Newbie with Questions Re: Dad

I hope someone here can offer some advice. My dad who is 81 had a prolonged cough which led to coughing up some blood, then a chest xray, then a CT and now a pet scan and his pulmonary doctor has concluded that it is extremely likely he has lung cancer. He has a mass about the size of a quarter/half dollar on the lower part of his lung and he advises surgery. He passed the "breathing test" yesterday. One year ago he had bypass surgery and has a pacemaker and defribbulater (sp?). My dad is scheduled to meet with his same surgeon who did the open heart surgery who is a cardio thoracic surgeon who does do the VATS procedure on lungs I'm told. My two main questions are: doesn't he need to meet with an oncologist? It seems odd to me that he goes from a pulmonary doctor to a cardio thoracic surgeon and no oncologist? Don't we first need a definitive diagnosis of cancer from a biopsy? Secondly and more importantly, he wants to use the same doctor who did his bypass surgery but I'm thinking he should meet with a thoracic oncologist, I have researched this board and found some great recommendations of top lung cancer specialists in his area, but I'm unsure if these doctors are the ones who also do the actual surgery. He is resisting my suggestion because he's "comfortable" with the doc who did his previous surgery which would be at his local hospital--not a comprehensive cancer center.

Any suggestions/input/comments from those more in the know than me would be greatly appreciated.

By cards7up
Posted October 14, 2009 at 12:11 pm
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Hi there, why don't you ask his doctor how he can be sure it's even cancer? Some people that have the surgery don't even see an onc. It depends on the pathology of the mass when it's removed.I believe the surgeon might do more testing for confirmation before surgery. Follow-up with the thoracic surgeon first and see how that goes. Take care, JC

By misself
Posted October 14, 2009 at 12:12 pm
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If your Dad has confidence in his surgeon that improves the outlook surgically.I had a small mass.It was sugically removed and they got it all.Did have a biopsy 1st.However with your dads other problems I would think that they want to do biopsy and surgery together to decrease risk.I did not see an Onc till post surgery.For Stage Ia often they don't since surgery is preferred treatment.But without biopsy I know thats not certain in his case but I think that is what they believe.Ask.You can ask anything if Dad is okay with that.Its hard to respect wishes of loved ones but it is his Body.Help him explore options.Be supportive as you are.He is lucky to have you.AndiB

By bethkiley
Posted October 14, 2009 at 12:22 pm
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Thank you, that makes sense. Do you know if a mass that is the size of a quarter or half dollar is considered small, or big? His pet scan showed just the mass in the lower lung and nothing else, does that mean it's stage 1 or how/when do we determine the stage?

Thanks again.

By pattyp1
Posted October 14, 2009 at 1:03 pm
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hey Beth,
I know this is scary.....BUT.....there is a good side to this...that isn't real obvious - only stage 1 is generally operable. he'll probably be referred to an oncologist afterwards. I'd take it as good, although painful, news.
hugs
Pat

By pattyp1
Posted October 14, 2009 at 1:04 pm
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and stage refers to where it has spread to - stage 4 - it's gone a long way from the primary site (e.g., to the brain), stage 2 - to somewhere else in the lung.
you can have a stage 1 and still be big or small.
hugs again
Pat

By bethkiley
Posted October 14, 2009 at 1:11 pm
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thanks everyone. So if the pet scan showed it didn't spread, can we conclude it's stage 1 then or not yet? cards7up stated that staging is determined after the biopsy, so I'm a bit confused by how does a biopsy determine if it's spread? Is it by checking the nodes?

you guys are really helpful, thank you again...let me know if I'm asking too many questions.

By Granny888
Posted October 14, 2009 at 4:25 pm
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Staging sometimes changes during surgery if they find more, or depending on lymph node involvement. Sounds like they have already ruled out mets pretty much.

So right now they aren't even positive it is cancer, so they can't absolutely stage it...but if it is in good location for surgery and looks like cancer they probably want to get it out and biopsy it at the same time. Sounds contradictory but it really isn't, and sometimes they do find more that is "hiding." They could stage it now but that doesn't mean it wouldn't change once they did the surgery. Non-oncologists I am not sure probably don't often get into staging themselves.

By miracle_b
Posted October 14, 2009 at 4:31 pm
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in my case my e.n.t sent me rite over to the throatic surgeon and st it up from there being that on the ct it seems be be a rather large mass they wanted to hurry up get it out sent it off to the pathology then when it comes back and if it is cancer thats when they refer you to the oncologist and its still a waiting period cause they want you to heal up and that takes about 6-8weeks so it gets frustarting but hang in there and of course if u dnt feel totally comfortable with the docs decision u can always get a 2nd opinion!

By HighlandGuy
Posted October 14, 2009 at 5:22 pm
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I disagree with everything Misself says.

1. You need to know if it is cancer, and finding out by the most minimally invasive technique possible with his history of heart conditions, etc. You don't go into surgery blindly.

2.Doctors who do heart surgery, rare have widespread experience with thoracic lung cancer surgery.

3. Lung Cancer is perhaps the most complex of all cancers to diagnose and treat, certainly of all the common cancers. Your dad needs to see an Oncologist who specializes in lung cancer. He is a high risk patient and few if any but Comprehensive Cancer Treatment, have the teams of specialist trained and experienced in lung cancer treatment.

4. Your dad needs to have not only a diagnosis, but if it is cancer to have it properaly staged and that means commonly an Oncologist. Pulmonologists are rarely qualified to stage and treat cancers.

