Biopsy questions

PBL said:

Hi Bailey,

Hi Bailey,

Although there can be false-positive PET scan results (showing hypermetabolism with some non-malignant conditions), everything in your case seems to fit the tentative diagnosis of lymphoma. As already mentioned in our replies to your original thread, a biopsy is necessary to not only confirm the malignant nature of your tumor, but more importantly to pinpoint the type of cancer (and if it is lymphoma, the type of lymphoma, as there are several dozen...) you are dealing with, as that determines the course of action.

When dealing with most lymphoma types  (lymphoma being a hematologic cancer  - or, so to speak, a solid tumor of a "liquid" cancer - can manifest itself anywhere in the body) and in most cases, surgery generally does not have a curative intent, and is basically limited to biopsies, as chemotherapy is the treatment.

The fact that your doctors now say you have to go forward with a thoracic surgeon would suggest that the PET scan did not find any more accessible tumors (such as, for example, an axillary or cervical lymph node) or bone marrow involvement.

The aim of the surgery will be to get a sufficient piece of your tumor for the pathologist to identify the type of lymphoma, and given the location, a thoracic surgeon is the most competent to proceed safely and successfully. General anesthesia does not necessarily mean that this has to be a lengthy or very invasive procedure - and I certainly hope it will not be.

In my case (primary bone lymphoma, no lymph node involvement), two open surgical biopsies under general anesthesia were performed by an orthopedic surgeon.

I suggest that you ask the thoracic surgeon to explain how s/he intends to proceed to get that piece of tumor, and whether there is a Plan B.

Do let us know how things go after that appointment next Tuesday.

PBL

P.S.: on a practical note, you may want to keep all your posts in one single thread (for example under the title "Mediastinal tumor" or whichever title is most representative of your case) as it can become difficult for others to keep track of your info over months (or even years) and as a result you may find that the replies you get are irrelevant or redundant. Also, this will be more useful to anyone coming to the forum with a similar diagnosis to yours and trying to figure out the road ahead.

Bailey,

Response to lymphoma begins with a correct diagnosis, which as I and others said previously, starts with an accurate biopsy.  Enough tissue must be removed for proper testing, which is why an aspirational ('needle') biopsy is frequently inadequate; stated more bluntly: they are often WRONG.   Recall, there are over 50 strains of lymphoma recognized by W.H.O., as well as the AMA.   Treatment for one strain is often inappropriate and ineffective agains others.  So Step 1 is a proper biopsy.

It is ideal that you are seeing a chest surgeon.  There is really no part of the human body (except sections of the brain) that cannot be accessed successfully, even if tricky.  A thoracic surgeon is precisely what you need currently.

Refer to the details in PBL's suberb response above as you proceed.   As mentioned, surgery is virtually never a curative-intent modality agains lymphoma, which is a systemic disease.   Therapeudic radiation (RT), escecially extreme-precision metholds, like SBRT or IGRT, are sometimes used against Stage 1 disease, but usually with chemo following as an adjuvant. 

It requires a truly expert medical oncologist to make these treatment decisions, and even such a doctor cannot choose wisely without an expert and definitive biopsy.