needle biopsy vs wedge resection

Is is better odds for survival if my father were to have a wedge resection of a 1cm tumor or to have a needle biopsy and radiation?
Do you know what the recovery time would be for either?
The dr states he thinks its stage 1.
My father has copd, emphysema.
Are there any other questions I should ask the dr?
My father has the appt tomorrow and I want my father to make the best decision.
Thank you.

[HeinrikMD]

Hi,

If this is really cancer, the better experience is with surgery. This is because those who are not candidates for surgery are advised radiation. Hence, it would not be possible to say if these two approaches are equivalent. However, if this would not be cancer, then of course, the risks of the wedge resection may not be worth it.

If the doctor is confident that the biopsy procedure would likewise yield sufficient tissue in order to make a definite diagnosis, this may be the first step before you would consider surgery or radiation.

You could also have him evaluated by a lung specialist/pulmonologist who will estimate if he has enough lung reserve despite the COPD to tolerate a reduction in lung capacity.

[concerneddaughter2008]

The Dr. said he is not sure it is cancer. He said the spot lit up on PET scan and the spot has grown over a period of time (6 months?).
He said he would do a needle biopsy.
My father also requires an angiogram
Then if the angiogram is ok, the dr would do a wedge resection.
If the angiogramis not ok,he will advise my father to have radiation.
Should I have my father get another PET scan? Are PET scans ever wrong?

[HeinrikMD]

Hi,

It seems that the plan is pretty clear.
I understand your concerns about the PET, since all this planned cascade of events begins from this test.
The test is of course, not fool-proof. There are conditions like tuberculosis - which may have features similar to cancer on PET. Same thing goes for benign lesions like an abnormal mass of convoluted blood vessels. The odds for these things are estimated from exposure history for infectious causes, and the incidence of these benign masses.
What you need to answer is this: at what point would you consider the biopsy? there is no imaging test that can give you a 100% guarantee it is cancer (because if it did - then we have no need for the biopsy), so you'll have to find your comfort level. You could refuse to go through with the biopsy - the risk of this is not likely to be higher than the angiogram (which seems we don't have much of a choice), but if it grows further in a couple of months or so - would you be more convinced (of course the problem with this course of action is that the more cancer there is - the odds of success with either surgery or radiation becomes smaller. Most folks focus on how invasive they are willing to go to help them decide. If he is willing to undergo surgery - then the consistent thing to do is to have the biopsy done earlier than later to improve success of the surgery.
Discuss the issues with your doctor.  

[concerneddaughter2008]

Follow up to my father's issue.
the dr said if after he had a successfull angiogram he does not have to do the needle biopsy and can just have the surgery to remove the cancer.
my father had surgical clearance from the angiogram, however, the cancer dr changed his mind and wanted to do the biopsy anwyay.
We had a discussion on this weeks ago. He said the biopsy was not 100% accurate, it could pose a false negative, therefore, he would do the surgery on my father anway.
Why would he change his mind again? He had the biopsy scheduled for a few days after the angriogram. Do you think he just wanted to do it? I did not want to put my father under unneeded stress. What do you think?

[HeinrikMD]

Hi,
I think you’ll have to discuss the reasons for the change in plans. Could it be possible that there were new images taken around the time of the angiogram that upon review, raised doubts to the feasibility of the biopsy?
Of course a second opinion wouldn’t hurt, I understand how your confidence would be shaken if the plan keeps changing without clear reason.