mets to lung
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Thanks all for the responses ladies.
Alabama Dee and moth -- Celebrex is a good idea, but Polly feels as though the pain is in the nerve and isn't sure Celebrex will address. Regardless, we'll pursue that with her MO. moth, I like the idea of a palliative pain team because we need some creative or out the box solution. The MO seems to want to jump right to opioid.
Imagine -- Yes her pain is right at the top of the shoulder.
SusaninSF -- Polly hasn't had a bone scan since the fall, but as mentioned above, she feels like it isn't in the bone as much as in the nerve.
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BLMike,
My primary care doctor just prescribed another NSAid today for me for lower back pain -- one I had not heard of before -it's called Meloxicam. She said she preferred it -- I think because she said it lasts for 24 hours? Another one your wife might want to check out.
Good luck.
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Thanks BevJen. Haha! Actually, I received a PM from someone here also suggesting Meloxicam. I discussed that with my wife yesterday but unfortunately, she had a negative reaction to that when it was previously prescribed by an orthopedic.
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Hi BLMike,
Sorry to hear your wife is having so much pain. I had a very similar experience and my MO did order a scan, and one small met was found on my coracoid process which was causing significant pain. Around the same time I did have some progression in my lungs, so I changed treatments all together, which resolved the bone met, however prior to changing treatments, I met with my radiation oncologist and we were considering radiating the met for pain management. If you are able to get imaging approved, that might be a good idea. It could potentially open up some other treatment options.
Hope this helps
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MissMonty -- Thanks. That does help. Polly is scheduled for a scan for a clinical trial she's associated with. It's not clear if she's going to be up for that, but she is experiencing a little less pain today. Your post may help nudge her to power through the scan tomorrow (if she can). Thanks again.
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Imagine - I have lung mets in my right lung. I also had a pleural effusion on the right lung. I would describe my pain as if I had wrenched my shoulder/neck area by jerking/lifting something heavy off the floor without bending my knees. It felt like muscle strain but, of course, I did nothing to injure my shoulder and kept assuming I must have slept on it funny. I was achy and uncomfortable 24/7 with occasional shooting pain across the top of my shoulder, but only my right shoulder. I thought the pain was coming from a pinched nerve in my neck, but then I started Abraxane and the pleural effusion resolved itself and went away and the shoulder pain went away with it.
BLMike - I'm with Polly - no opioids, please. I do have the option to use cannabis in my area and I have my prescription card. I haven't had to use it yet, but I'm definitely exploring alternatives. I also have an acupuncturist that is nearby and I'm definitely keeping that in my wheelhouse as well.
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Hi, I just had a pet and ct scan which showed a bc recurrence in my right chest wall., my mastectomy side., and a 13 mm lung nodule suspicious for mets. This is my third bc recurrence., first dx'd in 2008.
What is/was your treatment plan for lung mets?
Thank you.
p.s. I couldn't figure out how to start my new question under the topic, mets to lung. Take care to all.
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pabbie -- Sorry you are going through this. My wife was diagnosed with Mets to the lungs in April 2019. She started with Ibrance, transitioned to Piqray, and then to Xeloda. She's currently on a Clinical Trial for Lynparza for MBC. I know MBC is very scary but as a number of threads note, life doesn't have to end just because you have MBC. Fortunately, there are a variety of treatment options with more becoming available all the time. Hang in there! Best of luck on your MBC journey.
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Pabbie- Sorry you are going through this again. Stupid cancer
I had SBRT to my small lung met. I recommend a consult with a radiation oncologist. They may be able to treat the chest wall area also. It was an easy local therapy for me. Just some fatigue.
If you can get a biopsy(depends on the place in the lung), I would think a NGS test like foundation1 or TEMPUS may give you some answers. Especially since you progressed on aromisin. You may have an esr1 mutation which makes the AI therapy less effective.
I hope you get some answers for next steps. Local SBRT has studies that show an increase in overall survival.
Dee
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pabbie, I'm sorry to hear your news.
This is probably the best place to ask your question. We have threads for all the main mets locations and it's a way to stay caught up on people's treatments and options.
for me we have used a combination of systemic therapy (chemo & immunotherapy) & radiation treatment (traditional rads, not SBRT) to the met. If you can get a biopsy I agree with AlabamaDee that it would be a good idea to identify whether it is a met at all (people can have benign lung nodules) and whether your tumor markers have remained the same, as well as doing next generation sequencing/genomic testing for any targetable mutations.
What is your team suggesting as next steps for you?
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Thank you everyone. I am meeting with my oncology surgeon on Monday to discuss my treatment. I'm trying to gather some information beforehand.
Take care to all.
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Thank you. Take care to you and your wife.
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What is SBRT. I couldn't tolerate the side effects of the AI's., but completed 5 years of tamoxifen in 2008.
