Any suggestions about lung mets surgery

sreekanth said:

Surgery is routinely done for

Surgery is routinely done for metastatic lung cancers, I had surgery to remove a solitary lung nodule two years ago. The decision to perform or not perform surgery depends on the extent of metastasis. 
I have heard stories of people getting tumors removed from multiple sites in the lungs and liver (in colontalk forum). Please try to learn more about your condition and if possible, get second opinion

Well said!  Strongly agree..

Well said!  Strongly agree...Surgical opinion is always the best idea.

abita said:

I read somewhere just a

I read somewhere just a minute ago, that only 10 percent of lung mets are operable.

Does that sound right, or does it sound like maybe that could have been the case before but that there are so many new ways to remove or burn them or whatever, that the odds are greater?

And thanks all for helping me. I was so devastated by this news. And why aren't they researching new treatments!!!!!!!!

abita, Typical surgery (cut

abita, 
Typical surgery (cut and remove diseased portion) is the most commonly used technique. But I have read of other options like cryoablation and radiation ablation of lung nodules  in patients who can't get normal surgery. The number and accessibility of mets determines whether the surgeon can use some of these techniques.
Prayers for you

abita said:

I had liver mets when I

I had liver mets when I started at Sloan 2 years ago. The chemo made those disappear right away, and yet, two of the lung mets, only remained stable, which means a tiny bit of growth, until this last scan. Thanks for the explanation. That is exactly what I was wondering. At least nowI don't feel like I was stupid for not asking sooner about surgery. The liver mets were probably why not considered. I will look into ablation. A I crazy for thinking if something like ablation, which is not as invasive as surgery, could be done on even 1 of them, that is a good step?

I think it could be done

On just one but it's size dependent, at least it is for liver mets. Talk to someone see what they can offer you. It's not surgery at all it's a procedure. They use a probe to burn them and go in through the skin but not surgically.  I know sometimes you can go that day but they also occasionally keep you overnight. I do not know how they determine if they can do it or not though. 

 

abita said:

Now that you mention size, I

Now that you mention size, I think he waited too long. They are now two at 3 cm and two under a cm. Weirdly, the two smaller ones didn't grow when the other 2 did.

I am living on a roller coaster. There is even a part of my brain that still thinks the scan was wrong, that maybe because of the contrast compared with no contrast, or all the congestion, or the 10 pounds I lost, or anything. I sometimes think some miracle will happen. I sometimes have very sad thoughts too. And I am angry. I can't stop snapping at people for even minor annoyances. I let a coworker have it today for interrupting me in a meeting today to expalin what she thought I meant. Oh, my CEA rose from 10 to 20, which is the only reason I believe the scan. any less of a rise, and I could have convinced myself it was the allergies.

In the same boat as you,

In the same boat as you, abita when it comes to CEA rise. Wishing you peace of mind

abita said:

Immunotherapy is only

Immunotherapy is only approved for those with mutations. I don't have any mutations.

Immunotgerapy

Immunotherapy can be as far as I know used in 2 types of patients: first the MSI mutation. MSI is 15% of all cancer patients. 

Most patients have MSS, a microsatellite stable tumor. 

You either have a MSI (microsatellite instabile) or MSS (stable) tumor. 

Recent research showed that people with a MSS tumor can benefit from immunotherapy like keytruda. But to know if people fall into this category you need to do next genome sequencing or foundation one testing. These tests scan the tumor for a lot mutations and figure out which chemotherapies are affective as well. If these tests figure out that you have a high TMB (tumor mutation burden) then keytruda is possible to use as well. As far as it was with my dad, these tests are not standard so even though BRAF or RAS are not mutated in your case and you are MSS, it does not mean that TMB is low. It could be high enough to try immunotherapy but you need to test for it specifically. 

2 stepping around problems

Combined maneuvers, "multimodulated" approaches.  A good surgery buys 1-3 years time even if you don't get a full set of steps done.

We used daily chromomodulated oral chemo, a more sophisticated schedule than ADAPT but everything generic (~cheap), and LEF's 2010 immune approach to stop the spread and improve WBC and blood panels.  One of the problems with conventional chemo is that they abandon 5FU too soon, instead of re-sensitizing (relighting it) thru additional chemistry (for us, celecoxib was big, and some of the specific nutraceuticals). It is harder to do this after heavy chemo cycles, but maybe still possible.

We got a PALN surgery with difficulty, inoperable to most drs. We climbed higher up the pyramid of drs, finding literature, and eliminating/overcoming objections. The met spreads were  questionable before surgery, but we could claim some control of the worst mets with oral chemo +++ the other stuff.   Our surgeon agreed that the chemo was likely to work  better  with the biggest, likely most mutated mets gone - your drs opinions might not agree.  Answer is keep interviewing with better data and sales pitches each time.   

Post surgery the surgeons and pathologist felt that the metastates were going to be a serious problem, bigger, more numerous and nastier than anticipated - the head surgeon was pushing chemo on the 5th day after surgery, but we were even faster on the chemo application, following a good surgery, no complications, and much better wound healing routines.

I had been prepared for 3 years post op chemo by successful examples found in the literature but it took us 7 more yrs to burn out the rest.  (#1300)

 

Second opinion

Abita,

I would strongly recommend a second opinion!  I am in a situation where I have doctors telling me I need to have a gastrectomy.  Which I am trying to avoid.  My local doctors seem to think that is the only option.  I have decided with the help of my PMD to get a second opinion at the Cleveland Clinic.  Which that is exactly what I am doing.  I am still trying to have hope that I do not need a gastrectomy.  There are so many different doctors and surgeons there and they have so many different clinics and research.  If it is an option for you I would strongly recommend trying to go there!  I hope I am not over stepping, by making that suggestion.  They have multiple locations around the USA.  I am near Buffalo, NY and the main campus at the Cleveland Clinic is about 4 hours from my home.