My dad, 79, "probably" has lung cancer. We can't get a needle biopsy because the nodule in his left lung is relatively small - 1.5 cm and deep in the lung. This nodule and a thoracic lymph node are hot on PET scan. The only option for biopsy of either is surgical. Dad is so week from various other medical issues, so he and his dr do not believe surgical biopsy is an option for him. Pulmonologist says if this is malignant, dad would not be a candidate for surgery to remove either the nodule or lymph node.
Our only option is to re-CT in 3 months to determine if we have growth/activity, which I assume will confirm LC. Does this sound right? Are there any other means to dx?
And here's the kicker...if Dad is dx with LC, he does not want chemo/rad. He just wants to enjoy as much quality time as possible. My mom passed away 5 years ago with pancreatic cancer and sad as it is, my dad has been ready to join her every day since. He's not even upset that he may have LC.
As his daughter and primary caregiver, I need to understand what to expect for the untreated LC patient. Are there any resources someone can direct me to?
-Beth
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When biopsy is not possible
- By BethinAL
- Posted July 1, 2009 at 6:53 pm · 8 replies
- In Family members and caregivers
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- Edited July 1, 2009 at 6:53 pm
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Cancer Surgery Arthritis Spondylolisthesis Prostate cancer Lung cancer Pancreatic cancer
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- By barbaray
- Posted July 2, 2009 at 9:33 am
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Beth,
I am almost the exact age of your dad and have a 2 .5 cm lung nodule which cannot be biopsied because of location.
A PET scan showed a "faint" glow, I was told. (No lymph node problems.)
The surgeon told me that 96% of the time, such a nodule will be found to be cancerous. But since I had just recently completed another surgery for something unrelated, instead of immediate surgery (the surgeon's recommendation) I chose the "watch and wait"option.
Accordingly, I have been having CAT scans ever three months. At the end of one year showing no growth, the surgeon recently told me I can now have a CAT every six months, instead. (This is good because I understand one CAT scan emits 200 times the radiation of one X-ray.)
If eventually there is growth, I might be offered surgery and/or other treatment. I haven't made a final decision, but so far I think in that case I will opt for no treatment at all--your Dad's expressed wish.
I have lived a long life and because of years of smoking, have only 55% of lung capacity. (I quit smoking about 17 years ago.) I live alone.
Also, from exploring this site, it's obvious that current LC treatments can be hard. I have crippling arthritis and spondylolisthesis (spinal fracture). A hip replacement has served wonderfully, but now I need a second one. (I ruled out spinal surgery, having been told by the osteo that success is achieved only 50% of the time.)
I also don't know what to expect as an untreated lung cancer patient, if I do decide to be one. However, at some point I guess each of us must make decisions without full knowledge of what lies ahead.
However, I don't understand your pulmonologist saying that if your Dad's nodule is malignant, that he would not be a candidate for surgery. Did the doc explain why?
I would be interested in any info you care to send along as to what an untreated LC patient can expect. Meantime, you might want to read the helpful posts on this site of "Highland Guy," who is also elderly.
Warm wishes to both you and Dad, Barbara
- By Chum
- Posted July 2, 2009 at 9:49 am
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They are doing a clinical study now to see if radiation (cyberknife or some such very focused radiation) works as well as surgery on Stage 1 people. Now get this - apparently it will be a randomized study - flipping a statistical coin to see if you are given the "Gold Standard" surgery or the radiation. While I don't think I would opt for it, your dad seems the PERFECT candidate for radiation. This type of radiation is very focused - does not cause the damage to surrounding tissue that other radiation might cause. They already are doing this for prostate cancer (three "zaps" and you are through), brain cancer and some other cancers. There was a brief mention of it in the Wall Street Journal last week (or two weeks ago).
Frankly, this seems to be a perfect fit for your dad's case, if you can get someone to do the radiation! No downside that I can see, except it might cost money. Check it out.
Courage
Chum
- By amymaura
- Posted July 2, 2009 at 10:27 am
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I've heard some good stuff from Georgetown University about what Chum referred to as well. It sounds really promising.
But if your dad truly is not interested in being treated (whether it's confirmed or not), that's obviously his choice.
As far as what to expect... I think it's a good idea to have to go for the 3 month CT scans to show growth. Some lung cancers grow very slowly and others progress very quickly. Knowing what your dad's cancer "looks like" and how fast or slow it's moving will give you a sense of the timeframe to expect. It is very small now, and some people might have a small nodule for years before it starts to grow and spread. If it appears to be moving faster, the CT scans can help track where it's going and that can help you prepare, since the side effects of the cancer are going to be different depending upon where it is.
Hope that helps. If you want to email me, I can send you some links to info on end of life issues. Just contact me at apearson@lungcanceralliance.org
Best wishes,
Amy
LCA
- By BethinAL
- Posted July 2, 2009 at 11:32 am
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Thanks all for your kind responses.
I think the difficulty in dealing with this is not really knowing 100% that this is lc. I can deal with knowns, but unknowns are not easy for me.
Barbara, our Pulmonologist explained that evidence in the PET showed a spread to a thoracic cavity lymph node, which would suggest stage IV lc and therefore dad would not be a candidate for surgery. His only option would be chemo/radiation.
Chum & Amy, the study does sound good. But dad is convinced he does not want either chemo or radiation. My mom went through a pancreatic cancer study that was supposed to be tolerable but was horrible and ultimately gave her no quality in the 10 months from dx to her passing. It is difficult for my dad to see any other outcome than hers.
Amy, thanks for the advice on watching growth through CTs. I understand that the time it takes for the nodule to double will give us an idea of how slow/aggressive this is moving.
I've been lurking around this board for a few weeks and am constantly amazed at the courage of everyone fighting to win the battle against lc. I wish my dad had that fight in him....but I have to honor his wishes and just make sure he is comfortable and has quality for as long as possible.
- By bulldog500
- Posted July 2, 2009 at 12:03 pm
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Check into Cyberknife they are getting great results.
In fact I have a 1CM nodule in my left lung and am going to have Cyberknifed.
I had part of my right lung removed so I do not want any more cutting.
- By vatssurvivor
- Posted July 2, 2009 at 12:07 pm
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A ct scan every 3 months is the way to go. If the nodule grows, then they will make a decision. Sometimes nodules are Puss-balls and other times they are cancer. Read up on Non-small cel Cancer. My tumor was a carcinoid. When it started to grow , I got it removed (2 months ago). You also did not mention what side and what lobe.....good luck to you....
- By jean123
- Posted July 2, 2009 at 1:05 pm
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My husband was told at a local hospital that it was too small and deep to be biopsied so we went to Sloan-kettering in NY and they did it without any problem. It was cancer that time. You may want to check with a large cancer center.
- By cuddles53
- Posted July 2, 2009 at 11:03 pm
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Sloan-Kettering is one hoospital that did surgery on my nephew for GISTY cancer, it had spread to his liver, the big cancer hospial we have here told him otherwise and was only going to put him on the pill Gleevec, Thank God he got his second opinion from Sloan, it saved his life and he is now cancer free, had he listened to the hospital here, he would have still had cancer growing in his liver, At Sloan they told him that Gleevec is no match for the size of the tumors he had in his liver. so I also now say go for Sloan-Kettering, it is only one person I know of but it is good enogh for me.
Sandy
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