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PET/CT results...not so great

luv3jay's picture
luv3jay
Posts: 534
Joined: May 2009

Well, I had my PET/CT last friday and got the results from my onc today. The pelvis and liver are all clear, but a new small (less than 1cm) nodule showed up in my upper left lung lobe. There were already smaller ones scattered in the bottom right, but we were just keeping an eye on those because they never changed. Anyway, he's pretty sure this one is cancer, so he sent me upstairs to see a thorasic surgeon to schedule a lung wedge resection. Unfortunately, she had to go to the OR with another patient, so she wasn't able to see me. I have an appointment with her in the morning. Anyway, this means that radiation is out for me, for now, unless they find that what is in the lung is not cancerous. So it will be back to chemo for me after the lung resection. I have the KRAS mutation, so Erbitux is out...

Anyway, can some of you tell me your experiences with the lung wedge resect? Thanks!

-Sheri

dianetavegia's picture
dianetavegia
Posts: 1953
Joined: Mar 2009

I'm sorry to hear this but let's hope and pray this is one of those benign nodules that can be found in 50% of the adult population!

I don't have any wisdom to share since I've not gone through this but would like to pray for you, if that is okay.

Diane Tavegia

luv3jay's picture
luv3jay
Posts: 534
Joined: May 2009

Praying for me would be MORE than okay! Thank you, Diane!

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Hi Sheri,

Sorry to hear they found this nodule in your lung. As you know, I had not so great news on my recent PET scan as well. Since this is just one nodule in the upper right lung, I'm not understanding why radiation isn't an option for you. It seems like cyberknife could maybe be an option. (google cyberknife for more specific information). I would consult with someone who specializes in cyberknife (at least over the phone about it first- they have certain requirements of location, size, etc.- but it's supposed to do the job well). I can't get it because I have just too many nodules and they're too small.
Anyhow, it looks like they'll be able take care of it one way or another, but I'd still look into the cyberknife if I were you. Asking the lung surgeon about it is a guarantee for a bad response- surgeons always want to do surgery!

I know others on this site who have had lung resections can give you more advice on that.
I'm keeping you in my prayers & thanks for yours for me!

Blessings,
Lisa

luv3jay's picture
luv3jay
Posts: 534
Joined: May 2009

I'm going to ask about the cyberknife. It was so sudden, though and my onc just sent me straight up to see the surgeon. Tomorrow morning I should be a little more prepared, but today, I was just completely caught off guard! I will let you guys know the final result tomorrow after I speak to the surgeon.

Sundanceh's picture
Sundanceh
Posts: 4408
Joined: Jun 2009

Hi Sheri

Your post caught me completely off-guard this afternoon. I'm so sorry this has developed.

You may not know but I'm heading for some sort of lung resection myself in probably under a month - another CT ordered to compare with the last to see if its grown. I've got 2 spots on the pleura of my right lung - pleura is the protective membrane covering both lungs. These spots were about 1.5 mm last check and the PET revealed uptake of 6.4 to one of the spots and they are both close together.

I wanted to add a couple of points if I could - you know how I like to add on, right Lisa?

I like you, Lisa - I've finally found someone who likes to "talk and post" as much as I do. I think I may have met my match :) I always enjoying talking with you, Lisa - you are stimulating and ask alot of questions...gotta get up pretty early in the morning to stay with you.

And I like you too Sheri, you know that - just added you as my "friend." You've been very nice to me and Lisa has said nice things about too - I read Lisa and thank you.

Ok, here's what I think and some of what I know.

Sheri, I'm worried about the radiation and have told my oncs that it is a no-go for me on that one. What concerns me there is first, the scar tissue build up in the lung - I think there could be complications there, like shortness of breath. The other thing I worry about is the "spread of the ray" and what organs that the radiation hits. We don't want it to get near the heart - because this will fry our valves and arteries and again lead to a series of complications that none of us want, like mitra valve leaks and such. My uncle had radiation to his lung and it fried everything and he had to have open heart surgery. So, that's my take there.

Lisa has a great point on the surgeons and it made me laugh - sorry:( She said the surgeons "like to cut." And she's so right, that's what they do.

Which brings me to point #2 - CyberKnife. I was not aware that it could be done on the lung, so that's very interesting. I had CyberKnife done on my liver after the RFA procedure to cut out the remanat of my liver tumor locally - unbelievably it was the size of an ORANGE.

Now, I can't compare Lung to Liver, but this is what I know about CyberKnife. It is considered Radion Surgery, so you actually see a Radiation Oncologist, who consults with a surgeon and they map out the mathematics and put your gameplan together - this information is programmed into CyberKnife, which is laser precise, software driven, high intense radiation over a long period of time, typically 2 hours. Treatments are between 3 and 5 max.

However, the way the computer knows where to "cut" is their has to be radioactive seed markers placed in and around the tumor so they can destroy the main body and get the outskirts of it leaving a clear margin on all sides. To do that, they have to "open you up" by a surgeon and have those seed markers placed in there and then close you up.