My surgical oncologist put in a request for a biopsy of the met. What is an NGS test like foundation1 or TEMPUS.
Thank you.
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I am meeting with my surgical oncologist on Monday to fully explain my scan results. She wants to physically feel my lump in my right chest wall on my mastectomy scar to see if she can remove it.
She will refer me to an oncologist too. My oncologist retired.
I appreciate your post. Take care.
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hi Pabbie, It must be overwhelming to have these terms thrown at you. keep asking questions because we all learn so much here about the options available to us
Glad they want to do a biopsy. You can ask the surgeon to order the NGS test, next gen sequencing which analyses the tumor tissue DNA and RNA for mutations. Also called genomic testing or comprehensive genomic profiling, biomarker testing or tumor profiling. There are specific new drugs that may target those mutations. You can look up Foundation 1, or TEMPUS on the internet to research more.
SBRT is a specific kind of radiation treatment where the beams are very precise, targeted and intense. It reduces damage to surrounding tissues and has less appointments than traditional radiation.
I hope you get some answers and a good plan with great results.
Dee
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I hope you ladies don't mind my asking your opinion on the CT scan results I had last Wednesday. I have not heard yet from my oncologist and I have a call in to her (miffed about that but that's another story) but my results showed up on MyChart. Up to this point, I've dealt with bone mets and am currently on Xeloda, have been taking it for a year. The bone scan came back as pretty much no changes from last time. Here is the findings on lungs:
Lungs and pleura: There are several scattered bilateral pulmonary nodules of varying sizes with interval increased size some of the pulmonary nodules when compared to the prior CT scan. The representative examples include: A right lower lobe nodule measuring up to 5 mm (image 204, series3), versus 3 mm previously, more lateral right lower lobe nodule measuring up to 4 mm (image 187, series 3), interval more conspicuous 2 adjacent left fissural nodule measuring 2 and 3 mm each (image 203, series 3), more conspicuous right lower lobe nodule (image 228, series 3) and left lower lobe nodule measuring up to 4 mm (image 250, series 3) versus 2 mm previously. Scattered ill-defined, mostly peripheral bilateral pulmonary opacities are seen, nonspecific and may be related to atelectatic changes. Additional background bibasilar atelectatic changes and/or scarring. No consolidation. No pneumothorax. No pleural effusion or thickening.
I have no idea what to think. I had Covid in January and am wondering if any of the above could be some kind of residual from that. But of course, I understand it may be progression. But I'd really appreciate any insight and where I might go from this point. I will let you know when I here form the onc and what she says. Thanks.
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Hi Divine, ask away. Unfortunately I can’t be much help as my lung mets have never presented as nodules (perhaps mention of one possible nodule). Mine was malignant pleural effusion with thickening of the pleura. Hopefully others with nodules will chime in but I would certainly raise the issue of COVID, particularly given the impact it has on the pulmonary system. Perhaps your MO will choose to monitor this given that everything else is stable. That would be my preference if there is any uncertainty.
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Divine,
Nodule Nancy here! Your bout with Covid could have very well affected your lungs, causing temporary inflammation and scarring. That's what happened to me on Ibrance. Many dozens of new small nodules and opacities suddenly showed up on my scans last fall, so my oncologist referred me to a pneumonologist for a bronchoscopy. He looked at my scan and diagnosed medication-induced pneumonitis. I stopped taking Ibrance and my lungs began to heal, with the most recent scan showing most of the "new" problems resolved or diminished. The old nodules are still present, but either stable or slightly smaller.
So, take heart. I hope your doctor gets in touch with you pronto. And you may want to check in with a pulmonologist as well.
Best,
Tina
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Tina2, how long did it take for your pneumonitis to resolve?
I have radiation pneumonitis following rads to a lung met in Dec. I did a course of oral steroids starting Feb 24 + rapid taper. but my symptoms (shortness of breath) have crept back. I think I might need another course of steroids
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Moth,
My lung scan report in the fall (October) was frightening, and the only thing that got the attention of my oncologist after I had complained over months of feeling awful, with fatigue, shortness of breath and loss of appetite. After the pneumonitis diagnosis, I stopped the Ibrance, felt better over time, and was scanned last month. The report showed a real improvement.
So, approximately six months from "yikes" to "whew."
Tina
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Divine, It likely could be from Covid. My lungs are a mess from having Covid near the end of December. I have a few cancerous lung nodules that have remained stable. My post covid scan showed new nodules all over my lungs. I had 2 departments of radiologists look at it (my normal cancer team and my trial team) and they said everything new was from covid. I saw the scans. It looked like a grey cloud had filled up my lungs. It's very discouraging because it's going to be difficult to tell what is cancer and what is from covid. I am sorry you are also going thru this. I would have your Onc show you the scans so you can see the comparison. You may also want a second radiologist to look at your scans if Covid lungs are not brought up. ~Kar
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Thank you Tina. Glad you're feeling better now!
