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Any suggestions about lung mets surgery

abita's picture
abita
Posts: 1069
Joined: Dec 2017

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
Posts: 61
Joined: Apr 2017

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's picture
SnapDragon2
Posts: 582
Joined: Nov 2019

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

Diane_K's picture
Diane_K
Posts: 73
Joined: Jan 2019

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's picture
abita
Posts: 1069
Joined: Dec 2017

Thank you.

abita's picture
abita
Posts: 1069
Joined: Dec 2017

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's picture
abita
Posts: 1069
Joined: Dec 2017

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's picture
abita
Posts: 1069
Joined: Dec 2017

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
Posts: 61
Joined: Apr 2017

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's picture
Ruthmomto4
Posts: 706
Joined: May 2013

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's picture
abita
Posts: 1069
Joined: Dec 2017

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?

Ruthmomto4's picture
Ruthmomto4
Posts: 706
Joined: May 2013

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's picture
abita
Posts: 1069
Joined: Dec 2017

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
Posts: 61
Joined: Apr 2017

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

Ruthmomto4's picture
Ruthmomto4
Posts: 706
Joined: May 2013

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.

myAZmountain
Posts: 420
Joined: Apr 2018

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.

abita's picture
abita
Posts: 1069
Joined: Dec 2017

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

Tueffel's picture
Tueffel
Posts: 310
Joined: Feb 2020

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. 

tanstaafl's picture
tanstaafl
Posts: 1302
Joined: Oct 2010

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's picture
SnapDragon2
Posts: 582
Joined: Nov 2019

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
Posts: 9
Joined: Aug 2021

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.  

 

Erica2016's picture
Erica2016
Posts: 28
Joined: Oct 2016

I have three mets in my right lung and the thoracic surgeon decided that my mets were too small (3mm largest) to have surgery and thus I was disqualified. She did mention that if they grow they will revisit my case. Go for a second opinion, I myself am looking into one.

wishing you the best. 

abita's picture
abita
Posts: 1069
Joined: Dec 2017

I wonder if that is why mine were never onsidered. When I first asked, it was because they were in different areas of my right lung. Now 2 are at 3 mm. Thanks for that information

Was that just for surgery, or were you looking into ablation as well?

Erica2016's picture
Erica2016
Posts: 28
Joined: Oct 2016

My conversations with surgeons were always about the surgery, ablation was not on the table for me. She stated that my mets were inside my lung in different lobes. 

Diane_K's picture
Diane_K
Posts: 73
Joined: Jan 2019

Abita and Erica,

I don't know if my situation was different than yours, but my lung nodules were too small to biopsy with a needle.  I was given three choices. One was to wait for them to grow large enough to biopsy with a needle, the second was to go back on chemo again before the biopsy, and the third was to have a surgical biopsy.  I chose the third.  They did two wedge sections on my right lung to remove two nodules in the same lobe.  The surgical pathology found that they were metastatic colon cancer, and were removed with clean margins.  A couple months later I had a third one removed from my left lung.

OnTheRoad
Posts: 29
Joined: Jul 2018

On my last CT scan I had one "finding" on the left lung with 6mm of size and two lightly enlarged lymph nodes that "possibly"  are mets as well.

I am thinking what are my options... for the lung "finding" - if proven to be a met - I think my onc will ask a surgeon to join the team and have it removed. He told me surgery is the usual procedure for lung mets instead of ablation since ablations have a higher morbity than surgery for lungs. Diane_K, how was your surgery and the recovery of it ? Was it too harsh ?

For the lymph nodes, my onc thinks it is difficult for them to be cancer, since this is not a common place for colon cancer to spread to. Let's see what the PET-CT shows in a month from now.

Diane_K, after having the 3 mets removed did you had any recurrence ? Did you had any adjuvant chemo after the 2 surgeries ? How long are you NED now ?

Thanks !

Diane_K's picture
Diane_K
Posts: 73
Joined: Jan 2019

I had minimally invasive procedures using video and robot-assisted surgeries to remove the lung tumors.  The incisions were small, I spent one night in the hospital after each surgery, and I was able to manage my pain with extra strength tylenol.  They prescribed percoset but fortunately I didn't need them.  Before this I had two tumors removed from my liver and that was very painful.  The recovery took much longer.

Yes, I did have adjunct chemo after the lung surgeries for 6 months, Folfiri. 

I was diagnosed May 2015, had colon resection surgery, was on Folfox chemo for two months, had liver surgery and then finished 4 more months of Folfox.  Shortly after stopping Folfox the tumors in my lungs began to grow.  My last lung surgery was January 2017 and I am now 4.5 years NED.  My next scans will be in April 2022.  It makes me very nervous to go one year between scans.

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