Enlarged lymph node pressing on brachial plexus nerve.

[jack14]

Among other things, I have a supraclavicular node (1.5-1.75 cm), that is adjacent to my brachial plexus bundle and it is putting pressure on the median nerve. This is resulting in a terrible aching in my left arm along with a "burned tingling" sensation in my left index finger and thumb. It varies in intensity, and lately has been interrupting my sleep. Anyway my Oncologist said awhile back that she could refer me to radiology for an evaluation to maybe shrink it and relieve the pressure. I am worried about the bone or lung getting burned and wonder if maybe a surgeon could take it out with VATS or something? I will ak her about it when I see her in a couple weeks but wondered if anyone in here might have heard something about this issue?

Thanks

[BridgetO]

Hi Jack, SBRT radiation is really precise and, depending on the nodes location, might be able to get the node while not delivering much radiation to antything else. It's my understanding that SBRT uses very low dose beams focused on the target from a lot of direction, so that only the target node or tumor gets an effective dose. Tom G had this and knows a lot abount it. It's worth looking into.

Bridget O

 

[jack14]

Thank you so much Bridget O! That sure sounds a lot better than surgery to me. Hopefully, Tom G will share his knowledge and experience with me.

[Judy M2]

Like Bridget says, radiation these days is low dose and precise. They'll have to do a CT scan and map out exactly where to target. Ask about potential side effects. You could have some fatigue starting around about 2 weeks, if your radiation goes that long. (I had 30 sessions, but they were targeting tumors and lymph nodes.) It should be pretty effective to shrink the annoying lymph node. 

[Tom Galli]

Jack,

Welcome here. Indeed I believe a referral to a radiation oncologist to eliminate our pain is a good idea.

First, some information on radiation with lung cancer. There are two basic types: fractional radiation, and a term I call "precision" radiation to distinguish it from fractional. Fractional radiation was (is perhaps still) a first line standard of care (first treatment) for certain types of lung cancer that have say widely spaced tumors, perhaps in the lung and in close lymph nodes. It is often used in combination with chemotherapy, and I had it as my first treatment. It is given in small doses normally over a number of weeks (my treatment was M-F for 6 weeks).

Precision radiation, and there are many types and names of types, can be a substitute for surgery. So think of very focused radiation focused on a single tumor or lesion. Some of these type names are Stereotactic Body Radiation Therapy (SBRT), Image Guided Radiation Therapy (IGRT), Image Modulated Radiation Therapy (IMRT) and more. To complicate the name game, equipment manufacturers have trademarked machines that deliver these forms of "precision" radiation. For example, I had a CyberKnife procedure; this was SBRT delivered on a trademarked machine. This type of radiation is normally given over a series of consecutive days for say 3 to 5 days. Confused?

What really matters is what radiation does. Your enlarged lymph node, caused by metastatic cancer, is bruising your nerve causing pain. Any form of precision radiation will "fry" the cancer cells in the lymph node, killing the cancer and eliminating the pain. This type of procedure is called palliative care, and many of us receive it alone or in combination with curative care. Most important, it is very effective and it can quickly eliminate your pain. For more background, here is information on the types and methods of radiation used to treat lung cancer. And here is a further explanation of palliative care.

Let us know about your radiation oncologist consultation, or perhaps a surgical consultation. We'll be happy to answer your questions.

Stay the course.

Tom

 

 

[jack14]

9 hours ago, Tom Galli said:

Jack,

Welcome here. Indeed I believe a referral to a radiation oncologist to eliminate our pain is a good idea.

First, some information on radiation with lung cancer. There are two basic types: fractional radiation, and a term I call "precision" radiation to distinguish it from fractional. Fractional radiation was (is perhaps still) a first line standard of care (first treatment) for certain types of lung cancer that have say widely spaced tumors, perhaps in the lung and in close lymph nodes. It is often used in combination with chemotherapy, and I had it as my first treatment. It is given in small doses normally over a number of weeks (my treatment was M-F for 6 weeks).

Precision radiation, and there are many types and names of types, can be a substitute for surgery. So think of very focused radiation focused on a single tumor or lesion. Some of these type names are Stereotactic Body Radiation Therapy (SBRT), Image Guided Radiation Therapy (IGRT), Image Modulated Radiation Therapy (IMRT) and more. To complicate the name game, equipment manufacturers have trademarked machines that deliver these forms of "precision" radiation. For example, I had a CyberKnife procedure; this was SBRT delivered on a trademarked machine. This type of radiation is normally given over a series of consecutive days for say 3 to 5 days. Confused?

What really matters is what radiation does. Your enlarged lymph node, caused by metastatic cancer, is bruising your nerve causing pain. Any form of precision radiation will "fry" the cancer cells in the lymph node, killing the cancer and eliminating the pain. This type of procedure is called palliative care, and many of us receive it alone or in combination with curative care. Most important, it is very effective and it can quickly eliminate your pain. For more background, here is information on the types and methods of radiation used to treat lung cancer. And here is a further explanation of palliative care.

