Any suggestions about lung mets surgery

abita

I got the news that I have to switch drugs. I asked about surgery, and he said doesn't make sense because I am metastatic. But doesn't it make sense to get them removed if possilble, and continue chemo so others don't grow?

sreekanth

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

SnapDragon2

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.

Diane_K

You should get a second

You should get a second opinion from a surgeon.  Surgeons will decide if they feel they can safely and completely remove tumors, not an oncologist.  I had three small tumors removed from my lungs, two on my right and one on my left.  I also had two tumors removed from my liver, and I am now 4.5 year NED.  My oncologist wanted me to have radiation on my left lung tumor.  I wanted surgery instead so I made an appointment with my surgeon and he agreed to remove it.

Sending you best wishes, Abita

abita

Diane_K said:

You should get a second

You should get a second opinion from a surgeon.  Surgeons will decide if they feel they can safely and completely remove tumors, not an oncologist.  I had three small tumors removed from my lungs, two on my right and one on my left.  I also had two tumors removed from my liver, and I am now 4.5 year NED.  My oncologist wanted me to have radiation on my left lung tumor.  I wanted surgery instead so I made an appointment with my surgeon and he agreed to remove it.

Sending you best wishes, Abita

Thank you.

Thank you.

abita

Diane_K said:

You should get a second

You should get a second opinion from a surgeon.  Surgeons will decide if they feel they can safely and completely remove tumors, not an oncologist.  I had three small tumors removed from my lungs, two on my right and one on my left.  I also had two tumors removed from my liver, and I am now 4.5 year NED.  My oncologist wanted me to have radiation on my left lung tumor.  I wanted surgery instead so I made an appointment with my surgeon and he agreed to remove it.

Sending you best wishes, Abita

How do you find a lung

How do you find a lung surgeon to get a second opinion? In my mind, even if they aren't all operable, my lung term chances are better the fewer I have, especially if the bigger ones can go. It is so weird, but the 2 smaller ones remained unchanged, only the larger grew since the last scan.

abita

How do you find a lung

How do you find a lung surgeon to get a second opinion? In my mind, even if they aren't all operable, my lung term chances are better the fewer I have, especially if the bigger ones can go. It is so weird, but the 2 smaller ones remained unchanged, only the larger grew since the last scan.

The more I think about maybe some could be removed, the more hope slowly sinks back in.

I don't understand. Why would an oncologist not want a patient to see if surgery is an option?

abita

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!!!!!!!!

sreekanth

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

Ruthmomto4

Maybe see if they can be ablated

That would be an interventional radiologist. So with surgery typically they will not do it if they can't get it all. The risk outweighs the benefits. also, they typically won't touch lungs if it's in the liver or vice versa. I am not a doctor so I could be wrong so ask for a surgical consult. are you at Sloan? If not call them and have them look over your records and see what they can offer you. It's funny how many times I had to suggest something even  though it should be obvious. I am guessing your not candidate for immunotherapy?  That to you have to sometimes ask. I am sorry it grew I very hopeful there is sn option out there for you. I come often just to check on you. Xoxo

abita

Ruthmomto4 said:

Maybe see if they can be ablated

That would be an interventional radiologist. So with surgery typically they will not do it if they can't get it all. The risk outweighs the benefits. also, they typically won't touch lungs if it's in the liver or vice versa. I am not a doctor so I could be wrong so ask for a surgical consult. are you at Sloan? If not call them and have them look over your records and see what they can offer you. It's funny how many times I had to suggest something even  though it should be obvious. I am guessing your not candidate for immunotherapy?  That to you have to sometimes ask. I am sorry it grew I very hopeful there is sn option out there for you. I come often just to check on you. Xoxo

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?

abita

Ruthmomto4 said:

Maybe see if they can be ablated

That would be an interventional radiologist. So with surgery typically they will not do it if they can't get it all. The risk outweighs the benefits. also, they typically won't touch lungs if it's in the liver or vice versa. I am not a doctor so I could be wrong so ask for a surgical consult. are you at Sloan? If not call them and have them look over your records and see what they can offer you. It's funny how many times I had to suggest something even  though it should be obvious. I am guessing your not candidate for immunotherapy?  That to you have to sometimes ask. I am sorry it grew I very hopeful there is sn option out there for you. I come often just to check on you. Xoxo

Immunotherapy is only

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

Ruthmomto4

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

Ruthmomto4 said:

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. 

 

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.

sreekanth

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

Ruthmomto4

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.

I saw

3.5cm as a cut off BUT that's an internet search. call Monday and ask for a referral to an interventional radiologist. Of course your snapping at people your stressed, and worried. I understand stressed and worried just explain to people your having some personal issues and give yourself a break now and then.

Tueffel

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. 

myAZmountain

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.

Lung Surgeon specialising in cancer

Was the one person that truly gave me peace of mind, he went ove scans painstakingly and was willing to do surgery if needed--a lot depends on the location of the tumors, are they all in one lung? One lobe? They can remove a lobe --I would schedule an appointment ASAP with a surgeon.

tanstaafl

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)

 

SnapDragon2

My approach is combining

My approach is combining ADAPT+++ with many other multi-modalities such as inflammation control, blocking cancer pathways and hitting stem cells, daughter cells, mast cells, ect for super max control all based on bloodwork to either kill it off or catch it early for surgery.  After 2yrs nothing is still on scans but yet I have a CEA.  So, I have to think its traveling around somewhere just no clue where but it gives me more chances for success and cure.

To take advantage of ADAPT+++ you need alot of support from different drs (I have 2 NDs that have different skillsets/expertise I need for my approach and an intergrative onc.  That's it) and be research educated to advocate for yourself.

cstiller

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.