So, Sheri I'm going to be very, very interested to see if the same protocol is used on the lung - I'll be anxiously awaiting your answeres there, so I can learn something. The way I described was how it went for the liver.

Surgery - my oncologist told me this is the absolute gold standard for ridding Cancer. In preparing for my surgery, I've studied wedge resections and this seems to be a reasonable approach to your lung nodules. I must be facing something similiar with the pleura - still waiting to meet again with the chest surgeon to see what's up for me.

I don't know if post-op chemo would follow, but I'm sure both of our doctors will recommend it. That makes me sad for all of us.

Surgery - OK
CyberKnife - OK
Radiation - ???

I'm watching both of your cases Sheri and Lisa and I really want things to work out for all of us.

Sheri - we're going to be tied to the hip now, because we will be having chest surgery about the same time. I know its scary - I'm not going to let on, but it's safe to say I'm concerned. But we'll be able to share our experience with each other and everybody else and I'll be there for you when you need me - The Good Lord Willin' and the Creeks Don't Rise!

Great talking with you ladies, this afternoon.

Continued best wishes to each of you
-Craig

Fight for my love
Posts: 1530
Joined: Jun 2009

Hi Sheri,you know,once we hear about the C thing,our mind and hearing will fly out of the window.I am sure it will take a little while for you to recover from the shock. I think the surgeon will be able to do a biopsy.Anyway the resule will be always 50/50 percent.Best luck to you on your surgeon visit tomorrow.Take care.

HANRSC
Posts: 21
Joined: Apr 2007

In May I underwent thorasic procedure but afterwards found out about this new study update.

Colon Cancer News
http://patient.cancerconsultants.com/colon_cancer_news.aspx?DocumentId=43613#_ednref1

Surgery Unnecessary for Most Patients with Metastatic Colorectal Cancer
CancerConsultants.com - News 6/2/2009
Patients with newly diagnosed metastatic colorectal cancer do not need to undergo surgical removal of their tumor unless the tumor is causing complications, according to the results of a study presented at the 2009 Annual Meeting of the American Society of Clinical Oncology (ASCO) in Orlando, Florida.[1]

Colorectal cancer remains the second leading cause of cancer deaths in the United States. Metastatic colorectal cancer refers to cancer that has spread from the colon to distant sites in the body. Historically, standard treatment for metastatic colorectal cancer was removal of the primary tumor at the time of diagnosis. This was not to extend survival, but to prevent future complications that could be caused by the tumor.

However, many new chemotherapy drugs have proven effective in the treatment of metastatic colorectal cancer, and physicians have begun to speculate that surgical removal of the primary tumor is unnecessary and may carry more risk than benefit. Furthermore, immediate surgery often results in the delayed use of chemotherapy.

Researchers at Memorial Sloan-Kettering Cancer Center conducted a retrospective analysis of 233 consecutive patients diagnosed with metastatic colorectal cancer between 2000 and 2006 whose symptoms did not warrant immediate surgery. The patients were treated with one of three triple-drug regimens (FOLFOX, IFL, and FOLFIRI) with or without the addition of the targeted agent Avastin® (bevacizumab).

The results indicated that the majority of patients (93%) never developed complications that necessitated surgical removal of their tumor. The researchers concluded that most patients with metastatic colorectal cancer who receive immediate treatment with chemotherapy never require surgical removal of their tumor. They suggest that chemotherapy should be the standard of care for patients with metastatic colorectal cancer who do not have obstructed or bleeding colorectal tumors.

Reference:

[1] Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. Presented at the 2009 annual meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL. Abstract CRA4030.

Copyright Colon Cancer Information Center on CancerConsultants.com

Surgery Unnecessary for Most Patients with Metastatic Colorectal Cancer
CancerConsultants.com - News 6/2/2009
Patients with newly diagnosed metastatic colorectal cancer do not need to undergo surgical removal of their tumor unless the tumor is causing complications, according to the results of a study presented at the 2009 Annual Meeting of the American Society of Clinical Oncology (ASCO) in Orlando, Florida.[1]

Colorectal cancer remains the second leading cause of cancer deaths in the United States. Metastatic colorectal cancer refers to cancer that has spread from the colon to distant sites in the body. Historically, standard treatment for metastatic colorectal cancer was removal of the primary tumor at the time of diagnosis. This was not to extend survival, but to prevent future complications that could be caused by the tumor.

However, many new chemotherapy drugs have proven effective in the treatment of metastatic colorectal cancer, and physicians have begun to speculate that surgical removal of the primary tumor is unnecessary and may carry more risk than benefit. Furthermore, immediate surgery often results in the delayed use of chemotherapy.

Researchers at Memorial Sloan-Kettering Cancer Center conducted a retrospective analysis of 233 consecutive patients diagnosed with metastatic colorectal cancer between 2000 and 2006 whose symptoms did not warrant immediate surgery. The patients were treated with one of three triple-drug regimens (FOLFOX, IFL, and FOLFIRI) with or without the addition of the targeted agent Avastin® (bevacizumab).

