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NSCLC POSSIBLE LOCAL RECURRENCE


Banna

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NSCLC 1B. Bottom right lung lobectomy + 4 rounds of adjuvant chemo May 2019. No lympnode involvement. May 2021 nodule near surgery location grew 1mm. Appointment for PET. Is there a chance this is scar tissue. If not do I have a chance to live a long life and is a second lobectomy an option. Are there treatments for this. Is it bad if it comes back in same location?

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Hi, Banna, 

I made it three years after my lobectomy before it came back.  I assume you've been having scans every few months, right? Is this a nodule that's been there all along and is now 1 mm larger, or did it recently appear? 1 mm is pretty small--I think that amount of change could be due to the angle of the imaging. A PET CT will tell you a lot more.

When my recurrence first appeared and they thought it was confined to the one lobe, my then-oncologist said it was possible I'd be a candidate for CyberKnife surgery (precision radiation). Unfortunately, the PET CT showed it had spread to a number of lymph nodes and a spot on my sacrum, making me Stage IV, so surgery was out. 

You'll know a lot more after the PET CT. Hang in there--no matter what, there are lots of treatment options.

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  • 2 weeks later...

My wife had a similar situation, in case it helps inform your actions. She is 70 and was asymptomatic two years ago when a CT scan showed some minor growth in two small right lung nodules. Stage 1A. Largest had grown to 1.3 cm. She has COPD so the only recommended surgery was wedge resection. Lobectomy would have put her oxygen forever more. During surgery, the margin was considered clean by microscopic exam. The surgeon claimed the margin was clean under the staple. Apparently the micro METS evaded detection. Three months post-op, CT showed “nodularity” and “thickening” at the surgical site. Despite the surgeon’s intra-operation interpretations, the DX was malignant pleural effusion and Stage 4. Thorocentesis one time, then we went immediately to the chemo/keytruda triplet. So far, we have had great results. In eight months we have moved to Keytruda only after NPD and significant node size reduction at the surgery site. From what we have learned, this sort of thing is fairly common. The wife is functioning in full work mode and has only some SOB as side effects. We advise to get and save copies of each and every scan and pathology report. We wonder now whether the surgery attempt was wise without adjuvant rads/chemo. On the other hand, we see plenty of folks who have done all sorts of pre- and post-operative treatments and had similar MPE results and METS. Get familiar with the terms so you can help these marvelous professionals help you.

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Do you know if you had biomarker testing done? If there is a recurrence, that can determine what treatment options are available to you.  If they still have the sample but didn't send it out for testing, they might still be able to do that now.  Here is information about biomarker testing: https://lungevity.org/noonemissed

Here are different treatment options: https://lungevity.org/for-patients-caregivers/lung-cancer-101/treatment-options-for-lung-cancer

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