VATS Surgery After non malignant biopsy

[littlemissbags55]

Hi everyone,

  I've been looking well.. lets be honest, pretty much stalking these forums since my mother (age 62) was hospitalized last January for an upper respiratory infection (negative for pneumonia) and a CT scan showed a number of lung nodules.  Most were very small in size but one in particular looked suspicious of what they were saying was adenocarcinoma measuring 12mm. (spiculated, non glass)  She left the hospital with orders to follow up with an additional CT scan in 6 months and go from there.  Well here we are 6 months later, nodule hadnt changed much in the CT scan done in June and followed with a full PET scan.  Nothing lit up, not even the nodule they found suspicious.  She recently had biopsy  done and that also came back negative for malignancy.  We thought we were in the clear but at my mothers follow up appointment today both surgeons she met with suggested that maybe she undergo VATS surgery just in case the part that was left in her lung was cancerous or could potentially turn into cancer.  My mother was a smoker for over 30 years but quit almost 6 years ago (finally!! we all jumped for joy)  Her father died of lung cancer at the age of 50. (of course that was a long time ago where lung cancer was basically a death sentence)  My question to you all is this.  If you were in her position would you be running at the first chance to have this removed?  My thoughts are to monitor with scans and if it changes in any way then consider the surgery.  Any advice would be greatly appreciated.  It seems like even when they say its not cancer you still have to live your life as if it basically could turn into cancer at any particular time.  

[BridgetO]

Welcome to the forums. I'd be disinclined to hav surgery in your mom's situation, I think. I had a VATs lobectomy in 2016. I had a small spiculated nodule. Like your mom's mine didn't light up on the  pet. But mine was in a location thaat couldn't be biopsied except by removal of the lobe, so I had it done. An additional factor in my case was that my nodule was discovered in a routine CT to surveille for possible metastases from an earlier non-lung cancer. Alao the nodule had grown a little since the scan 3 months earlier. The docs thought it didn't look like a metastasis, though, since apparently they ususally aren't spiculated. I think that if I'd been able to have a non-surgical   biopsy and it didn't show cancer, I probably would have chosen to have the lobectomy, but rather to have  another scan in 3 months. But everybody  has different risk tolerance, so who knows what's best?

[littlemissbags55]

Hi Bridget,

  Thank you for responding to my post.  Ive convinced her to seek a second opinion before any further action is taken.  After reading a number of peoples stories on this site it appears my mothers is not unlike many others.  I really had no idea you could go through countless tests/operations and still come up with it being inconclusive.  She left her follow up appointment yesterday more confused than ever.  It appears they are basically putting the ball back in her court and saying she can either choose to wait and re scan or get the surgery to have it removed.  I wish there was a little more direction given in what route she should take in order to have the best outcome.  Everything seems really unclear at this point.  Hoping to get a more definitive answer with another surgeon.   

[BridgetO]

Second opinion sounds like a great idea.

[Tom Galli]

Welcome here.

You should have some comfort from the periodic screening and if she maintains the screening, a change in state could be discovered quickly. My concern rests with "a number of small nodules" that were discovered. Surgery to remove the largest does nothing to address the remaining unless they are all in the same lung or lobe. But, your mention of adenocarcinoma implies a biopsy was performed and cancer was confirmed by histology (visual examination of tissue by a pathologist). Is that so? 

Does your mom have an oncologist engaged? Surgeons are important but cancer treatment is normally quarterbacked by an oncologist. I would seek an oncologist's opinion before deciding on surgery. 

Moreover, other factors play into a surgery now or later such as competing health problems and age. Her age is not a problem now but it is a factor to consider if metastatic disease is discovered five years from now.

There is no right universal answer for surgery in this circumstance. Even after an oncology consult, you will still have uncertainty. Cancer it seems breeds uncertainty.

Stay the course.

Tom

[littlemissbags55]

Hi Tom

  Thank you for your response.  Over the past 6 months or so she has had 4 ct scans, a pet/ct scan as well as a bronchoscopy.  The CT scans showed small nodules kind of scattered in her lungs as well as one larger lung nodule that was measuring around 1.2-1.4 cm. The radiologist who read her ct scan wrote something to the effect of could be adenocarcinoma or benign.   She had a pet scan in which nothing lit up.  She then underwent a bronchoscopy a couple of weeks ago in which they took half of the nodule and that half was tested and came back negative for cancer.  The dr also said she looked at her lymph nodes (looked good) and swabbed (wrong terminology?) her windpipe to test for pre cancerous cells and all came back negative.  We thought that this was all good news until her follow up appointment yesterday where the dr was suggesting she still have VATS surgery to remove the leftover part of the larger nodule.  I have convinced my mom to get a second opinion.  So because everything has come back negative we haven't gotten to the oncology part bc we still are unsure if it actually is in fact cancer.  not really sure where to go from here except to get another opinion 

[Tom Galli]

Well done.