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Update from Pabbie.,
Onc will be able to remove my recurrence on my right breast mastectomy scar., it's not attached to the chest wall. But I have to meet with a plastic surgeon before surgery just in case my surgeon can't find enough skin to sew me up. The plastic surgeon will supply some skin from my side close to my back.
Not sure we can biopsy the lung met., it's not in an easy spot plus she considers it small. I'm also meeting with a medical oncologist to discuss chemo. That's all for now. One day at a time. Take care to all.
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I’m so grateful for all of your input.
My onc called and said the findings on this scan aren’t significant enough to make any changes in my current treatment. She does not think there is a need for a biopsy, and only would do that had there had been a significant jump in nodule size, say from 3 mm to 10 mm. I raised the issue of my having Covid in January and would that be affecting the scans, and she said I made a good point, that it’s a possibility. She said we will monitor all of this. I do trust her knowledge base.
The cancer center moved into its new, state of the art wing of the hospital last year and the sad part is it’s become much less personable. Before that, I had a direct phone number to my onc’s nurse who returned every call on the same day. Now, my call goes to a nurse who isn’t even at the hospital! She puts my message through to MyChart and I wait for a call. It’s always a different nurse when I call, and they do not know my name or face. I always worry about being forgotten about.
Also, I don’t think I’m talking specifically to oncology nurses. The one yesterday was putting fear into me by alluding to bad results on my scan reports which she could see but I hadn’t accessed yet and telling me she’d mark my call a high priority and to call back in a few hours if I hadn’t heard from the doctor. My onc and her nurse are never, ever alarming.
My onc (and her nurse) will both retire this year, they’re only working 3 days a week. I only have one more visit with her. They’ve been my medical team for 10 years.
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Divine, I'm sorry you're dealing with hospital stuff like that. I can message my MO via my patient portal, and I usually hear back from her nurse the same day. My MO from 12 years ago retired, and I have a new MO. I like her and she's young, so hopefully she won't be retiring any time soon. We need that personal touch, right?
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Divine, I'm sorry as well that you are dealing with issues accessing your medical team and even more sorry you are losing your MO. I live in fear of losing mine. He's technically been treating me since 2001 as he was my MO when I was initially diagnosed as stage IIa. We have a good rapport and understand each other so the though of breaking in another MO... eek! I am also fortunate that he provided me with his email address after I was diagnosed with MBC. I try very hard not to abuse the privilege but am so appreciative that I have a direct line to him if I have any questions/concerns. He's very responsive, typically replying within minutes if things aren't too crazy for him. Very lucky...
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Divine- I had a few lung nodules that showed up. They did a PET scan to see if any were active. Only 1 was active and I got SBRT to that one.
It really stinks that your care experience is not as good. I hope you can find a way to get improvement at your next visit. I would certainly speak up. Ask for the new nurse’s direct line, express the emotional toll it is taking on you as a patient, point out the lack of discretion by the nurse who made you worry. Our care team should not cause us more stress.
FYI- I spoke up at my local clinic about an issue and the CEO actually contacted me that day chair-side. He listened and helped me get a new MO whom I love.
Dee
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During a liver biopsy, the Interventional Radiologist noticed that I had a large pleural effusion, 2 liters in my right lung! I had been complaining about extreme shortness of breath and severe pain in my shoulder/neck on my right side for weeks. I was sent to a Respiratory Screening Clinic just a few days earlier and after a bunch of swab tests and an x-ray, was told there was nothing wrong. The IR tried to remove the liquid but about halfway through, he had to stop because the pain in my shoulder was too severe when I coughed. He was able to remove 850 ccs. A week later, went to my Interventional Pulmonologist who removed another 800 ccs before, again, the pain was too great in my shoulder when I coughed. The removal process causes coughing. He suggested I get a Pleurx so I could drain the fluid every day myself.
Has anyone else gotten a Pleurx? If so, what was your experience? I dread not being able to swim for 3-4 months and wonder if I will be able to do yoga with it. At the same time, I can't keep going through the roller coaster of having fluid build-up and getting Thoracenteses. Prior to this episode, I had one Thoracentesis a year ago when he removed 500 ccs. Not so bad but I wonder if the build-up will increase more rapidly going forward.
Hugs, Susan
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oh Susan I am so sorry you are going through this junk. My sister and uncle have both had chest tubes for drainage for different causes but the same reason- couldn’t drain enough in multiple procedures. They got used to it being there after about a week. They both were able to do minor activities but no swimming like you said. Hopefully you can figure out a way to do yoga- seems like it would be good for drainage. Sister was 2 months with the tube. Uncle was about the same. It really helped them. Hope it goes well for you
Dee
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Thanks Dee! The positive experiences of your sister and uncle really help lower my stress over this procedure.
Hugs, Susan
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