Lung biopsy

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1/30/2011 4:16pm
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Replies: 11

I was diagnosed in Oct with Stage IIIb melanoma (upper right back nodular, sentinel node involved - all others under right arm clear).  I had a CT/PET scan done 11-1-10 that came back clear.  I had a CT scan done 1-13-11 in order to try and qualify for a trial.  That scan showed multiple nodules on both lungs.  I'm trying not to freak out too much - but it's hard not to have some (ok a lot) of anxiety over all of this! 

My doctor said the spots are too small for a needle biopsy.  So my options are wait and rescan in 2 months or a different type of biopsy that is a little more invasive (don't remember what it's called).   Has anyone had lung biopsies done?  I'm hoping it's nothing (since the CT/PET didn't pick them up)...  blood work looks ok so far and I feel pretty good (no fever or cough - do feel like I have a bit of  sinus infection though). 

I guess the blessing is that I switched doctors and they did these scans (if they do end up being something) otherwise I wasn't scheduled for new scans until April.

Any thoughts/encouragment/guideance you have is greatly apprecaited.  I meet with a thoracic surgeon on Wednesday to discuss the biospy procedure.  Guess in my mind I'd rather go thru the surgery for the biopsy vs waiting 2 months... 

Cheers,

Erin

www.melanomaandthecity.blogspot.com "people will forget what you said, people will forget what you did, but people will never forget how you made them feel' Maya Angelou

kylez - (1/30/2011 - 7:02pm)

Hi Erin,

I was in the same position last year -- 8 lesions in my lungs, all too small for needle biopsy. I was given the option of waiting another 3 months for the lesions to possibly be large enough to needle biopsy, OR go for a surgical procedure called VATS (video assisted thorascopic surgery). That's probably what you'll be talking with the thoracic surgeon about this week?

I asked to have the VATS procedure. In my case it confirmed melanoma, which meant I could go ahead with stage 4 treatment. Getting the VATS seemed better than waiting 3 months for "it" to possibly grow, if "it" was melanoma. They didn't (and couldn't because they were on both sides) try to get all the nodules, they got 2, both enough to confirm melanoma -- they felt that if melanoma was present in the lungs, it would need to be treated systemically.

I encourage you to do what you think makes sense for you. I pushed for the VATS.

Kyle

Erinmay22 - (1/30/2011 - 9:06pm)

Kyle -

Thanks for the info.  I am going to push for the VATS - I think I'd much rather know now than wait another 2 months and worry every day about some little symptom!

So sorry that yours was Melanoma...  What was the VATs surgery like?  What was your recovery time? 

What about treatment did you do for fighting this beast?  I joked with my med onc that I've met with more doctors in the last 3 months than my entire life! 

I just want to feel like I can start to move forward with all this mess... 

So thanks for the info. 

Erin

www.melanomaandthecity.blogspot.com

"people will forget what you said, people will forget what you did, but people will never forget how you made them feel' Maya Angelou

kylez - (1/31/2011 - 12:23am)

Erin,

I got a lot of confidence when I talked to the thoracic surgeon to go ahead. The most unpleasant part of the VATS was just being in the hospital itself. I hadn't been overnight in a hospital for decades. The awkward TV remote, food that may or may not be hot, double room, busy nurses, etc. I was happy to go home.

I was discharged late in the afternoon the following day if I remember correctly. I don't remember much about the recovery period after that, so it must not have been too bad. The biopsy from the VATS unlocked the next step, beginning stage IV treatment, in my case either IL-2 or biochemotherapy.

I chose IL-2, started the end of May 2010, and apparently I'm in the percentage where it's helped. I've had PET scans in July, Sept and Dec saying there's no activity in my lungs. But, IL-2 apparently doesn't cross the blood brain barrier too well, and I had a couple of brain mets show up that I was treated for in Oct/Nov. Currently I'm considered 'NED' i.e. no grossly visible disease. Next MRI in 3 weeks. 

I have no doubt these treatments I've gotten have extended my life. I'm very grateful to my doctors.

TAC - (1/31/2011 - 8:03am)

I am Stage IIIb. Had a spot show up on a PET scan. Had needle biopsy. It wasn't melanoma but was adenocarcinoma (lung cancer). Had upper left lobe of lung removed. Have had numerous PET scans over the years...since 2001. I do have spots in other lobes of right lung. My thoracic surgeon told me that a fairly high percentage (30-40%) of people have spots in their lungs and not always a sign of cancer. On my PET scans these spots have not changed over several years so the Docs assume that they are not cancer and they are too small for needle biopsy. Best of luck to you.

kylez - (1/31/2011 - 10:31am)

That's a good point. I forgot to mention, that in my case, part of the decision was, the lung lesions looked a little bit bigger on a second CT scan (Mar) than the first CT scan (Dec). Since they appeared to be growing, that's the point where I was referred to an oncologist. So there were two CT scans 2.5 months apart. At that point I had choice of 'wait and see' or VATS.

