We met with Dr. Cohen of the Huntsville Cardiothoracic Surgery Group... of their several surgeons, he is the one with the most experience with lung diseases, treatments and surgeries, and the only one who does certain procedures such as the laser brochoscopy. He has to catch a flight this afternoon for an out-of-state meeting, but came into the office early this morning specifically (and only) to meet with us. We're blessed to have such a dedicated and caring doctor to be part of the team. He reviewed the CT & PET scan images and reports.
As we had suspected (but hoped otherwise), surgery to remove the tumor is not possible at this time since it extends past the lung wall into the adjacent lymph nodes behind the sternum. The placement of the main tumor is in a "good" location for lasering where it is blocking Lisa's airway, and he believes that will help her a lot with her chest discomfort and cough, and make her feel better through the rest of the treatments, as well as reduce the chance of infection or pneumonia. Of course, that's what they call a "palliative" (reduce and/or improve symptoms and make you feel better) procedure, rather than curative. The laser brochoscopy is scheduled for the morning of Wednesday, February 9, his first open surgery day after he returns.
The doctor took the time to sit with us through a review of the PET scan, and now I better understand why the tumor looked the same as on the ealier CT scan. A PET scan has two parts... and the first part *is* a regular CT scan. The second part is done with digital recordings of the radiant/nuclear indications of metabolic activity (the "glow" part, often called "standardized uptake value" or "SUV"). The radiologist then takes special software which overlays the "glow" with the regular CT scan images, so that their position and orientation can be determined. My current software won't do that kind of overlay, but I now understand the series of images which appeared out of focus but did show the hotspots, including in the main tumor area.
Good news: The surgeon said that as long as the cancer is limited to the one area in the chest, there's definite hope that radiation and chemotherapy can promote a complete cure, and he has had that happen with other patients of his. If the radiation & chemo shrink the main tumor enough that it is no longer active in the adjacent lymph areas, then they can remove the upper lobe of that lung for a potential long-term cure. If and when we get to that, it's a 4 to 5 hour surgery, and Lisa would be in the hospital for 5 to 7 days, with an overall six to eight week recovery. But even knowing if that's in the cards is at least six to eight weeks away, until after the first radiation and chemo regimens are completed and retesting is done.
Of course, key to what the surgeon said is that "the cancer is limited to the one area in the chest". The PET scan showed that there are other small nodules (not the little white calcium spots that are no concern) in the same lung but away from the main mass. The largest of these is only a half inch in size, and these weren't seen in the first CT scan, though that doesn't necessarily mean they weren't there -- the PET is more capable and detailed. The report stated that there is also a 'suspicious small focal hypermetabolic lesion' (visual hot spot) on the right femur (thigh bone) and warrants additional examination. Before we left the thoracic surgeon's office, I called the oncologists office, and told them I would like the determination on the right leg "fast tracked"... the oncologist hadn't yet looked at the PET scan report, but checked it while I was on the phone and then scheduled an MRI for this very same afternoon. Though these are all caring doctors, they have many patients and you really do have to be willing take on the responsiblity to sometimes 'gently push' to be bumped to a higher priority.
The femur indication could be trivial... it could be the result of an old injury, or arthritis, which does run in Lisa's family. We're hoping and praying that it is unrelated to the cancer. We probably won't be told the results of the MRI until our regular appointment on Monday afternoon, but I'll squeeze it out of them earlier if I can. At least we know that no other organs are compromised.
Michael
