Aa
Wedge resection/lobectomy/also breast & fibro
Hi,
I'm looking at a possible lung cancer (never smoked, though, or been around smokers; it was picked up when I had pneumonia last Nov & hasn't changed despite antibiotics). May 5th, the lung surgeon is planning to do a wedge resection, and if necessary, a lobectomy. I'm dreading this, especially since what's showing up is located in the upper posterior part of my lung, so at the least, 2 of the 3 keyholes will be in my back/back of shoulder (if it's benign), right where I have my worst problems with my severe fibromyalgia. I've also just been diagnosed with breast cancer in the opposite breast: I just got my wire-guided excisional biopsy results yesterday. it's located way back near the chest wall: Invasive tubular adenocarcinoma, 1.1cm, grade 1, excision margins clear, estrogen pos+++, greater than 90% of invasive cells; progesterone. pos+++, approx. 10% of invasive tumor cells; HER/2 neg. Ductal and lobular carcinomas are in situ. The breast surgeon plans to do a sentinel node biopsy at the same time as the lung procedure May 5th.
My questions are: 1) would it make sense to check out the lymph nodes first, even if it means two anesthetics, if it might make the lung procedure pointless? 2)) Since my breast tumour was so close to my chest wall, and my mother's breast cancer metastized to the bone, would a bone scan be a good idea at this point, to help determine txt? 3) If my lymph nodes are malignant, might that change txt for lung & breast, and might it perhaps make the lung procedure pointless (I'm dreading the lung operation because of my fibromyalgia & am trying to avoid it!!.) I'm only 54, but I'm more interested in quality of life than length of life, when I'm dealing with basic needs
Thanks so much. All this is so overwhelming, not just that I'm dealing with both breast and lung, but especially the effect it will all have on my fibromyalgia, and how it will make my disabilities even worse (driving, personal care, etc)
Thanks.
I'm looking at a possible lung cancer (never smoked, though, or been around smokers; it was picked up when I had pneumonia last Nov & hasn't changed despite antibiotics). May 5th, the lung surgeon is planning to do a wedge resection, and if necessary, a lobectomy. I'm dreading this, especially since what's showing up is located in the upper posterior part of my lung, so at the least, 2 of the 3 keyholes will be in my back/back of shoulder (if it's benign), right where I have my worst problems with my severe fibromyalgia. I've also just been diagnosed with breast cancer in the opposite breast: I just got my wire-guided excisional biopsy results yesterday. it's located way back near the chest wall: Invasive tubular adenocarcinoma, 1.1cm, grade 1, excision margins clear, estrogen pos+++, greater than 90% of invasive cells; progesterone. pos+++, approx. 10% of invasive tumor cells; HER/2 neg. Ductal and lobular carcinomas are in situ. The breast surgeon plans to do a sentinel node biopsy at the same time as the lung procedure May 5th.
My questions are: 1) would it make sense to check out the lymph nodes first, even if it means two anesthetics, if it might make the lung procedure pointless? 2)) Since my breast tumour was so close to my chest wall, and my mother's breast cancer metastized to the bone, would a bone scan be a good idea at this point, to help determine txt? 3) If my lymph nodes are malignant, might that change txt for lung & breast, and might it perhaps make the lung procedure pointless (I'm dreading the lung operation because of my fibromyalgia & am trying to avoid it!!.) I'm only 54, but I'm more interested in quality of life than length of life, when I'm dealing with basic needs
Thanks so much. All this is so overwhelming, not just that I'm dealing with both breast and lung, but especially the effect it will all have on my fibromyalgia, and how it will make my disabilities even worse (driving, personal care, etc)
Thanks.
Hello again,
The approach refers to the surgery. The description you gave makes me think of video assisted lung surgery, in which scopes would be inserted (the keyholes you mentioned on your back). While this would effect less stress and earlier recovery – if there is a reason to avoid the back – then maybe you could explore another approach. A different approach may mean an open chest surgery. This may avoid the back area in the surgical field – but it would entail a longer operating time, it may not be feasible to perform it with the breast procedure, and of course you would need to stay in the hospital longer as recovery is slower. In such a scenario, avoiding the back during surgery may be offset by staying in bed for a long time (especially if your back hurts if you lay on your back for a long time). If you can review such options, then maybe the original plan would not seem too invasive for you.
