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  • I need advice on what to ask Chest Surgeon Monday HELP!!!!!

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    Old 06-04-2005, 12:33 PM   #1
    korusgirl
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    I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    I was told last Tues. a 2cm lesion in upper left lobe lit up on pet scan.
    Pulmonologist made an appointment for me with Chest surgeon Monday.
    I'm dazed really and don't know what to expect nor what questions I should be asking.
    Could some of you kind people give me some ideas?
    My questions are so voluminous regarding the nodule and my brain is so full of mixed thoughts right now, I feel like fainting.
    Do any of you know, that if you have several lesions in your lung, and only one lights up on a pet scan, is that a good thing?
    Does anyone know what the difference is between nodules, lesions, masses, patch densities, spots, etc.
    Or is this just a radiologist preference?
    I had a few patch densities that didnt light up. And I dont know if I should be feeling good about it. If they r not cancer now can they turn into cancer later?

    Are pet scans reaaaaaalllllly accurate for picking up cancer. I read on the net that they are not good if the cancer is small. Is this true?
    Is a bone scan the same as a Pet Scan from your chin to your thighs? Or is a bone scan different and only checking for soft tissue cancer?

    Will I be scheduled for a biopsy first thing?
    Is this done as an outpatient or inpatient?
    Are there various ways to do a biopsy depending on where the lesion is?
    How long do you wait for those results?
    And if surgery is recommended, I presume it is done swiftly, right? Have any of you gotten a second opinion on the recommended treatment you were advised to receive?
    Are there tests you have to have done, other than lab work, that need to be performed before chest surgery?

    Also, one other question. Regarding surgery, I did have Pulm function testing already and I have an idea that FEV1 is important. Does anyone know what that number should be and what it represents?
    If you have bad lungs, does that mean they don't operate.
    If you have one nodule, do they take the whole lung?
    Do you remember years ago, when someone had cancer, they said once they open you up blah,bla,blah...you know. Well. is that the reason the whole lung is removed?

    Last edited by korusgirl; 06-04-2005 at 12:36 PM.

     
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    Old 06-05-2005, 08:17 AM   #2
    smithn
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    Quote:
    Originally Posted by korusgirl
    I was told last Tues. a 2cm lesion in upper left lobe lit up on pet scan.

    I'm assuming you had a Chest CT done prior to the PET? It would be important for you to get that report (and your PET and ALL other reports) to know exactly what that impression reads and so you know what you are dealing with here.

    Pulmonologist made an appointment for me with Chest surgeon Monday.
    I'm dazed really and don't know what to expect nor what questions I should be asking.

    I think that you are already asking some good questions. For now, it's difficult to know what to ask until you know exactly what you are facing.


    Could some of you kind people give me some ideas?
    My questions are so voluminous regarding the nodule and my brain is so full of mixed thoughts right now, I feel like fainting.

    I hope you have family or a good friend that you can talk to and spend time with right now! You definitely need support right now. I think you should try to do some vigorous exercising (brisk walking etc., to help you with the pent-up anxiety you are experiencing. I know it won't resolve the anxiety altogether, but it will help you get through this and help to alleviate some of the stress.

    Do any of you know, that if you have several lesions in your lung, and only one lights up on a pet scan, is that a good thing?

    They produce a radioactive substance that will attach to a natural body compound (usually Glucose (sugar) and once this substance is administeredv, the material will localize to the appropriate areas in your body. Different colors or degrees of brightness on a PET image represent different levels of tissue or organ function. For example, because healthy body tissue uses Glucose for energy, it will accumulate some of this "tagged" Glucose which will show up on the PET images. Cancerous tissue uses more Glucose than normal tissue, so the cancerous tissue accumulates more of the substance and will appear brighter on the PET image. So, to answer this question, if a person has several lesioins in their lung, it's better to have only one "light up" but until all of your studies are complete, it's not safe to say just how well off you are right now. I'm sorry for lack of a better answer

    Does anyone know what the difference is between nodules, lesions, masses, patch densities, spots, etc.

    A nodule is round-shaped and solid; a lesion is a broader term that is really any pathological or traumatic discontinuity of a tissue; a mass is a lump or collection of cohering particles - it doesn't really move; patch densities are small superficial areas that ae different than the rest of a surface and spots are simply locations of abnormal areas.


    Or is this just a radiologist preference?

    No, they determine these by characteristics - they are all different.


    I had a few patch densities that didnt light up. And I dont know if I should be feeling good about it. If they r not cancer now can they turn into cancer later?

    If you lung nodule turns out to be a cancer then, yes, the cancer could spread.

    Are pet scans reaaaaaalllllly accurate for picking up cancer. I read on the net that they are not good if the cancer is small. Is this true?

    PET scans are at least 95% accurate in detecting cancers. It makes no difference if the cancer is small or large - the cancer will use more Glucose than other tissues and it will "light up".


    Is a bone scan the same as a Pet Scan from your chin to your thighs? Or is a bone scan different and only checking for soft tissue cancer?

