Joan M
06-12-2008, 08:21 PM
I'm hoping your collective bc intelligence and support can help me sort out this puzzle.
I want to give you an update on the nodule that was diagnosed in the apex of my left lung in mid April, after I had a similar, small (9 mm) nodule removed last year in April from the same area of the lung via video-assisted thoracic surgery. Except for those two nodules, I've had no others outside the breast. I'm trying to figure out what to do about the new nodule and have been gathering information on sterotactic body radiotherapy and radiofreqency ablation and meeting with thoracic surgeons.
It was the RFA guy who first suggested that the new nodule is a local recurrance from last year's surgery, and then a thoracic surgeon, both of them at Sloan, agreed, and further suggested that the first nodule may have been lung cancer rather than a bc met.
Please give me your thoughts. I could use some insight into this problem which is weird.
I feel like I'm back to square one, or having a flash back to last year, when the first solitary pulmonary nodule was discovered and every surgeon and pulmonologist I consulted with thought it looked like lung cancer. Since I was a former fairly heavy smoker it was a consideration (I quit in 1993). The only surgeon I consulted with who thought it was probably a bc met is the same one from Sloan (she took an educated guess).
Since Sloan was not in my medical insurance last year (although they are this year) I had a core biopsy and then VATS at another hospital in the same area.
The biopsy showed adenocarcinoma -- problem is both non-small cell lung cancer and breast cancer are adenocarcinomas -- and a differential diagnosis could not be made based on the chemistries. A gross microscopic comparison with my original breast cancer slides favored a diagnosis of bc and the tumor was ER- and Her2+ like my original bc. However, even when the nodule was removed the surgical report still mentioned "favoring" a bc diagnosis.
A six-month Pet/Ct showed NED, but a one-year follow-up on April 15 showed another nodule right in the area of the wedge resection. Nothing else lit up.
The surgeon wants to get my original bc slides and lung nodule slides and have them examined in Sloan's lab. In the meantime I'll meet with an oncologist there, who I'd met with before when I had early stage bc and again last year when the first lung nodule was discovered, and then the two of them will discuss the case and the surgeon will let me know.
She said the scans look like classic local recurrence of lung cancer removed by a wedge resection because the patient couldn't withstand a lobectomy -- which is the standard treatment for lung cancer, as opposed to a wedge resection which is the standard treatment for lung mets. The surgeon also said that it's been a year and there are no other mets either in the lung or anywhere else. I've been on Herceptin but came off of it for three months in the fall because of a drop in my LVEF. My sense is that it's not all that uncommon for mets to hold steady or for a bc patient whose had mets to be NED for a while and I think since she's a thoracic surgeon, there's a bias there (that she can't help).
Afterward when I was absorbing all this information which I wasn't expecting, I googled it ("local recurrence" lung cancer margin), and it turns out that it's rather common in both stage 1 lung cancer and mets removed by wedge resection to get a local recurrence even if the margins are clean, and mine were clean. And one of the articles also said that the probability of a local recurrence raises when the margin is less than 1 cm as opposed to being greater than 1 cm, and my margin was 6 mm.
As for the RFA and SBRT, I would be a candidate for both of those procedures, meaning that there are not obstructions in the area of the nodule, etc.
I was hoping to have had this settled after my appointment but I guess that's not in the cards.
I really am bothered by all this uncertainty, which is how I felt last year.
I want to give you an update on the nodule that was diagnosed in the apex of my left lung in mid April, after I had a similar, small (9 mm) nodule removed last year in April from the same area of the lung via video-assisted thoracic surgery. Except for those two nodules, I've had no others outside the breast. I'm trying to figure out what to do about the new nodule and have been gathering information on sterotactic body radiotherapy and radiofreqency ablation and meeting with thoracic surgeons.
It was the RFA guy who first suggested that the new nodule is a local recurrance from last year's surgery, and then a thoracic surgeon, both of them at Sloan, agreed, and further suggested that the first nodule may have been lung cancer rather than a bc met.
Please give me your thoughts. I could use some insight into this problem which is weird.
I feel like I'm back to square one, or having a flash back to last year, when the first solitary pulmonary nodule was discovered and every surgeon and pulmonologist I consulted with thought it looked like lung cancer. Since I was a former fairly heavy smoker it was a consideration (I quit in 1993). The only surgeon I consulted with who thought it was probably a bc met is the same one from Sloan (she took an educated guess).
Since Sloan was not in my medical insurance last year (although they are this year) I had a core biopsy and then VATS at another hospital in the same area.
The biopsy showed adenocarcinoma -- problem is both non-small cell lung cancer and breast cancer are adenocarcinomas -- and a differential diagnosis could not be made based on the chemistries. A gross microscopic comparison with my original breast cancer slides favored a diagnosis of bc and the tumor was ER- and Her2+ like my original bc. However, even when the nodule was removed the surgical report still mentioned "favoring" a bc diagnosis.
A six-month Pet/Ct showed NED, but a one-year follow-up on April 15 showed another nodule right in the area of the wedge resection. Nothing else lit up.
The surgeon wants to get my original bc slides and lung nodule slides and have them examined in Sloan's lab. In the meantime I'll meet with an oncologist there, who I'd met with before when I had early stage bc and again last year when the first lung nodule was discovered, and then the two of them will discuss the case and the surgeon will let me know.
She said the scans look like classic local recurrence of lung cancer removed by a wedge resection because the patient couldn't withstand a lobectomy -- which is the standard treatment for lung cancer, as opposed to a wedge resection which is the standard treatment for lung mets. The surgeon also said that it's been a year and there are no other mets either in the lung or anywhere else. I've been on Herceptin but came off of it for three months in the fall because of a drop in my LVEF. My sense is that it's not all that uncommon for mets to hold steady or for a bc patient whose had mets to be NED for a while and I think since she's a thoracic surgeon, there's a bias there (that she can't help).
Afterward when I was absorbing all this information which I wasn't expecting, I googled it ("local recurrence" lung cancer margin), and it turns out that it's rather common in both stage 1 lung cancer and mets removed by wedge resection to get a local recurrence even if the margins are clean, and mine were clean. And one of the articles also said that the probability of a local recurrence raises when the margin is less than 1 cm as opposed to being greater than 1 cm, and my margin was 6 mm.
As for the RFA and SBRT, I would be a candidate for both of those procedures, meaning that there are not obstructions in the area of the nodule, etc.
I was hoping to have had this settled after my appointment but I guess that's not in the cards.
I really am bothered by all this uncertainty, which is how I felt last year.