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?2cm lung met with no symptoms

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Lulu View Drop Down
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    Posted: Aug 19 2013 at 7:16pm
Recent annual mri has shown recurrence in right lymph nodes plus "20mm contrast enhanced lesion" in right lung.

I have no lung symptoms, not breathless no cough cant quite believe this could be a lung met.... Do they occur singularly? At 2cm would i not have symptoms?

Having US on thurs and biopsy of nodes to confirm mri findings. Also have bone scan booked the same day and chest CT on fri for more info on new lung lesion.


Last recurrence was in my left interpectoral lymph nodes with invasion to muscle treated with surgery then carboplatin and taxotere followed by 20 rads. Last mammo in feb was normal and mri last aug showed no lung lesions.

This is my 4th recurrence of breast cancer and dont know if it is TNBC again this time... Cancer no 1 was hormone pos then no 2 and 3 were tnbc.


Not really worried just wondering whats ahead

Cheers
Lulu x
04/06-13mm,ER+, gd1, stg1,R WLE, rads
05/09-19mm,TNBC,gd3,stg1,LVI,L WLE,E-CMF,rads
01/10-BRCA2+ c.2409T>G
09/10-TAH&BSO
08/11-IPL nodes -L WLE- tax/carbo, Rads
08/13-R lung & LN mets. ENCHANT trial
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dmwolf View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: Aug 19 2013 at 8:02pm
Oy vey!    I'm so sorry it's back to visit yet again, and really impressed that you are not stressing about it too much.  That's the attitude I aspire to.    It is possible to have a 2cm lung met without symptoms, but until there's proof positive in the form of a biopsy, I'd assume it's a mystery nodule.   Is it operable?  If so, you might want to take it out, as if it is a lung met, surgical removal of isolated lung mets improves prognosis.

Good luck with the next steps.  You can count on us to help you make decisions, or at least keep you company.
DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Lulu View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lulu Quote  Post ReplyReply Direct Link To This Post Posted: Aug 20 2013 at 2:52am
Thanks thats good to know re the surgical option.... Not sure exactly where it is i never asked that yet.... Will start making a list of questions.

I was surprised i could have a met that big with no symptoms as many folk with tiny ones do have symptoms. They dont biopsy lung mets routinely here due to the whole puncturing a lung type scenario.... But CT scan should hopefully help clarify things.

Thanks for your response.
Lulu
04/06-13mm,ER+, gd1, stg1,R WLE, rads
05/09-19mm,TNBC,gd3,stg1,LVI,L WLE,E-CMF,rads
01/10-BRCA2+ c.2409T>G
09/10-TAH&BSO
08/11-IPL nodes -L WLE- tax/carbo, Rads
08/13-R lung & LN mets. ENCHANT trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: Aug 20 2013 at 12:50pm
If solid lung mets don't cause a lot of inflammation, they can be symptomless (a good thing!).  The lung-type met that almost always causes symptoms is a pleural effusion.  Those cause serious shortness of breath.  Both kinds can cause coughing, but they don't always.    Strangely enough, lung mets in themselves don't seem to be that dangerous, at least on short time scales.  Lots of people walk around with them for years without problem.   As opposed to liver and brain mets, which really need to be controlled unless they are indolent.   But several trials show that surgically removing isolated lung mets leads to longer survival, probably, because it won't have as much of a chance to seed other sites.   Anyways, if I had up to 3 isolated lung mets I'd remove them surgically instead of relying on chemo on its own to keep them in check.  I'm a big believer in local treatment in addition to systemic ones if the number of sites is small.
DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Lulu View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lulu Quote  Post ReplyReply Direct Link To This Post Posted: Aug 20 2013 at 4:37pm
Thanks dmwolf thats very interesting. I guess each time i had chemo id had surgery before hand so never really sure the chemo is effective... I suppose ill know more when i get the final results and the prof has come up with a plan.

04/06-13mm,ER+, gd1, stg1,R WLE, rads
05/09-19mm,TNBC,gd3,stg1,LVI,L WLE,E-CMF,rads
01/10-BRCA2+ c.2409T>G
09/10-TAH&BSO
08/11-IPL nodes -L WLE- tax/carbo, Rads
08/13-R lung & LN mets. ENCHANT trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Adnerb Quote  Post ReplyReply Direct Link To This Post Posted: Sep 21 2013 at 5:41pm
The lining of my left lung has multiple, tiny mets.  Only the left lung, and only on the lining.  The right one is clear.  In your opinion, would surgery be better than chemo?  I don't know if I have a choice, but I am going along with chemo because my thinking is:  If the cancer were not in the bloodstream to begin with, why would it travel to my lung?  What do you think?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lotusblossom Quote  Post ReplyReply Direct Link To This Post Posted: Sep 21 2013 at 9:10pm
Adnerb,
 
I also have multiple tiny mets to the lungs.  I have been told that they are inoperable compared to one big lesion.  My oncologist has managed to control them with chemo for over 4 years.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Adnerb Quote  Post ReplyReply Direct Link To This Post Posted: Sep 21 2013 at 9:16pm
Hi Lotusblossom,

I've seen you at breastcancer.org!  I am hoping to be like you and I am rooting for you all the way!  I did not know you had TNBC.  Did you every have pleural effusion?

I did gemzar/carboplatin yesterday.  What chemo cocktails have you had?

Brenda
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lotusblossom Quote  Post ReplyReply Direct Link To This Post Posted: Sep 22 2013 at 7:31am
Hi Brenda,
 
I have never had pleural effusion, but have had multiple mets and 'ground glass opacity' in the lungs. I have been on Gemzar/Xeloda, Caelyx, Taxol and now Navelbine.
 
