Post lobectomy, help me with lymph node findings

[Cin]

So the report on lymph nodes are posted; my appointment is on Wednesday and I will get an explanation then.  They tested 19 lymph nodes.

 

The first one was from the wedge and said lymphatic invasion (or similar)  which indicated cancer.  BUT it was from the wedge.  The other 18 lymph nodes were from my upper right lobe (which was removed), and were all negative for cancer.

 

Should I be concerned about the one lymph node?  Or does this sound like they got everything?  I don't want to go in there feeling I've got it beat if the report doesn't indicate that's the case.  Thoughts? Thank you to the experts here who understand the fear and are wiling to share their experiences!

[LexieCat]

Well, I would THINK that any presence in any lymph node is concerning for future potential metastasis. I met with my surgeon the other day (re this trial I may have--he is going to try to get samples from any cancerous lymph nodes he can find), and I asked him a question that came up from one of our new members, who was concerned about lymphedema as a result of removing lymph nodes and questioning why they needed to remove so many. What he (surgical oncologist) said is that unlike, say, the lymph nodes in your armpit, the lymph nodes in your chest don't go in any particular order. They are networked in a way such that you can't say just because this node was positive and that one wasn't, you  can be certain other lymph nodes beyond the negative one are clear. 

Obviously you'll have to see what your doctor says, but it seems to me that some adjuvant chemo might be best to minimize the chance of any metastasis, given that it's gone to at least one lymph node.

Just my two cents. I'm neither a doctor nor do I play one on TV.

[Jesse L.]

While I can't give you any idea of what they'll tell you when you go in for your post-op appointment, I can tell you of my case for comparison. 

I was diagnosed originally with stage 1a adenocarcinoma and after scans and a confirmation bronchoscopy, I had lobectomy surgery to remove my RLL on 2/25. Of course, wouldn't you know it while they were in there and poking around they came across two affected lymph nodes and they removed them as well. That discovery led me from a stage 1a to a stage 3a. Because of that stage upgrade, it was highly recommended that I receive four rounds of chemotherapy (Carboplatin/Alimta) with each infusion being three weeks apart and which I started on 4/5. The reasoning my medical team gave me for the chemotherapy was that even with the complete removal of all the affected areas, there is no guarantee that some rogue cancer cells may not have escaped my lymphatic system and be roaming around my bloodstream. Just to be sure I looked it up myself and according to the American Lung Association website, they did state that while the lymphatic system is capable of killing cancer cells, there is no guarantee that it will kill all of them. Some in fact just may escape and they then could become metastatic anywhere in the body. 

After my last infusion on 6/7, I have more scans on 6/17 and then further appointments with both my  radiation and chemotherapy oncologists respectively on 6/20 and 6/21. Given that I am to see my radiation oncologist a second time (I originally met her before chemotherapy started), that of course begs the question why? The question is even more pertinent given I've never been recommended for nor needed radiation yet. Well, I was told that that was just being done as a precaution in case I needed radiation treatments in the future. 

Now, I am certainly not trying to scare you or anything and you may certainly look it up yourself, but an instance of lung cancer makes a person more susceptible to getting it again. And please oh please understand that is the last thing I want to have happen in yours or anyone else's case. It is however a statistical fact...  

Understand though that while none of us are experts, we can give you a broad expanse of our experiences with how this has affected our lives. My recommendation is to stay positive, be strong, learn all you can, and know that lots of folks are living very long lives even with such a diagnosis as lung cancer. And you'll have our support when you need it.... 

[Cin]

5 hours ago, LexieCat said:

Well, I would THINK that any presence in any lymph node is concerning for future potential metastasis. I met with my surgeon the other day (re this trial I may have--he is going to try to get samples from any cancerous lymph nodes he can find), and I asked him a question that came up from one of our new members, who was concerned about lymphedema as a result of removing lymph nodes and questioning why they needed to remove so many. What he (surgical oncologist) said is that unlike, say, the lymph nodes in your armpit, the lymph nodes in your chest don't go in any particular order. They are networked in a way such that you can't say just because this node was positive and that one wasn't, you  can be certain other lymph nodes beyond the negative one are clear. 

Obviously you'll have to see what your doctor says, but it seems to me that some adjuvant chemo might be best to minimize the chance of any metastasis, given that it's gone to at least one lymph node.

Just my two cents. I'm neither a doctor nor do I play one on TV.

Thank you for adding your opinion here.

[Cin]

Thank you both LexiCat and Jesse.  This is all so confusing and I think I jumped the gun on thinking the Lobectomy was a "cure". Guess I need to ask surgeon about the results and next steps to be taken, if any.

[Jesse L.]

Please understand... While a "cure" is the ultimate goal, that is very hard to achieve with cancer. When there is "no evidence of disease" we state that a person is NED. And when that is achieved the usual protocol is to get a new CT scan every 3 months for the first two years, then every 6 months for the next two years, and then it goes back to 1 scan per year. Now, if a recurrence happens or even a new cancer for that matter, then the whole thing starts all over. It may be hard to tell whether it's new or recurrent, but in either case the result is the same. Of course, the whole point of the abbreviated scan schedule is to catch any cancer as early as possible so it will be easier to treat.

Somebody on here once used the metaphor that a person doesn't just deal with cancer, but rather they play chess with it. With all the psychological and physical effects cancer has on a person, that is a more than fair comparison. 

My best recommendations remain the same, be positive, be strong, ask lots of questions, and learn all you can about what is affecting you. In order to be your own best advocate, you will need to do those things. Last but certainly not least is to have hope...as many will tell you on these forums there's a lot of cancer survivors that have lived many, many years after an initial diagnosis. It's not the bad old days anymore; new treatments are happening all the time.

Ask any questions you like and we'll try to answer as best we can...you will always have the support we offer as well.

 

[Cin]

Oh no, I lost my reply! Thank you Jesse, I will re-read your comments several times I'm sure.

[TJM]

Cin

One diagnosis at a time. Let the disease come to you....tho stay informed 

Peace

Tom

[Tom Galli]

Can,

Welcome here. I’m just getting caught up, so pardon my delay in responding. On cure, NED, remission, or no progression, we aim for NED or no progression but hope for cure.

Lung cancer is so dangerous because it recurred frequently. Recurrence rates for stage I are about 33-percent; rates for stages II and III are about 66-percent. These data are about 4 years old but the big change in fighting recurrence is immunotherapy. I know so many stage IV who are surfing NED from that treatment. Hopefully, the NED wave will break to cure. 

Lexie’s point on lymph node involvement is well made. Do everything you can in terms of treatment to put off a recurrence. If your doc suggests adjuvant therapy, then take it. 

Stay the course.

Tom