[Joan M]

Raquel,

An RFA, or radiofrequency ablation, is a minimally invasive procedure done by an interventional radiologist. It uses radio waves (NOT radiation) to burn a tumor. It is less invasive than surgery.

RFAs have been done very frequently in the liver for both primary liver disease and liver mets. Lung RFA is a newer procedure.

The IR doc makes a very small slit in the back usually and inserts a probe about the thickness of a pencil.

I was put out under general anesthesia.

Most oncologist do not take to these procedures. If you are interested, mention it to your onc, who will probably not be interested. If you'd like to know more go directly to an interventional radiologist to find out whether the procedure can be done. For a lung RFA it would be better to be in a major medical center where they have a lot of experience doing lung RFAs.

Lung surgery is usually also minimally invasive, called VATS, or video-assisted thorasic surgery. The surgeon makes three, two inch slits. Mine were on my upper flank. One slit is for a camera, and instruments are put in the other two. I was put out under general anesthesia.

The lung does not hurt at all in either of these procedures, and there is really no pain with an RFA. With VATS there was some pain at first when I coughed, sneezed, etc., but I was on painkillers in the hospital. The pain didn't last a long time. Maybe less than a week. I can't exactly remember, but it was not unbearable.

I had a similar experience of my 5 mm lung tumor appearing in the CT scan part of the PET/CT and not being reported. When it reached 1 cm it lit up and was reported. Generally, with a PET/CT a nodule has to usually be about 1 cm to light up.

It's very difficult to biopsy a 1 cm lung tumor. That is, to get enough tissue to give a meaningful answer. My biopsy report said it was an adenocarcinoma. But both lung and breast cancers are adenocarcinomas ... My oncologist suggested that the pathologists compare the biopsy to my original breast cancer slides, and based on that comparison they decided it was probably bc and not lung cancer.

Doctors often wait when a tumor is small, or less than 1 cm, is see how quickly it is growing over a certain time period. They look at doubling time. Not to get into the details of that, docs can sometimes determine the probability of whether a tumor is benign, malignant, or an infection based on this measure. However, a CT scan can sometimes show directly whether a nodule is benign or malignant (but not a PET scan). That is, my tumor had spiculated edges, and that's a sign of malignancy, regardless of a PET scan lighting up. A PET scan can light up for benign processes as well, like tuberculosis, etc.

Joan