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Mom’s lung nodule/hoarseness


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Hi all—my mom has smoked for years. She developed a hoarse/raspy voice pretty much overnight in early September. The doctor thought it was allergies and prescribed a nasal spray and allergy meds, but after 2 weeks, it was no better so she sent her for a CT scan. They discovered a 2cm nodule and one swollen lymph node, the latter of which they believe is pressing her vocal cord. From how it looks on the scan, they think the nodule is likely malignant. They did not see anything else concerning on the scan (no other nodules or swollen nodes).


She needs to get in for a PET scan but they can’t get her in until a month from now, which feels crazy to me. She’s trying to get in sooner. They said because of the location, surgery may not be possible (assuming the PET doesn’t show other masses) and they will do chemo and/or radiation. She is also going to have an endoscopy in 2 weeks.

The one other thing is that she had Whipple surgery + adjuvant chemo for bile duct cancer 8.5 years ago and is considered cured, but there is a very small chance it is a long-term distant met from that cancer, which commonly recurs in the lungs and/or liver. 

She has no other symptoms other than the hoarse voice.

I’m just looking for any sort of stories about people who have had hoarseness as their primary symptom. 

I’m both not shocked given her history of smoking and previous cancer and deeply scared. She is 79 and otherwise healthy. 

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Tmph,

The endoscopy ought to secure tissue and a tissue histology exam will reveal if your mom has cancer and disclose the type: lung or a distant met from the bile duct episode. But, the PET scan is used to stage your mom's cancer, and staging is mostly about whether or not surgery can be performed. If there are several distant metastatic areas involved, surgeons are reluctant to operate and just remove one. Systemic treatment (chemoradiation) in these cases is often used. Here is information about lung cancer staging.

Your mom ought to have a consultation with a radiation oncologist and be sure to ask if precision radiation can be used to treat multiple metastatic areas if indeed your mom has multifocal disease. Precision radiation can substitute for surgery in certain circumstances. Here is information on precision radiation used to treat lung cancer.

Stay the course.

Tom

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Sorry you guys are going through this again.   A PET  scan while part of the process can not tell one way or another if something is cancerous or not.   I've had more benign lesions light up a pet than malignant.  And my profile picture is a bunch of malignant ones.

I went to the ER and came out with an appointed for an oncologist, pulmonologist the next week.  A biopsy 12 days lster and a PET scan a little over a month out. It ended up being closer to two months.

They should know during the endoscopy if it appears to me malignant so the pet will be for staging.   Or if it end up being non diagnostic. 

It's in noway guaranteed to be malignant.   Many Heterogeneous Enhancing solid lesions with irregular edges are not cancerous.  40 to 60% are benign.  And they represent the scariest of lung lesions. Her past history is definitely going to play into.

I had no symptoms.   My first symptoms were from my brain tumors the day I was going to get my chemo port put  I lost the ability to see to the left that morning.  It was restored for a little over a year and went away again.  I'm not alone being asymptomatic. Even late stage lung cancer do not alway have symptoms.   1 in 4 are asymptomatic. 

 

 

 

 

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Thank you both so much for your input. I have a little more info since writing this. I looked at the report of her scan, and it's a bit more than she said, though I'm obviously not a radiologist so I know I don't know what I'm talking about, ha. There is the primary nodule, which is 2.2 x 2.3, on her upper right lung, and some smaller scattered nodules in both lungs. Some of them may have been there before (I was able to look at her last post-Whipple scan, which was a year ago, and it noted multiple stable lung nodules that were unconcerning). It appears there are multiple swollen nodes. One of them is causing the hoarseness (pressing her vocal cord or nerve), not the nodule.

My brother and I will be going with her for a bronchoscopy and other testing on Friday, which will include a lymph node biopsy (I believe?). I'm assuming if the lymph node biopsy is positive, they can start the ball rolling for treatment, right?

She is being treated at MSKCC in New York, which is where she was treated previously. She's going for a brain scan tomorrow. Next week, she is seeing an ENT at MSKCC who *might* be able to do something to alleviate the pressure on her vocal cord. I know they will do a lot of genetic testing and have already talked to her about targeted treatments and immunotherapy. They said there are a lot of clinical trials as well. 

Sigh. I was sure her last cancer was her "big" one. It was a bit of a miracle situation--caught incidentally and early, and the surgery was considered curative after 5 years. She had switched to yearly scans literally last year.  

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Tmph,

A biopsy (histology--microscope exam) result disclosing the cancer type may allow systemic treatment to start for certain forms of lung cancer. However a result pointing to non small cell adenocarcinoma or squamous cell lung cancer may delay systemic treatment until a follow-up laboratory analysis for biomarkers (genetic testing?) is complete. New and effective systemic therapies are now in play for certain forms of these types and the results of biomarker testing disclose if one or several of these therapies will work. Here is information about biomarkers and related therapies.

I'm almost certain a bronchoscopy exam will include a lymph node biopsy. You might want to have a consultation with a radiation oncologist about addressing the pressure on your mom's vocal chord. Sometimes 3 to 5 precision radiation treatments can eliminate the problem and not complicate planned systemic therapy.

Stay the course.

Tom

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i think my primary symptom was the pressure in my chest.  when my voice changed, that is when i insisted on seeing an ent.

began as hoarse voice and eventually became difficult to speak because i was out of breath.  the ent shoved a little wire up my nose (it was a camera) and said my left vocal cord was paralyzed.  that allows all your breath to escape when you try to talk.

he said the nerve that controls your left vocal cord passes down through your chest.  the right vocal cord has a different path.  the lymph nodes in my chest (cancer) pinched the nerve causing the paralysis.  the ent ordered my pet scan that led to my diagnosis.  pulmonologists missed it completely.

one surgeon said he could not biopsy without cracking my chest open.  a more experienced surgeon said he would try to get to the lymph nodes in my chest by entering under my arm pit.  he was successful. 

i went on chemo and immuno.  after maybe 6 months, my pet scans began to come back clean.  and my voice cleared up.  the ent said that when the nerve is pinched, its rare to get the voice back to normal.  i do not know if my left vocal cord is still paralyzed or if the right somehow compensated.  

i had no surgery to remove cancer.

this began about 2 years ago and i still take one chemo and immuno.  and for me, i have had remarkable few side effects.  

sounds like they caught hers earlier than mine.  

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