the lymph nodes, the surgeon can halt the procedure without extensive surgery.  Then depending on the results, he may proceed with resecting the middle lobe.  That is what happened to me and my nodes were clear.  Then my entire right lung was taken by performing a pneumonectomy.  

As to your best practice question, surgery is the most effective way to deal with lung cancer. 

Stay the course.

Tom

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Hello,

Thank you for both responses.  

The mass can be biopsied without difficulty.  He seems not to believe that the result of the biopsy would be informative.  He said, if the biopsy shows cancer he would remove the mass.  If the biopsy doesn't show cancer you still can't be sure it isn't cancer so he would likely recommend removing the mass anyways.  If upon remove it turns out to be an infection then he things removal wouldn't have been such a bad choice anyways since removal would clear the infection and 18 months of antibiotics would not be necessary.  She has not had a PET scan yet.  The only test she has had was a CT, just for reasons of previous breast cancer.  She has no symptoms.  

Tom, yes, what you describe seems to be what he is describing.  I am wondering, if the central nodes have evidence of cancer, would a surgeon normally continue with the procedure and remove the mass or would a surgeon normally then opt not to remove the mass?  If typically the mass wouldn't be removed, why?   Also, Tom, if it is okay to ask, if your nodes where clear, why was the whole lung taken?  I am trying to get a sense of how surgeons determine how much they should remove vs how much lung to preserve.  

Thank you again.

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Hi fauna,

I can only tell you my experience but it seems somewhat similar. I had a large mass in my left lung plus a central lymphnode show up on a pet scan. The location of my mass was such that they decided to only biopsy the node. The node came back positive for adenocarcinoma. The surgeon said he could only remove the mass if it the lymphnode was clear. I ended up not having surgery due to the positive lymphnode. Instead I went through the chemo and radiation treatments. Perhaps surgeons don't do the surgery if there is a positive lymphnode nearby....?? That's how I perceived it anyway.

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Fauna,

All my lymph nodes were clear of cancer. Therefore, the surgeon could proceed with my pneumonectomy. 

There is no normal in lung cancer. With that in mind, normally doctors ensure that lymph nodes are clear of cancer before tumor removal. But there are exceptions made. 

My whole lung was taken because my tumor completely filled the main stem of my right lung’s bronchus.  Removing a tumor that large required removing the entire lung. 

Surgery is not an exact science. Judgement is a key attribute and unfortunately a surgical course of action often emerges during surgery. Despite advances in diagnostics there is no substitute to eyes on the problem. I hope this answer helps. 

Stay the course. 

Tom

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