    Bone scans are similar in that radioactive tracers are injected but instead of it being "tagged" to Glucose, it is tagged to Calcium. Normal bone tissue will acquire normal uptake and the abnormal or affected tissue, will acquire a greater amount of uptake and will therefore stand out on imaging. The bone scan is performed to find out if any type of cancer has spread to the bones.

    Will I be scheduled for a biopsy first thing?

    That will be determined by the surgeon and depends on what your CT and PET scan impressions read.


    Is this done as an outpatient or inpatient?

    Bronchoscopies, Thoracentesis, and Needle Biopsiesare done on an outpatient basis. A Thoracoscopy with biopsies can be scheduled as wither outpatient or inpatient - depending upon the surgeon's choice and your status following completion of the surgery. Your surgeon will discuss the surgery of choice with you.


    Are there various ways to do a biopsy depending on where the lesion is?

    Yes


    How long do you wait for those results?

    2 days. With the exception of tissue being sent out to another hospital for a second diagnostic opinion. In that case, it may take up to 2 weeks.

    And if surgery is recommended, I presume it is done swiftly, right?

    Taking into consideration all of the results of all of the studies you have had, your surgeon will schedule you as quickly as he feels necessary.

    Have any of you gotten a second opinion on the recommended treatment you were advised to receive?

    I would get a second opinion if my doctor was having a difficult time deciding on whether it was a cancer or not. If I was diagnosed with a lung cancer, the only way I would go for a second opinion is if he didn't want to remove it. If cancerous, I would want it out of there as quickly as possible.


    Are there tests you have to have done, other than lab work, that need to be performed before chest surgery?

    A chest x-ray (which I am sure you have already had), an EKG if you are over 40, and of course appropriate labwork with studies dependant upon your physical history/current medications.


    Also, one other question. Regarding surgery, I did have Pulm function testing already and I have an idea that FEV1 is important. Does anyone know what that number should be and what it represents?

    A pulmonary function test evaluates your respiratory status. FEV1 calculates the volume of air that is forcefully exhaled in one second. The key lung volume is TLC (total lung capacity) represented by percentage. 80% - 120% is considered the normal range. Under 80% represents a restriction and over 120% represents lung hyperinflation.


    If you have bad lungs, does that mean they don't operate.

    No, it doesn't mean they don't operate, they just don't function as normal lungs would.

    If you have one nodule, do they take the whole lung?

    If you have a lung cancer, you will need to know what type of a lung cancer it is so a good question to ask is whether the cancer is a small cell or non-small cell form. Non-small cell cancer may be treated in several ways, depending upon the extent of the disease. Small cell cancers spread more quickly and in many cases, the cancer has already spread to other parts of the body by the time the cancer is first diagnosed. Whether or not they take the whole lung, a small portion or section, depends on the location, stage of cancer and type.


    Do you remember years ago, when someone had cancer, they said once they open you up blah,bla,blah...you know. Well. is that the reason the whole lung is removed?
    Don't go by what was done years ago, what a family member had done or by wild stories people will tend to tell you. Cases are individual and medicine has come a long way. Rely on the expertise of your doctor, the support of good friends and family and above all, faith in God. All of us here certainly wish you the best and many of us will add you to our prayer chain!

    Last edited by smithn; 06-05-2005 at 08:22 AM. Reason: additional comment

     
    Old 06-05-2005, 11:45 AM   #3
    korusgirl
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    Smithn,
    When I got to the end of your post, it brought tears to my eyes
    It's hard to believe someone would be as nice as you were to take so much of their time on this beautiful weekend to answer my post.
    God Bless You and thankyou so very very much.
    I do have my cxr, cat scan reports and pet scan report as well as the films. The pet scan report did not mention any of the other patch densities that were picked up on the cat scans but it does say there was a mild uptake in the thoracic spine which worries me a little too.
    Joyce from Upstate NY

    Last edited by korusgirl; 06-05-2005 at 11:50 AM.

     
    Old 06-05-2005, 04:00 PM   #4
    sportzjunkee25
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    First let me say I hope everything will turn up ok for you......Smithn did an excellent job answering all of your questions.....I think if you are told to see an Oncologist he will help you with any question or concern you may have.....make sure when you see the pulm,onc or any other Dr. keep your questions coming........they seem to not want to offer anything they may know...if you don't ask

     
    Old 06-05-2005, 05:44 PM   #5
    smithn
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    Quote:
    Originally Posted by korusgirl
    Smithn,
    When I got to the end of your post, it brought tears to my eyes
    It's hard to believe someone would be as nice as you were to take so much of their time on this beautiful weekend to answer my post.
    God Bless You and thankyou so very very much.
    I do have my cxr, cat scan reports and pet scan report as well as the films. The pet scan report did not mention any of the other patch densities that were picked up on the cat scans but it does say there was a mild uptake in the thoracic spine which worries me a little too.
    Joyce from Upstate NY
    Helping YOU made my weekend better! You are welcome. I certainly don't have all the answers and don't think I know more than anyone else but I am real happy to share what I do know just as I know others would (and do!) help me!