Let us know about your radiation oncologist consultation, or perhaps a surgical consultation. We'll be happy to answer your questions.

Stay the course.

Tom

 

 

Thank you so much Tom. No, I wasn't confused at all, you are quite clear and concise. I also have some prior knowledge having been a medical educator and clinician now retired. Although it was entirely focused in critical care and virtually zero in oncology, it has helped me to study and understand this business somewhat.

I was put on palliative care when I first began treatment and I am on Keytruda (11 infusions to date).

Here is what my scans have revealed from the day I was first diagnosed:

 08/01/2019 CTS nc VA:

6mm avg dia irreg right medial apical right upperlobe pulmonary nodule
No evidence of lymph node enlargement

02/04/2020 CTS nc VA:

8 x 6mm right medial apical right upperlobe pulmonary nodule
2.7x2.4 cm left axillary lymph node (new)- removed 03/23/2020 for biopsy

05/11/2020 CTS nc Randolph:

1.0 x 0.8 cm medial apical right upperlobe pulmonary nodule
1.4 cm left retropectoral node 
1.1 cm left supraclavicular node

07/30/2020 CTS nc Randolph:

9 x 8 mm medial right upper lobe pulmonary nodule
1.1 cm left subpectoral node
1.0 cm left supraclavicular node

11/18/2020 CTS nc Randolph:

9 mm medial right upper lobe pulmonary nodule
1.8 cm left subpectoral node
* left supraclavicular node

*NOTE: Asymmetric nodular soft tissue in the left supraclavicular region, extending into the high left subpectoral region, appears more prominent than on 07/30/2020 

[jack14]

PS I will definitely opt for the radiology consult. Thank you everyone, and I will let you know what happens.

[Sabacat]

Not to hijack this thread, but since Tom is so knowledgeable about radiation maybe he can prepare me for my visit with the radiation oncologist on Tuesday.  I'm being sent to him because my primary tumor has not responded to the triplet (well, it appeared to after 2 infusions, but then seemed to enlarge back to and/or slightly above original size).  I did have some other lymph nodes that did improve.   Anyway, when the NP (due to onc being away for the holiday) shared this with us and we asked about side effects, she said there really shouldn't be any except possibly fatigue BECAUSE THEY WILL USE LOWER DOSES OF RADIATION AS THIS IS PALLIATIVE.   She has a very difficult accent and we didn't pursue that with her further, but I was somewhat shocked.  I thought they were going to try to 'kill' the primary tumor with this radiation treatment.  That is certainly MY goal.  

Also, in her conversation with the radiation oncologist, who was looking at my scan at the time, he said that he saw a couple of lymph nodes that he could probably include.  If they "zap" the lymph nodes, does that destroy them just as if they were surgically removed?  If so, does that increase the chances of lymphedema, which I already am having.  I am seriously concerned about that, as they say there is no cure for it and I can see that having a significant negative impact on my quality of life down the road and might want to opt to try to let the chemo and immunotherapy afterwared take care of those lymph nodes. 

Of course, I will take up all these questions with the radiation onc, but any thoughts you might have with all your experience would be appreciated. 

thanks!

Susan 

 

[Sabacat]

PS - he also told her it would likely be 10 treatment sessions. 

 

[Tom Galli]

Susan,

I can only offer general answers because (as you know) I'm not a doctor. Some of us have had "precision" radiation methods where doses have been dialed back a bit and the number of treatments extended. My SBRT treatment was about 20 minutes of table time-per-day for 3 consecutive days. I know of others who've had say 10 minutes of SBRT table time for say 5 consecutive minutes. Ironically, my daughter was treated for a brain tumor (non cancerous meningioma) with IGRT. The tumor was in a very difficult location, wrapped around the optic nerve, and her treatment was administered daily over the course of 7 consecutive days. 

I'm not sure there is a relationship between the amount of radiation dose and palliative care. Palliative care is performed to lesson pain, and those I know that have had it, say for a bone met, the met was "fried" by radiation. However, the curative care (chemotherapy, targeted therapy or immunotherapy) continued because there were other mets in other areas of the body that were still a problem.

I also know others who've had precision radiation with metastatic disease in a number of locations throughout the body. Read this blog as but one example. Radiation oncologist are getting very aggressive using precision radiation to address mets in Stage IV disease. 

I don't know anything about lymphedema; further, I have no idea what radiation would or might do to your lymphedema. This is definitely a question for your radiation oncologist. I do hope your consultation is productive.

Stay the course.

Tom

[Sabacat]

Thanks, Tom!  Just read Judy's blog post - very interesting!  Thanks for pointing it out or I would never have found it. 

My medical onc definitely plans to continue chemo and immunotherapy after the radiation. 

Anxious to hear what the radiation onc has to say!

Susan 

[jack14]

Godspeed Susan.You are in my prayers.

[Sabacat]

Thanks so much, Jack!