New and facing a lung biopsy

[Trish557]

Hello all

I'm glad I found a community for this particular type of cancer. I'm not new to cancer having already had breast cancer twice.

I started to have SOB about a month ago, and finally went to the doctor to check if I had pneumonia (I have had it before although not a severe case). He sent me off for an X-ray, and they saw a very large mass in my left lung. I then had a CT scan which shows a left upper lobe mass measuring 7cm anteroposteriorly, 6.7cm transversely and 5.7cm craniocaudally. The mass contacts the anterior chest wall, extends to involve the aortopulmonary nodal region directly and abuts the superior aspect of the left hilum. There are adjacent abnormally enlarged anterior mediastinal and aortopulmonary lymph nodes. There are nodes at the left hilum. There is a small (< 1cm) right paratracheal node. No pericardial effusion. 

The report further states that the appearance favours a primary lung malignancy. Lucky me! I guess that with two separate primary breast cancers five years apart (the last one four years ago) I was wondering if it could have metastasised to my lung. This would be a lot harder to treat.

I have a lung biopsy scheduled for Wednesday of next week.

I'm wondering if anyone can tell me what to expect from the lung biopsy. After all I've been through over the past ten years, I'm a bit of a sook when it comes to procedures now. So - like to be prepared. I know that we won't know what we are dealing with until the pathology comes back - but if anyone can explain what the report means, I'd be grateful. Obviously I understand the mass is pretty big, but I'm not familiar with the terms about the nodal regions etc. I know an awful lot about breast cancer, and almost nothing about lung cancer.

I'm in a very calm place believe it or not. After dealing with a cancer diagnosis twice now, I feel like .... ok, what's the next step now. Very different from the first time when I felt my whole world had imploded.

Also - I'm in Australia so I'm wondering if there are different ways of doing a biopsy in different parts of the world.

Thank you for reading this far, and I really look forward to reading any replies.

Trish

 

[Tom Galli]

Trish,

Welcome here. 

First, let me suggest a little reading that covers most types and forms of lung cancer biopsies.  With your large tumor, you'll likely have a Bronchoscopy or Transthoratic Needle Biopsy. Of course, the large questions to be answered given your breast cancer history is does your tumor result from a new form of cancer (lung cancer) or is a recurrence of your breast cancer now present in the lung? 

Either way, the biopsy will provide the answer. By way of expectation, you may also be schedule for a further scan to check against distant metastasis--a PET scan. Here is information on this procedure.

I wouldn't know if there are different ways of performing biopsies in Australia versus the US. I would think they are a pretty standardized procedure worldwide. When you get your biopsy report I'd advise going over it line by line with your doctor.  I'd also advise that you obtain a personal copy of the report, in fact, I'd encourage you to keep a personal copy of all tests and procedure reports you receive during treatment.  I've found personal copies invaluable to me in my 16 years of surviving lung cancer.  If you still have questions, post them up.  We are not physicians but together as a survival community, we've had just about every recognized lung cancer treatment and procedure. So our collective experience may be helpful in answering your questions.

Stay the course.

Tom

[BridgetO]

Hi Trish and welcome here. I'm  also a cancer third-timer with my lung cancer. I had a stage 1, grade 1 breast cancer in 2008 and a stage 3, grade 3 endometrial/cervical cancer in 2011. In 2016 a routine CT scan to surveille for possible recurrence or metastases of the gynecologic cancer showed  small, approximately 10 mm nodule in my left lung. It turned out to be a primary lung cancer  (adenocarcinoma stage 1a) and I was relieved it wasn't a metastasis.

Your mass is obviously bigger than mine and it looks like you may have lymph node involvemet, so if this is a cancer, it will probably be greater than stage 1. I recommend that you ask for biomarker testing of your biopsy sample if it is diagnosed as malignant.  Here is where you can get information about biomarker testing: https://lungevity.org/for-patients-caregivers/lung-cancer-101/types-of-lung-cancer.  There are a lot of new cancer treatments out there and the biopsy with biomarker testing can help determine what treatment is best for an individual.

Hang in there and let us know how the biopsy goes and what the results are.

Bridget O

[Trish557]

Thank you Tom and Bridget for your replies.

I know a PET scan is in my immediate future, but the biopsy is first.

I guess my most pressing question at the moment is what does it feel like to have the Transthoratic Needle Biopsy, that's what I'm having Wednesday. I'm not scared about having lung cancer but the biopsy absolutely terrifies me.