    The mild uptake in your spine is worrisome but hang on to that word "mild" and find out just what can be done. I'm happy you see your surgeon tomorrow. Take a little notepad and pen and make notes if you need to, as the doctor speaks with you. It would be nice if someone can go with you also - an extra set of ears helps with the overwhelming information.

    Whatever you are scheduled for at this point, request timely appointments. If you feel something is scheduled too far out, call the proper office and talk directly with that doctor's nurse and not the receptionist. Nothing against receptionists but the nurse is closest to the doctor and speaks with him daily. Appointment dates can always be moved up or switched with another patient etc. Happens all the time. Try to stay as positive as you can. I have a little saying that I cut out, placed in a frame and have sitting on my window sill.... it says, "Angels will be helping you make your decisions today". I look at it every day. I wish you the best as you are making yours as well!

     
    Old 06-05-2005, 08:44 PM   #6
    korusgirl
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    Hugs and prayers tonight for you all for giving me such wonderful support amd information. I am going it alone tomorrow morning, under my own steam as I don't want to share this with family just yet...pen and pad in hand as Smithn suggested. I am also armed with list of "more intelligent" questions thanks to this message board.
    Thank God I found you.
    Sleep tight,
    Don't think I will be doing much of it tonight, tho ...hehehe
    Joyce in Upstate NY

     
    Old 11-04-2005, 01:18 PM   #7
    adarapt
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    I thank you so much for these Q & A's. You answered so many of my questions that I was going to ask the Dr. next week.

    Last edited by adarapt; 11-04-2005 at 01:20 PM. Reason: messed up spelling

     
    Old 11-11-2005, 08:11 AM   #8
    Tiz
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    An active fungal or bacterial infection can show up on a PET scan to LOOK like cancer, your doctors and surgeons need to be SURE they're not sending you to lung surgery over an infection. Nodules under 2cm size are very rarely cancer (from what I've read, a "spot" on your lung less than 2cm is called a nodule, if it's over 2cm it's called a mass).

    What are your risk factors for cancer? What are your risk factors for a fungal infection?? I live in Iowa, fungal lung infections are so common here nearly every one has lung scars from them....a scar won't take up light on the PET scan and could show that the other spots in your lungs are old infections that healed on their own and left a scar behind. Look up Histoplasmosis and other fungus infections. Did you grow up on a farm, especially around chickens, or around pigeons a lot??

    Look up accuracy of PET scans and biopsies; remember that a surgical biopsy is actual lung surgery. Get all the information you can before you make your final decisions. Doctors are trained to "think cancer first" and most believe that whatever a lung nodule is it should be surgically removed "just in case". As many as 60% of lung nodules removed turn out to not be cancer...again, know what your risk factors for cancer are, if you're young, don't smoke, don't have a family history of cancer and live in an area where fungal infections are common then cancer sure might not be what you have. It could be, but it might not be.

    I would get a second opinion before I did surgery, from a pulmonologist and/or and infectious diseases specialist, maybe from a cancer specialist....if the doctor diagnosing you is just a "general practitioner" you NEED a second opinion.

    Anyway, please just be sure to gather as much information as you can to help you make your decisions.

    Sincerely.............Tiz.
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    Old 11-11-2005, 08:19 AM   #9
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    Re: I need advice on what to ask Chest Surgeon Monday HELP!!!!!

    An active fungal or bacterial infection can show up on a PET scan to LOOK like cancer, your doctors and surgeons need to be SURE they're not sending you to lung surgery over an infection. Nodules under 2cm size are very rarely cancer (from what I've read, a "spot" on your lung less than 2cm is called a nodule, if it's over 2cm it's called a mass).

    What are your risk factors for cancer? What are your risk factors for a fungal infection?? I live in Iowa, fungal lung infections are so common here nearly every one has lung scars from them....a scar won't take up light on the PET scan and could show that the other spots in your lungs are old infections that healed on their own and left a scar behind. Look up Histoplasmosis and other fungus infections. Did you grow up on a farm, especially around chickens, or around pigeons a lot??

    Look up accuracy of PET scans and biopsies; remember that a surgical biopsy is actual lung surgery. Get all the information you can before you make your final decisions. Doctors are trained to "think cancer first" and most believe that whatever a lung nodule is it should be surgically removed "just in case". As many as 60% of lung nodules removed turn out to not be cancer...again, know what your risk factors for cancer are, if you're young, don't smoke, don't have a family history of cancer and live in an area where fungal infections are common then cancer sure might not be what you have. It could be, but it might not be.

    I would get a second opinion before I did surgery, from a pulmonologist and/or and infectious diseases specialist, maybe from a cancer specialist....if the doctor diagnosing you is just a "general practitioner" you NEED a second opinion.

    Anyway, please just be sure to gather as much information as you can to help you make your decisions.

    Sincerely.............Tiz.
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