5. When it comes to potentially lung cancer, the worst thing you do is to be influenced by doctors, who you "like!" You need Oncologists but not only any Oncologist, but an Oncologist who specializes in and has widespread experience in treating lung cancer. And, that does for surgeons as well.

Our graveyards are overflowing with men and women who went to doctors who were "nice guys or gals!" This is potentially lung cancer, the most lethal disease we have in this country, in the world! Would you go to a bicycle shop to repair a Cadillac?

Above all, we need to use common sense. Ten years ago I had openheart surgery with a doctor I "liked," and he messed me up and tried to cover up his errors. It nearly cost me my life. I wear a pacemaker. Nine years ago, I tried different Urologists, (for my extemely aggrssive bladder and prostate cancers), three different Oncologists only to find them totally incompetant to treat my cancers. I also had Stage 1B adenocarcinoma NSCLC that we discovered was growing at three timess the average growth rate of the cancer. I am a survivor today at age 85, because I went to experts, (no doubt in the world) for care and treatment. There is all the difference in the world between doctors and their qualiafications. You want doctors who are qualified whether you like them or hate them!

I know I may not be telling your father what he want
to hear, but I speak from hard experience, frankly and openly.

HighlandGuy

By cards7up
Posted October 14, 2009 at 7:52 pm
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I would go to grace.org and post to Dr. West. They are cancer specialists there and can answer your questions about surgery first or oncologist. Good luck and take care,JC

By Chum
Posted October 15, 2009 at 7:46 am
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Listen to Highlandguy. Get thee to a specialist who can do the VATS procedure. S/he will know which lymph nodes to take out to examine and lots of other "good" stuff.

Courage

Chum

By suzyyyy123
Posted October 15, 2009 at 9:53 am
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I agree with others, read what Highland wrote.

My mom is 83, and she has had lung cancer 3x's. Each time, they caught it early with a CT scan, but she also had a PET scan to see if it metastasized, then a needle biopsy through the chest wall before surgery.

She has had 2 surgeries done by a highyly regarded thoracic surgeon that works primarily with lung cancer patients, and one ablation procedure (an altertative to surgery) done by a radiologist. It was only after these procedures that she was referred to an oncologist. During her surgeries they biopsied the lymph nodes even though they saw nothing on he scans.

First, she went to a general oncologist... my father as well because he's battling prostate cancer. Highland is so very correct, and its really important advice that you want to find one that specializes in the exact type of cancer that your father has, so now both of my parent's oncologists are researchers as well as clinicians. You also want to ask about targeted chemo as opposed to general chemo. That means the chemo can be sent straight to the cancer cells without damaging healthy tissue elsewhere which is very important given your father's age. You don't want the toxicity if you can avoid it for someone older, and still get the job done.

Classic chemotherapy is directed against malignant cells but also against normal cells that very actively proliferate. That means that not only malignant cells but also cells of the immune system, cells in the gastrointestinal tract, for example - not only these - but these organs are really in danger. What is really important is that the immune system is not damaged.

It's not wonderful news that your father has cancer, but it is wonderful news that he's a surgical candidate. Very, very few lung cancer patients are because by the time it appears via symptons, it has spread too far... and yes, as Highland also mentioned, it's deadly and kills more people than I believe all the other cancers combined. So, consider your father very lucky that they caught it early & best of luck.

By suzyyyy123
Posted October 15, 2009 at 10:06 am
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In October 2006, Dr. Claudia Henschke of Weill Cornell Medical College jolted the cancer world with a study saying that 80 percent of lung cancer deaths could be prevented through widespread use of CT scans.

Thats how they caught my mom's... through a screening CT, and not because of symptons. Therefor, more smokers, previous smokers or others at risk should get the annual screen... even if the insurance companies balk at the cost... but the reason I bring this up ...is Cornell near you? Or relatively close? I saw you're in New Jersey & I know they do lung cancer research & may have a good team of doctors for your dad.

By bethkiley
Posted October 15, 2009 at 11:16 am
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Thank you all so much for your input. I think I might ask my dad to read this thread. Right now he has an appt. to meet with his surgeon (who did his bypass surgery and does do VATS too) next week. I want him to meet with someone else that I can find who specialized in lung cancer. I found some names of excellent lung cancer oncologists in his area (South Florida) from searching on this board. But my question is, since he's supposed to meet with his surgeon next week...am I supposed to be looking for a lung cancer oncologist for him to get a 2nd opinion or should I be looking for a top lung cancer surgeon. Which comes next? I'm guessing that the lung cancer oncologists are not the ones who actually do the VATS--or am I wrong? So if my father is willing to see someone else that I find, which doctor am I looking for to consult with him and I also wonder how quickly I can set up an appt. --I wonder if these "top" guys have long waiting lists for appts.

Thanks again, this is so helpful.

By suzyyyy123
Posted October 15, 2009 at 6:09 pm
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I think the very first step is surgery with a good thoracic surgeon if he's a candidate. Not with someone that does bypasses & heart stuff (my brother is an anesthesiologist, so I get some of this from him)... a good thoracic surgeon that understands cancer. Chemo & the specialized lung cancer oncologist are secondary. Oncologists arent surgeons... but they would be the follow-up docs post surgery if he needs chemo, but get a specialized one that understands & works solely with lung cancer. Sloan Kettering is good near you... I don't know Florida. I don't know waiting times, but push... you HAVE to be his advocate and a strong one at that! This is survivable at stage 1, but he needs your help. Message me if you need more. You sound like a loving daughter.

Welcome to Inspire!

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