Erinmay22 - (1/31/2011 - 10:20pm)

Thanks guys!  I had a CT/PET scan done November 1st that showed no update or even a potential hot spot.  So I'm hoping that maybe is a good sign.  These spots are too small they said to get picked up by a PET and they are still pretty small that they can't do a needle biospy...  so we'll see. 

I had the CT scan taken Jan 13th and that is the one that showed several small spots in both lungs.  I still think I'll do the VATS so that I know for sure!  and can move on. 

So I'll meet with the surgeon on Wednesday to talk thru this some more.  

Cheers,

Erin

www.melanomaandthecity.blogspot.com

"people will forget what you said, people will forget what you did, but people will never forget how you made them feel' Maya Angelou

Erinmay22 - (1/31/2011 - 10:20pm)

Thanks guys!  I had a CT/PET scan done November 1st that showed no update or even a potential hot spot.  So I'm hoping that maybe is a good sign.  These spots are too small they said to get picked up by a PET and they are still pretty small that they can't do a needle biospy...  so we'll see. 

I had the CT scan taken Jan 13th and that is the one that showed several small spots in both lungs.  I still think I'll do the VATS so that I know for sure!  and can move on. 

So I'll meet with the surgeon on Wednesday to talk thru this some more.  

Cheers,

Erin

www.melanomaandthecity.blogspot.com

"people will forget what you said, people will forget what you did, but people will never forget how you made them feel' Maya Angelou

NancyGM - (1/31/2011 - 11:46pm)

Erin, Four years ago I had a walnut sized tumor in my left upper lobe, wrapped around pulmonary artery. My surgeon attempted VATs but converted procedure to a thoracotomy- which is pretty major surgery ( 6 days in hospital). Because of the dangerous location, it couldn't be completley removed. I did 10 rounds of Temodar ( a chemo pill usually used for brain mets) and I have been NED for 3 years now. Just wanted to give you some hope. I am with you about not doing the waiting bit. Very best of luck to you!

NancyGM

Erinmay22 - (2/1/2011 - 9:31pm)

Nancy - thanks for your note.  Yes the waiting bit is the worst.   I've had the worst anxiety ever but it's getting better.  I do appreciate you sharing your experience and hope!  

www.melanomaandthecity.blogspot.com

"people will forget what you said, people will forget what you did, but people will never forget how you made them feel' Maya Angelou

Wetterhorn - (2/2/2011 - 3:35pm)

Erin

I was in a similar position in 2008. Was getting regular CT scans that showed a spot on my lung in December 2008 of 5mm, up from 3mm in Sept (doc or radiologist report made no mention of this spot in Sept). PET was ordered in December and came back clean, so I took the wait and see approach. Sure enough, in March 2009, CT showed spot was 7mm and it finally got picked up on PET. Went in for VATS in April and they successfully removed a 1cm melanoma.

The waiting never gets easy. I occassionally take xanax for anxiety around scan times and found it helps. I was 17 months NED until last week (apparently) with what appears to be a small lesion in my "bowel region". Lung has remained clear though since April 2009.

Best of luck to you

wetterhorn

Erinmay22 - (2/2/2011 - 6:45pm)

Wetterhorn - thanks for the reply!  I met with a thoracic surgeon today.  I feel a little bit better since he said he doesn't think the spots I have are melanoma - so maybe I'll sleep a littie bit better tonight?  but my med onc would still like to know what they are so we can move on with deciding what treatment course I follow.  Have been dragging my feet in doing interferon.  Was trying to do the Ipi trial - but since we have to figure out what these spots are I'll be past the 12 week time limit to start from initial diagnosis... 

So - sounds like next Thursday I'll have a VATS done to remove a few small nodules on my left lung (at least this balances out my scars on my right side, right? :) hehe!  I'm kind of freaking out a litlte having that procedure done.  But hopefully I'll recover quickly!

Sorry to hear the small lesion - hopefuly it's nothing! 

Erin

www.melanomaandthecity.blogspot.com

"people will forget what you said, people will forget what you did, but people will never forget how you made them feel' Maya Angelou