Shadowing on lung with 4mm mass

[Sherry811]

I am a smoker (terrible, I know) and I was diagnosed with bladder cancer 5 years ago. After treatments, surgeries, and partial removal of my bladder, a bag, everything seemed to be fine. Two years later, the cancer came back and spread to my cervix, uterus and one ovary. Had  a COMPLETE radical hysterectomy, and more treatment for the bladder cancer. It has been one year that I have been considered cancer free. This past December, I had a heart attack, and a stroke due to DVT. I have a blood clotting disorder. While in the hospital (for three weeks) I had SO many tests done. One test in particular was to check to see if the blood clot that broke off that caused me to have a stroke and heart attack, ended up in my lung. (Pulmonary embolism) Well, there was no clot in my lung, however, they did find shadowing in the very base of my left lung, a 4mm mass, and two spots on the upper part of my lung. I also have 5 enlarged lymph nodes in the same area. I am on 10 mg of coumadin for the rest of my life to avoid other heart attacks or strokes. Right now no one is doing anything about the lung because I can't stop the coumadin. What do I do, and is this lung cancer? I am so scared and I don't know what to do, where to turn to and with my history I'm even more worried. Not to mention that my dad's mom died of lung cancer/lymphoma, as his father, and now my dad has lung cancer. Could this shadowing, mass and lymph nodes be something other than cancer? Where do I go now? Who should I see? Please, please help. Thanks and God Bless everyone.  Sherry  

[Sherry811]

Thanks again for the response, it is very kind of you to talk to me about this. I will let you know that I am waiting to meet personally with my first oncologist. I am going to see what he says. I will let you know what he suggests or decides after I meet with him. Again, thank you from the bottom of my heart.
Kind Regards, Sherry

[HeinrikMD]

Hi,

I think you’ll have to weigh the chances of success of the surgery (and what target is acceptable – would you risk the surgery if it meant minimal improvement in symptoms now?) and then the risks of holding the coumadin. It is possible to undergo surgery, in which the coumadin will be replaced by a drug that clears faster in the blood, so that a surgical window where the blood thinners are absent will be allowed. A withdrawal of coumadin of 3 to 5 days is common practice, in which the control of blood clotting is monitored to ensure that the level of the control achieved with coumadin is achieved with the replacement drug.
If I were you I would inquire about success rates (this is a big decision, and I think it would be worthwhile to attempt to set it in numbers to guide the decision) and complication rates, the estimate duration of improvement of symptoms, the estimated duration of survival and then financial implications, and then each choice will be reinterpreted using these numbers, from which hopefully, a clear choice would emerge.  
Of course, the other question is whether you could tolerate the degree of lung resection entailed. Have you been evaluated for lung reduction surgery?

[Sherry811]

PPS, I also have pleural thickening.

[Sherry811]

PS, my MRI of the brain shows edema on the right side with gray matter. The doctors are unsure as to why I have edema and swelling on the right side of my brain. Could this have anything to do with the lung issue? Thanx again, Sherry

[Sherry811]

Thank you so much for responding to me. The embolism was ruled out by the MRI that showed the shadowing in the lower left lobe, along with 2 spots on the upper lobe of the same lung. I also have hypo-inflated lungs, 5 enlarged lymph nodes all around the same (lung) area. Two of them are behind the heart. I don't have a size of the spots at this time, but I handed my entire file, with ALL 900 pages of medical records from the hospital and from the current oncologist that is treating me and gave them to another oncologist who has treated me with chemo in the past. I dropped off all my records this past Friday at 4pm. He said that he would call me as soon as finishes going over the records I gave him. My lungs have been killing me more and more every day, tightness, short of breath, etc. I've been using my Albuterol inhaler more often. (I also have asthma, and emphysema) I have pain (upon inhaling) in the front of my chest, and really achy constant pain in the back. I am CONSTANTLY fatigued, I have no appetite what-so-ever, and everything just hurts, achy like the flu. I have had constant diarreah and occassional vomiting. And when I do try to eat something, it feels like it is stuck in my esophagus and it is very painful and ucomfortable. I have severe night sweats that I change 2-3 times a night. My cough is unbearable, and it seems like it has gotten worse over the past month or so. I wheeze a lot too, but that could also be my ashtma. I also found in my MRI photo, that my liver is enlarged as is my thyroid tissue. My current oncolgists clinical asst., called me the other day to tell me that my cells are "mutating at an accelerated rate." when I asked her what does that mean, she told me not to say that she told me, but to start asking my doctor some questions without saying that she said anything. She also told me that nothing surgical wise could be done at this time because I NEED to stay on the coumadin for life.That it is critical and crucial for me to be on it.I am so confused and so worried and that is why I got all of my records and went back to my old oncologist. So far, he suggested that another lung surgeon that he works with, MAY remove half or all of my lung and start heavy chemotherapy. He wants to admit me at least 5 days prior to stop the coumadin and have me monitored constantly. Does this sound normal to you? What would you do if you were me? What would you do if you were treating me? I know that this is all hypothetical, but any feedback would be GREATLY appreciated. Best Regards, Sherry

[HeinrikMD]

Hi Sherry,

The description you gave and your background history does raise the possibility that the findings in the lung may be cancer. A 4 mm shadow by itself is not likely to be cancer, would you have a description of size on the spots? What test was done to rule out the embolism?

I think you’ll need to have a thorough discussion with your doctor. You need to find out what to expect about your condition now after the stroke, the heart attack without the cancer. Is there a survival estimate? Then consider the possibility if cancer is present. If there would be a large impact, you may begin discussing the possibility of an IVC filter. This is a device that will prevent emboli from the legs to get into the lung (brain or heart). If you have one you could discontinue the coumadin. Is the plan to stop the coumadin for a biopsy?