The results indicated that the majority of patients (93%) never developed complications that necessitated surgical removal of their tumor. The researchers concluded that most patients with metastatic colorectal cancer who receive immediate treatment with chemotherapy never require surgical removal of their tumor. They suggest that chemotherapy should be the standard of care for patients with metastatic colorectal cancer who do not have obstructed or bleeding colorectal tumors.

Reference:

[1] Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. Presented at the 2009 annual meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL. Abstract CRA4030.

Charles

mom_2_3
Posts: 965
Joined: Nov 2008

Charles,

This study refers only to the removal of the primary colon tumor, not to metastatic tumors.

Amy

mom_2_3
Posts: 965
Joined: Nov 2008

Sheri,

This isn't the news I was hoping to hear from your scan results. I am sorry you have another skirmish coming up. But you have lots to fight for and so you will fight. I continue to keep you and your family in my prayers!

Amy

idlehunters's picture
idlehunters
Posts: 1792
Joined: Apr 2009

Hi Sheri,

Can you please keep me updated on your progress. Like Craig, I too am facing "something" that needs to be done with the 15 mets scattered on my lungs. I just completed my 4th treatment today and will be seeing my onc. tomorrow about my options according to the success of my chemo thus far. I also have 4 mets on liver but they cannot be addressed until lungs are clear... at least that is what onc. says. I will keep you in my prayers.

Jennie

PhillieG's picture
PhillieG
Posts: 4912
Joined: May 2005

That is GREAT news about your pelvis and liver being clear, not the best with the other news. I have had wedge resections in my lungs 2 times and the surgical removal of part of the lower right lobe last year.

My experience was that the wedge resections have been a very good way of removal of the tumors with a safe margin included. I have had it in both lungs too. I'm not sure why and never asked because the chemo has worked for me but radiation was never brought up to me at all in the 5+ years cancer's been on board. Neither has a biopsy ever been done prior to surgery. I had asked shy they never did do a biopsy and the reply was that there is a chance that they could direct the needle into an area that is not cancerous therefore giving a false negative result. I also think that my nodes were definitely there so what would the point be of doing a biopsy anyway.

So, back to the "wedgies". They have been very effective and I've probably had about a dozen removed overall. I don't count them, it's not really important to me. I don't think the hospital gives any prizes for the number of wedgies you get ;-) The pain is relative, I have a high threshold and during the recovery sometimes it hurt like hell. The chest drain tubes always caused me the most problems and discomfort. I've also had issue with pain meds and narcotics in general with how they tend to slow down the bowels. It has made every hospital stay longer than the average ones for that reason. Overall though, I'd rather get the wedgies than removal of a larger portion of my lung like I had last time. Not that it's less painful, I just would like to keep as much of me as I can. As far as lung capacity goes, I lost maybe 5-10% of my total but then again, if I got off my *** more and did more swimming or walking my lung capacity would strengthen so it's really up to me.

One thing to ask for if you get the wedgie is to have them do a "muscle sparing technique" on you. Instead of them just cutting you open willy-nilly, they go in through your side of the ribcage and gently spread the ribs and muscles to get to the lung area they need to get at. This way, they cut through less muscle and a faster recovery time and you'll be playing the violin as before and in no time. There is also a limit as to haw many lung operations a person can have. Each operation can create some serious scar tissue and getting through that is time consuming and not always possible. That is why for my last (and final due to too many lung operations) operation they had to go in through my back to get to the area.

So there is my experience with the wedge resection. I think it's a very good way to go.
The best to you, keep us all posted.
You'll be in my thoughts.
-phil

luv3jay's picture
luv3jay
Posts: 534
Joined: May 2009

Well! You know, this board has been such a place of comfort for me. When I don't feel like I have anyone to turn to, I can always look to you guys for stregth and support and even humor! What a wonderful blessing you all have been! Thank you so much for everything. Yesterday, I wanted to be scared, but seriously, I thought about everyone here who continues to make it while they are going through and I got so much inspiration to stay strong! I said a prayer for all of us, and just kept forging ahead.

Anyway, I spoke to the surgeon this morning and she showed me my scans. It seems that I actually have 3 nodules on the left lobe. The approx 7 on the right lobe have all cavitised (sp?) so they feel as though the chemo may be working on those. So for now, she is going to perform VATS on the 3 nodules in the left lobe. Then I'll be switched to irinotecan chemo to fight some more. Radiation has been postponed indefinitely until they control the spread. My onc wanted the surgeon to open the chest and get both lobes all at the same time, but the surgeon said she only wants to concentrate on the left lobe for now. It's supposed to be minimally invasive with only an overnight stay and 2 week recovery. Which is great because I can't afford anything else at this point. So surgery has been set for Aug 10th. They both told me to enjoy my vacation next week (we head out saturday) and be prepared to start fighting again after that. So I will keep you guys updated at every turn and I definitely want to be updated on your status!

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Sheri,

Sounds like your surgeon has a good plan. You go and enjoy your vacation- give your mind a vacation from all the cancer stuff for awhile too- you deserve it!!

Take care and keep us posted!

Hugs,
Lisa

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