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Totally confused


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I had an appointment with my surgeon Tuesday to see how the plueral effusion was clearing up. I had an x-ray when I got there. He came in the room with the x-rays, put them on the light and said how well I looked and how well my chest was clearing from the empyema. He proceeded to go on about the fact that I was looking better than the last time I saw him, etc. He said I'm still a 1A and have an 80% chance of the cancer never recurring.

I told him I had a quick question.

I had been going through the papers my primary care doctor gave me to give the oncologist because I'm deciding on whether or not to take chemo. I pulled out the paper that read:

10 mm indeterminate left adrenal nodule apparently increased in size since the chest CT of 5/30/04. Dedicated adrenal CT or MRI would be most helpful for further evaluation.

I asked him if that could be cancer and he said yes and if it was it would make me a stage 4 and he would suggest no chemo, just pallative care.

This man must be nuts!

I can't figure out why it was never mentioned to me by anyone of the specialists or why it wasn't biopsied when I had my surgery in July. I had the vats surgery but would have gladly had the old fashioned opening of the whole chest to biopsy a suspicious growth.

This CT was taken on August 9, I was back in the hospital because of the plueral effusion I got after my surgery.

Is this normal? I mean a surgeon ignoring a growth while he is already operating on someone for cancer?

I'm so upset I can hardly stand it.

This thing that my surgeon already knew about while I was being operated on could cost me my life.

Just need to vent



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Get a second opinion from an oncologist. A surgeon is someone who opens a person up and removes or fixes what someone else finds (radiologist, etc.). An oncologist deals with cancer... If you think you may be dealing with cancer or have questions regarding cancer, take them to your oncologist.

As for this guy not being aware of other things, I say "HUH?" When I had my gall bladder out, the surgeon took a good look at my liver since he was 'in there anyway' and said it looked great. The gall bladder surgery had nothing to do with cancer but the surgeon knew my history...

The surgeon giving you a "stage" isn't right. Don't buy it, ask someone who specializes in the field.

Hang in there,


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Bless your heart for posting this!

I can't tell you how sick I've been feeling over this. Now I know I have hope that it isn't malignant. I won't know for 3 weeks, that's when I see the surgeon again. I'm in for a long 3 weeks but it won't be quite so stressful.


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Kaf;...I had those same redoubts when the onc. ordered all tthe scans AFTER my surgery. I asked "why not before, to see if the surgery is curative or only partial treatment>? It seems surgeons are very narrow-focused on the primary tumor...dont bother to investigate anything beyond that, seems to me. Additionally; there may be a good reason why my bronchoscopy was inconclusive, necessitating a needle biop.; the path report reads "right lung washings cytology examined"...my tumor was in left lung...sigh...if there were left lung washings, there was no report given to me with the others. sigh....Im probly lucky they removed the correct one! Fortunately, my scans were clear, just by luck, but I could easily have been in the same situation. Still could be as I have one MRI to go yet. My surgeon never suggested any further investigation before surgery either...sounds like their all similar, or most anyway, huh?

But dont jump to conclusions yet, get it investigated , by all means, but you cant assume its cancer for sure. Could be lots of other things as folks on here have mentioned in posts...cysts, benign growths, etc. Heres hoping its nothing....but do get those scans, and be sure by biopsy before the next move, if necessary.

I think people would all do well, ..tho there is no medical protocol in place to ensure it, to not allow a surgery to be done until AFTER seeing an Onc. and getting a thorough body investigation to get the overall picture, now that we know about these events...(sigh, ..Drs. aint what they used to be.)

Anyhow, try to relax, it might be nothing...hopfully...Im sure youll get lots of info and support to follow here...

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For Oncodoc; No, I dont lump all drs. as bad guys...I had an anesthesiologist who was exceptional, and now the Onc. seems quite thorough and helpful......sorry if my post sounded that way. I was just noting that a number of posts now, have related some pretty remarkable behavior and oversights by some drs., as I also experienced in my surgery adventure. So to be more accurate, I maybe should have said SOME drs. aint what they used to be.

As for yourself; I commended you in the dr./patient relationshiip thread on your caring enuff to ask the members here for their opinions , etc. You obviously strive to improve your care of patients, by gaining more insight and perspective. Kudos for that. The fact that you participate here speaks to that fact, and your professional input is very helpful to us all. No offense intended toward good docs, but again, sorry if it sounded that way. Rich

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oncdoc, is the attenuation value of the CT scan on the adrenal a good indication? And I guess if it is a lipid poor adenoma then a FNA should be done or PET?

Also what does a functioning mass vs non-functioning mass mean?

Isnt it better to find out if it is a met earlier when the met is < 3 cm and possibly remove the met than wait.

I have read that a solitary adrenal met can be removed. I am not saying it is but shouldn't patients be given all this information instead of reading by themselves?

I know there is a trade-off between too much information and worrying a pateint with maybe unecessary info. How does a Dr decide on what info to provide?

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Rich I'm just teasing, you can rip on docs all you want!

And John you are right right and right.

Adenomas of the adrenal gland can be determined to be benign with 99% certainty by CT. They should do a dedicated CT of the adrenals with fine cuts, and calculate the Hounsfield units which will determine if fatty or not. If fatty, almost certainly benign adenoma. If not fatty, then need to get a biopsy. I don't trust PET scan with lesions this small, biopsy would be best if any doubt.

A functioning adrenal tumor can produce hormones....pheochromocytoma (adrenal cancer) is an extreme version, but most are benign and produce cortisol. Most are non-functioning however.

Definitely better to diagnose early and I agree that surgery to remove it would be the way to go if it is a solitary met, it along with the brain is one of the metastatic sites that can be cured with surgery, I have one patient 7+ years out who is living proof.

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Actually I do have an appointment with an oncologist this Monday. I had already made the appointment which is why I had that particular paper to begin with.

It seems so coincidental to me that I would have lung cancer growing in my chest and a benign growth happening at the same time on my adrenal gland. I have to admit I'm scared but the thought that it could possibly be completely removed is such a relief! I did have a whole body scan before I left the hospital which must be when they saw that the spot on the adrenal gland had grown. I still don't understand why someone didn't point it out to me way back in May when it was first discovered. Especially since it was April when they first discovered my cancer, I would think they would have seen that as suspicious.

Oh well, I guess only our doctors know why they do some of the things they do.

I do have my GP who I have lots of faith in, he truly cares about his patients, we are people, not chart numbers.

Oncodoc, you can bet I'm printing this out, I want to read it when I'm feeling so nervous about the CT scan since it will be another 3 weeks before I have any sort of answer.

Thank you all for writing and rich, you know I've been watching and waiting for your scans to come out clear, knew they would! :wink:


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