Hi there.
My Dad just informed me that a spot that he's had on his lung for over 5 years now has increased in size and is now putting pressure on the main artery carrying blood back to his heart. All the veins above his heart are enlarged and his heart cannot get enough blood to supply his body with oxygen. He is experiencing pressure/pain in his back and on his vocal cords as well.

The spot has been biopsied 4 times, and the doctors have told him it is not cancerous. He IS, however, a long-time heavy smoker. He is to have another biopsy next week.

It sounds to me like he's headed towards heart failure. I guess my questions are...does this particular condition have a name? And what will likely be his treatment options?

Hoping you can help,
Cindy

It depends on what the "spot" is. It doesn't have to be cancerous to cause a problem, and it sounds like he's having a problem.

His doctors will be watching him closely to make sure that he does not develop heart failure, which is very visible on a chest x-ray. Heart failure on an x-ray will show up as very wet lungs, full of fluid, with an enlarged heart.

If he IS afraid that he is going into heart failure, as in, the veins aren't slightly enlarged and his venous return isn't just SLIGHTLY impeded, they should seriously look at removing the mass. The problem with removing a mass in that area is it requires major surgery and an intensive care stay, with a chest tube put in post-operatively. He might also be put on a life-support machine for a few days. It's a very very very invasive surgery, and it'll be their last resort. Recovery time from that kind of surgery would be at least a month, if not more, as they might have to saw through ribs. Basically, they won't just take it out if they don't absolutely have to. And I have a feeling that's what they're waiting for -- that crucial point where if it gets any worse they're going to have a bigger problem on their hands.

In the meantime, it's a good thing he's getting regular biopsies, because it is possible that it might turn into something cancerous.

P.S.; Is he having regular diagnostic tests to see the degree of blockage it's having, or the rate of its growth? Things like angiograms or at least chest x-rays?

[This message has been edited by wrin (edited 03-21-2003).]

Hi Wrin,
First of all, thank you for your reply!

My dad's had a number of x-rays, 3 MRI's and 2 CAT scans in the last 3-4 years, in addition to the biopsies. Speaking with him further, he said that they're simply trying to decided HOW they're going to remove it (laser, regular surgery etc.). I did mention my fears to him about heart failure (via email) but he hasn't responded yet.

So...it sounds as though it will be removed. You mentioned length of recovery, hospital stay etc...will the duration/severity of the surgery be reduced if they can do it with a laser? I imagine it would, and I further imagine that it's far less invasive and therefore preferable to do it that way.

Any further thoughts would be appreciated.
Thanks again,
Cindy

[This message has been edited by girlnamedlou (edited 03-21-2003).]

If they can laser the sucker off through a bronchoscope, that potentially eliminates having to put in a chest tube. That would dramatically decrease recovery time -- recovery time with open thoracic surgeries is so long partially because of the invasiveness of the procedure. Hence, if they can do it less invasively, the recovery time will be shorter.

Laser is a great thing but it isn't appropriate for every size of mass. Depends on how close it is to the surface of someplace they can stick a laser. If it's embedded deep in the lung, they might end up removing a couple of lung segments along with the mass just to keep things easy. By 'segments' I mean a small chunk of a lobe -- like 1/10th of one lung. But it all depends on your surgeon of choice -- I'm not a surgeon.

Rest assured, if they can get away with doing it the least invasive way, they will. It means less OR time, fewer anaesthetist costs, fewer staffing issues.. blah blah blah. Everybody's short-staffed and everybody's waiting in line for surgery. That, and they want to make the experience the least hellish for the patient as possible.

Your father should be asking his doctor (pulmonologist?) these questions, like recovery times for each procedure, and what the procedure entails. I'm making general statements, the surgeon would be able to tell you more without running the risk of being hugely out to lunch.

Thanks Wrin...you've been a big help.
I am much obliged.

Cheers,
Cindy