With all that information, I agree surgery should be off the table at this juncture. She may develop cancer; any of us may develop cancer. But she doesn't have cancer now and monitoring appears to be the prudent thing to do. The biopsy sample showing no cancer is our gold standard.

I'd still check-in with an oncologist even if it is just to audition one just in case.

Stay the course.

Tom

[Lisa L]

Hi I am going through the same thing as your mom.  I’m 52 and had random ct in December and they found a 9mm spiculated nodule, 3 weeks later pet with no uptake not even a little on the nodule. I then got a pulmonologist who issued another scan in April which didn’t show any growth, first scan 9mm, pet scan 8mm, April scan 9.7, so all different machines and all could be off by a mil or so.  At first I freaked out so bad and everyone on this forum is amazing so I calmed down quite a bit.  I’m supposed to be having another Ct in a week or so and this one I believe will map it out to get a needle biopsy. So it’s a challenge as to what to do, my pulm dr. Says if it is LC it is very slow growing and sometimes are just indolent and never do anything and I would have never known it was there if not for the ct scan.  When I start feeling anxious about it I get on this forum and it really seems to help, anyway keep us updated. 

Love and Light ❤️

Lisa

[littlemissbags55]

Hi Lisa,

 I'm so sorry you are going through the same thing as my mom.  The anxiety of the unknowns I think play a major part in it all.  I was lucky enough to get her into a world renowned thoracic surgeon yesterday (last appointment before he leaves for vacay thank god!) and he had some differing views as to how to move forward than the other team my mom had seen.  With her pet scan not lighting up he seemed to think this was a very positive thing (as the other team didnt think it held that much weight) and he said unfortunately the bronchoscopy procedure she had to biopsy didn't really add much information to what they already knew.  In fact, he said that due to the size of the nodule a biopsy more times than not would not give them accurate info.  ( he is suspect as to whether or not they were actually able to get a slice of the nodule) so basically the bronchoscopy was for not.  He also said the same thing as you which is that even if it is adenocarcinoma it could lay indolent and never go anywhere or really change much.  She could have it the rest of her life.  His course of action would be to rescan in another 4 months and see if it has changed at all and go from there but because in her case surgery would require a partial if not full top lobectomy he would steer clear of that until the nodule became really suspicious.  I'm just so glad we were able to get a second opinion.  I had a similar case when I was younger w a cyst where the first doctor said theyd have to take my ovaries and Id never have children (at age 25!) and the other said nope we can do this minimally invasive and you should be good to go.  I had my daughter over 2 1/2 years ago.  Thank god for second opinions!  I hope all goes well with your next scan and if you ever have any doubts with the care you are getting, get a second opinion!  

[Pattymac]

Hi all, just wanted to let you all know that I am the topic of this discussion, my daughter (littlemissbags55) is my hero, always searching for the right thing to do with my situation! I can’t even tell you all how this has impacted my life, yours too for sure, but I am so greatful that so many of you on this forum have responded to her, I thank you from the bottom of my heart! God bless you all! Obviously, as my second opinion said, I will be scanned for many years, unless there is a change in the nodule on ct scan! Then off to surgery, probably!!

[BridgetO]

Hi Patty, I'm glad to hear from you personally! Good you got the seco opinion.

[Pattymac]

Yes, thank you Bridget! I’m grateful I was able to!

[Curt]

I had an 8mm nodule discovered by accident and watched it for a year with no change and no PET activity.  I have a family history of lung cancer and it was a spiculated nodule.  After a year of no changes the doctor recommended having a lobectomy.  I was floored.  I was feeling really good about the no changes.   When I received the first recommendation for surgery the doctor used the term lobectomy.  I couldn’t understand why they would recommend a full lobectomy without knowing it was cancer.  I went for a second opinion and the doctor said that he would do a wedge resection to see if it was cancerous, if it was he would continue with the full lobectomy at that time.  I followed up with the first doctor and was told that was what they were recommending, they just didn’t describe it well.  I decided to go with the second doctor. The nodule turned out to be cancerous and I had the full lobectomy about six months ago.

Watching it for changes is a perfectly reasonable approach in my opinion.  I was a bit more aggressive because of a significant family history and the fact that I was told it would be a very minor or no quality of life difference for me to have surgery.    

Most nodules are not cancerous but things like family history, spiculated, ground glass, female, former smoker and multiple nodules increases the concern.   

Recovery from a lobectomy is different for everyone.  It is not fun but many are able to make full recoveries with little to no quality of life differences.  I have in six months.  How far you can recover depends on your age, physical health and pre/post surgery routines.  

I hope you are one of the majority of people who have nodules on your lungs that are nothing.  Know that if you are of the unlucky minority of us that it is cancer that there are treatment options and this community is here to help get you through it.