The approach refers to the surgery. The description you gave makes me think of video assisted lung surgery, in which scopes would be inserted (the keyholes you mentioned on your back). While this would effect less stress and earlier recovery – if there is a reason to avoid the back – then maybe you could explore another approach. A different approach may mean an open chest surgery. This may avoid the back area in the surgical field – but it would entail a longer operating time, it may not be feasible to perform it with the breast procedure, and of course you would need to stay in the hospital longer as recovery is slower. In such a scenario, avoiding the back during surgery may be offset by staying in bed for a long time (especially if your back hurts if you lay on your back for a long time). If you can review such options, then maybe the original plan would not seem too invasive for you.
Thanks so much for your elaborate reply; I really appreciate it. Just wanted to ask about your last comment: "Perhaps you need to discuss expected functional outcomes with your current disabilities, and explore other operative approaches."
What would be the hoped-for outcome of discussing functional outcomes/my disabilities, and with whom? And what other operative approaches might there be (& are you referring to lung or breast, or both?). Thanks so much; I've asked my GP and my 2 surgeons these types of questions, but they have not had any comments or suggestions. Maybe I can try again, but could you perhaps clarify what you mean? Thanks so much.
What would be the hoped-for outcome of discussing functional outcomes/my disabilities, and with whom? And what other operative approaches might there be (& are you referring to lung or breast, or both?). Thanks so much; I've asked my GP and my 2 surgeons these types of questions, but they have not had any comments or suggestions. Maybe I can try again, but could you perhaps clarify what you mean? Thanks so much.
Hi,
On checking the lymph nodes first:
You are correct that the procedure if it turns out to be positive would increase the chances of having a metastasis. The problem is, the odds of this happening for a small breast cancer is smaller than the chances for a non-smoker to get lung cancer. So, if the nodes are positive, it may only mean that the breast cancer has reached the lymph nodes – it would not be conclusive that the finding in the lung is secondary to the breast.
On bone scan:
The size of the tumor and the overall clinical stage classifies you as early breast cancer, women in this group rarely have bone disease and hence a bone scan is not warranted. While the disease is close to the chest wall, if there is no evidence of invasion the bone scan still won’t be necessary. If it really invades the chest wall, the breast surgery may not be recommended at all.
On treatment changes:
You are correct that treatment may change, but not radically. For the breast you would need chemotherapy and hormone therapy based on current findings already. For the lung, if it is very early disease, the treatment ends with surgery. More advanced lung disease may mean chemotherapy for the lung. There are drugs that may treat both lung and breast.
On avoiding the lung operation:
While indeed this may have more impact on your quality of life, lung cancer is more aggressive and would radically shorten your life compared with breast cancer. You are among those who may be potentially cured of lung cancer, however, this comes at a cost of greater operative interventions.
Perhaps you need to discuss expected functional outcomes with your current disabilities, and explore other operative approaches.
Stay positive.
On checking the lymph nodes first:
You are correct that the procedure if it turns out to be positive would increase the chances of having a metastasis. The problem is, the odds of this happening for a small breast cancer is smaller than the chances for a non-smoker to get lung cancer. So, if the nodes are positive, it may only mean that the breast cancer has reached the lymph nodes – it would not be conclusive that the finding in the lung is secondary to the breast.
On bone scan:
The size of the tumor and the overall clinical stage classifies you as early breast cancer, women in this group rarely have bone disease and hence a bone scan is not warranted. While the disease is close to the chest wall, if there is no evidence of invasion the bone scan still won’t be necessary. If it really invades the chest wall, the breast surgery may not be recommended at all.
On treatment changes:
You are correct that treatment may change, but not radically. For the breast you would need chemotherapy and hormone therapy based on current findings already. For the lung, if it is very early disease, the treatment ends with surgery. More advanced lung disease may mean chemotherapy for the lung. There are drugs that may treat both lung and breast.
On avoiding the lung operation:
While indeed this may have more impact on your quality of life, lung cancer is more aggressive and would radically shorten your life compared with breast cancer. You are among those who may be potentially cured of lung cancer, however, this comes at a cost of greater operative interventions.
Perhaps you need to discuss expected functional outcomes with your current disabilities, and explore other operative approaches.
Stay positive.
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