Bridget, I will be a lot "happier" when the biopsy confirms it is a new primary and not mets from the breast cancer. Both the radiologist and the pulminary specialist were fairly sure it isn't mets, as they look different in the lung than a primary lung cancer. I'm sorry to hear though, that you too have gone through this three times too. It's not great that some people have bodies that just love to make cancer.

Trish

[Tom Galli]

Trish,

With either a bronchoscopy or needle biopsy, you won’t feel a thing. Needle biopsies are normally performed by interventional radiologist in the US. You may be sitting in front or behind a screen-like device that allows the doctors to see your tissues and needle at the same time. 

They may sample two or three times. 

Stay the course. 

Tom

[BridgetO]

Trish,  I should have mentioned that I never had a biopsy. My nodule was in a location that made it impossible to biopsy either with a bronchoscope or needle., so I can't tell anything firsthand about those prosedures. My pulmonologist, my thoracic surgeon and the tumor board all agreed that it looked like a lung cancer and not a met, and they were right.

Bridget

[MBinOregon]

Hi Trish,

I had a needle biopsy (by an interventional radiologist) - it was an outpatient procedure.  I had about an inch incision right under my breast (he didn't put any stitch, just a bandage, I think).  I was under general anesthesia and when I came back around, it didn't hurt much, but when they told me to watch for symptoms of collapsed lung, it freaked me out and I barely slept that night.

Sending warm thoughts,

MB

[Trish557]

Thank you all 

I've got this! 😨   You are all so kind 😀

[Trish557]

It all went so much better than I was expecting.

They dosed me up with Fentanyl and Midazolam so I was floating!

Now to wait for the results of that, and hopefully a PET scan on Thursday before seeing the specialist on Friday.

Thank you all for your support - it's very much appreciated.

Trish

[LouT]

Trish,

 

I haven't been around for a while, but I'm glad that you got to meet some of our really experienced folks.  I just wanted to welcome you to the group and I look forward to hearing about your results and what treatment protocol they'll recommend.  My case was surgery only, but so many folks here have had many forms of treatment and will be able to answer questions you may have.  Stay strong and know we're here for you.

Lou

[Trish557]

Pathology results are back and it's Small Cell, @#*!

I see my specialist on Friday morning.

 

[LouT]

Please let us know what happens tomorrow and fingers and toes crossed for you.

Lou

[MyWifeSCLC]

Hi Trish ... I'm sorry to hear of your Small Cell diagnosis ... There are a few of us on here with SCLC or have a family member with it. I see you are already familiar with cancer and may have a better handle on it than some of us.

I thought I would share some good news about my wife's SCLC that I just learned an hour ago to you first on this forum ... Her post first-line treatment PET scan showed no activity in her primary tumor. Hopefully this will help cheer you up a little.

You might post on the SCLC portion of the forum to update us when you want.  This forum is really great with support so ask anything you want. Someone will get back to you.

Steve

[LUNGevityKristin]

Please let us know how your appointment goes today.  Thinking of you!

[Trish557]

Hello everyone

Well, I don't have too much more to report yet. Here in Australia you can't get a PET scan for small cell, our medicare system doesn't cover it (not sure why), but I did have a brain MRI on Friday after my appointment, and will have a bone and CT scan tomorrow. Then I have an appointment with a medical onc on Tuesday who will go through all my options. The only thing I know is surgery isn't an option.

So - still more waiting and more tests.

Thank you all for your thoughts, I know that communities like this are fantastic. I have been a member of a fabulous breast cancer community for 10 years now, and know the support and comfort from fellow cancer patients is worth its weight in gold!

Trish

[D iane]

On 5/16/2020 at 11:02 PM, Trish557 said:

Hello everyone

Well, I don't have too much more to report yet. Here in Australia you can't get a PET scan for small cell, our medicare system doesn't cover it (not sure why), but I did have a brain MRI on Friday after my appointment, and will have a bone and CT scan tomorrow. Then I have an appointment with a medical onc on Tuesday who will go through all my options. The only thing I know is surgery isn't an option.

So - still more waiting and more tests.

Thank you all for your thoughts, I know that communities like this are fantastic. I have been a member of a fabulous breast cancer community for 10 years now, and know the support and comfort from fellow cancer patients is worth its weight in gold!

Trish

So sorry to hear this.  I hope the bone,  CT scan and brain MRI are clear.  It's a lot easier if there are no mets and this is just in you lung and they get you going on treatment.  Good luck!