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Lung nodule strategies - welcome your advice/experience

YoVita's picture
YoVita
Posts: 590
Joined: Mar 2010

I'm just finishing up some research on treatment of lung nodules. I was diagnosed with rectal cancer stage IIIC two years ago. Was clean until a recent ct scan followed by a petscan which showed one lung nodule. My oncologist recommended I have it surgically removed and then possibly followed by a new regiment of chemo (folfiri). He strongly believes it's cancer. He does not recommend a biopsy - he thinks they're not effective. My appointment with the surgeon is tomorrow morning. I'm learning more about non-surgical strategies now including RFA and Cyberknife. I'm wondering why my oncologist didn't suggest these as alternatives. Is the conventional wisdom that you cut it out if you can and only use these other techniques if you can't? I appreciate hearing your thoughts. I trust my oncologist but just wondering about alternatives. Thanks.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

Our order of battle for pre-existing "lung thingies" (~6mm, no SUV) has been continuous immunochemo first with watchful waiting. If measurable growth occurs and surgeon can reach it, surgery with VATS if possible. SBRT (e.g. CyberKnife) or perhaps ablation if surgery is not possible.

I am not decided at what point we would be willing to abandon immunchemo as ineffective, mere progression of a few lesions would not be reason to abandon. Second surgery restored CEA responsiveness to the immunochemo, got rid of the less responsive nodes. No new met sites had occurred despite the growth of the para-aortic lymph node cluster and some nodes' resistance to immunochemo after too low a dose.

Our experience has been informed by much different points of view for each modality and provider - surgeon, med onc, rad onc, radiologist, alternatives MD. Caveat emptor, multiple opinions can be useful in multimodal situations.

taraHK
Posts: 1961
Joined: Aug 2003

I had three small solitary lung mets at three different times. Each time treated surgically followed by "mop up" chemo. They sometimes tried biopsy with me but it's not easy -- depends on size of nodule and position in lung. I guess one advantage of surgery over say Cyberknife is that you try to get clear margins. But this would be a good question for your oncologist. By the way, I have had no further lung mets.

I wish you all the best! Lung surgery sounds scary but it's OK.

Tara

PhillieG's picture
PhillieG
Posts: 4885
Joined: May 2005

I've had that done four times so far, for lung mets. It was 100% successful with the mets they went after. Prior to the RFA, I had wedge resections done for spots in my lungs. That is MUCH more invasive. I never had them biopsied prior to the procedures. My Onc felt strongly that they were what they were and while there's a place for biopsies, this wasn't the place!

I never had the cyber-knife done but I am a big fan of the RFA's.
Three out of four times I went home the same day...
Best wishes.
-phil

YoVita's picture
YoVita
Posts: 590
Joined: Mar 2010

Thanks to all for your responses. It just goes to show that there doesn't appear to be one strategy for all. I met with the lung surgeon. We've scheduled a VATS which might turn in to a thoracotomy due to the deep position of the nodule. This does seem scarier than my original surgery - although that may be because I have more time to research and brood about it. I'm still going to ask my oncologist about RFA and cyberknife before the actual surgery takes place.

ggg647
Posts: 1
Joined: Jul 2012

I am curious as to what the RFA is? I have 4 nodules in one lung and 5 in another. They tell me it is impossible to biopsy them. I have been on chemo 3 years. Were yours cancer when they did the RFA? I've been told any nodules react to treatment yet my CEA does fluctuate..

Wenchie
Posts: 88
Joined: Apr 2009

Hey Phil, I think I've talked to your before but I have a question...when you had your Radio Frequency Ablation, did you have nodules in both lungs and did they do both lungs at once? I've been turned down for RFA at Moffit due to the fact that both lungs are involved but I don't understand why they don't do one at a time.

peterz54's picture
peterz54
Posts: 343
Joined: Feb 2012

I occasionaly ask questions related to my wife's Stage IV colon cancer at cancergrace.org. They are building up a staff specialists, mostly oncologists I think, to answer questions in their forums. This way you may get and answer from a trained professional.

GRACE currently has specialists in lung cancer, which I know is different than lung cancer which is secondary to colon cancer, but there is a good chance one of the Drs there can offer a different perspective

Global Resource for Advancing Cancer Education

YoVita's picture
YoVita
Posts: 590
Joined: Mar 2010

Great resource. Thanks for the link. I hope they expand to CRC.

peterz54's picture
peterz54
Posts: 343
Joined: Feb 2012

Dr West at GRACE said he would make a concerted effort to get a specialist in colorectal cancer on staff..

lesvanb's picture
lesvanb
Posts: 911
Joined: May 2008

because I had four nodules total in four lobes: upper right and left, lower right and left. I'm now having VATS to remove the RLL since it's grown slightly since SBRT in Jan 11. This growth could be a radiation side effect according to my radiation oncologist. Since we've been watching for 6 months, we opted for VATS to give us a definitive answer to what's going on. PET would likely pick up residual radiation inflammation. Given a choice I would opt for surgery first since radiation does leave scarring and there are late side effects. I have been off chemo for three years and nothing else nowhere else has shown up.

Good luck!
Leslie

Kenny H.'s picture
Kenny H.
Posts: 503
Joined: Aug 2010

Surgery is your best option to be sure they get it all. But your looking at a couple weeks recovery time ea side.

peterz54's picture
peterz54
Posts: 343
Joined: Feb 2012

Dr Weiss's answer to my question about lung nodules might be of value:
treating-lung-nodules

Also, on the same site there are quiet a few answers about different aspects of RFA:
Ablation

and cyberknife
Cyberknife

Julie061
Posts: 18
Joined: Jul 2012

His information is exactly what my doc at Cancer Treatment Centers of America told me. It really does give me hope that there are several more drug combo's that can be used to fight my battle! Just because I am incureable, doesn't mean the battle is over.

My thoracotomy and resection of three small nodules for biopsy purposes was performed 12-10. Once mets was confirmed my next question was when do we take the rest out? It turns out you don't. With chemo, some disappeared and some more showed themselves. At this point they are in almost every lobe and in both lungs, but all very small.

It has been a year since my last round of chemo was over. Scans are pretty stable so far and I am enjoying every day. My doc will let me know what is next when the time comes.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

[off topic, thought about other surgeries]

dmj101's picture
dmj101
Posts: 527
Joined: Nov 2011

Yo Vita...
I have several mets im both my lungs.
We are hopefull that the chemo will shrink them and cut them down.. and then we are talking about posssible RFA
They wouldn't want to cut and make swiss cheese of you lungs if you have many.. at least that is what they have told me.. ..

I am having scans this week and hoping to hear all the mets are gone. but preparing to possibly hear RFA can be done if any are left..

luvinlife2
Posts: 172
Joined: Jul 2012

I had this done in 2010. I had a very fast recovery and would have gladly gone back to the OR to get the others removed but they don't do that. If I was in your position, I would have it (along with the safe margins) cut out. Follow up chemo? I don't know...I'm a bit skeptical with doing chemo if nothing lights up and the CEA is low. There are lots of natural things you can try that are easier on the immune system.

Good luck :)

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