Good luck to you!!!
 
Lotusblossom
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Lulu View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lulu Quote  Post ReplyReply Direct Link To This Post Posted: Sep 22 2013 at 2:14pm
I have a single lesion in my right lung plus right hilar lymoh node and paratracheal lymph nodes, but iv been told they cannot operate because its mets and would only surgically remove if it was a primary if nodes werent involved... Im in the UK and know thaings are a bit different, but just wondering if anybody else has experience of this?
04/06-13mm,ER+, gd1, stg1,R WLE, rads
05/09-19mm,TNBC,gd3,stg1,LVI,L WLE,E-CMF,rads
01/10-BRCA2+ c.2409T>G
09/10-TAH&BSO
08/11-IPL nodes -L WLE- tax/carbo, Rads
08/13-R lung & LN mets. ENCHANT trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Adnerb Quote  Post ReplyReply Direct Link To This Post Posted: Sep 22 2013 at 6:47pm
Lotusblossom,

Are your mets stable or reduced?

Brenda
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Lulu View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lulu Quote  Post ReplyReply Direct Link To This Post Posted: Sep 23 2013 at 4:10am
Hi ladies

I had epi-cmf for my primary and then carbo&tax for my recurrence

I havent started treatment yet for the lung mets.... Im asymptomatic and picked up by accident on breast MRI, then comfirmed on CT and then had a bronchoscopy to confirm they were TN.... Which they are..... And hopefully going on the ENCHANT trial for ganetespib in the next couple of weeks.

I take it they will only operate if stable.... And how long do you have to be stable for before they would consider surgery?

The single tumour i have is only 23mm and the largest node is 16mm so in terms of lung i dont think they are that big... But this is all new to me.

Edited by Lulu - Sep 23 2013 at 4:16am
04/06-13mm,ER+, gd1, stg1,R WLE, rads
05/09-19mm,TNBC,gd3,stg1,LVI,L WLE,E-CMF,rads
01/10-BRCA2+ c.2409T>G
09/10-TAH&BSO
08/11-IPL nodes -L WLE- tax/carbo, Rads
08/13-R lung & LN mets. ENCHANT trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MammaVic Quote  Post ReplyReply Direct Link To This Post Posted: Nov 13 2013 at 9:51pm
LotusBlossum: what was your original diagnosis and which drugs did they try in what order.  They had me on Xeloda and it didn't work, so now he wants to put me on Gemzar.  Any input on what has worked for others??   Thanks for your help, I'm at my wits end with this Doc.   Vicki
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Adnerb Quote  Post ReplyReply Direct Link To This Post Posted: Nov 14 2013 at 12:38am
Vicki,

I got very lucky with the carbo/gemzar combo.  Lung mets disappeared after only 5 weekly treatments!

Good luck.

Brenda
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sherrmorr Quote  Post ReplyReply Direct Link To This Post Posted: Nov 20 2013 at 3:38pm
I am hearing wonderful things reading this board.
Mom was dx 2010 (Feb) has mastectomy, 4 rounds cytoxen and taxetere. Clean until last month. Mets right rib.
The doctor said she will be on chemo for the rest of her life, however long that is. Said this is pallative treatment only. He cannot cure her. Said all recurrances are considered stage IV. Do we need another oncologist?
You guys have had recurrances. Your docs are working to get you to remission. Is it because Mom is 78?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lulu Quote  Post ReplyReply Direct Link To This Post Posted: Nov 20 2013 at 7:51pm
Hi sherrmorr

A recurrecnce in the breast or the lymph nodes is not considered stage 4 and is still curable, but a recurrence in a distant organ or bone is considered stage 4 and is not curable but can be controlled with chemo and radiation... But this is for the rest of her life.... Depending on how fit she is some treatments maybe too hard for her to tolerate but if she is an otherwise fit and health 78 year old she may live for years on maintenance treatment.... Im 45 and apart from my lung mets im perfectly healthy but i will be on chemo for the rest of my life.... But iv been told im unlikely to see 50.

Everybody with mets is treated with a palliative intent rather than with a primary which is treated with curative intent..... You cannot cure mets you can just hope for remission or stable disease.

Generally palliative is taken to mean the end stage but in medical terms it just means they cannot cure you.

Hugs to you and mum... Im sure having such a caring daughter will help your mum with all the treatment she has to face.

Im on a research trial called ENCHANT not sure if its on where you are... But if mum only has mets in bones then iypts unlikely she will fit criteria as usually need to have lungs or liver as well to fit criteria. X
04/06-13mm,ER+, gd1, stg1,R WLE, rads
05/09-19mm,TNBC,gd3,stg1,LVI,L WLE,E-CMF,rads
01/10-BRCA2+ c.2409T>G
09/10-TAH&BSO
08/11-IPL nodes -L WLE- tax/carbo, Rads
08/13-R lung & LN mets. ENCHANT trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sherrmorr Quote  Post ReplyReply Direct Link To This Post Posted: Nov 20 2013 at 11:29pm
thank you so much for your kind reply. The term "palliative" sent me over the edge. Mom is as tough as they come. If i got herS news, I would be curled up in the corner wailing.She feels good. Not happy with forever chemo, but hey if it works, . OK.
Mom is in Charleston, WV. I am wondering if taking her to a major facility  would be more helpful?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Nov 20 2013 at 11:37pm
Sheermorr,

If it's possible, would your mom get a second opinion from a major cancer center, NCCN facility? A second opinion is always a good idea to get treatment ideas.  Here's a link to the NCCN locations:



Edited by 123Donna - Nov 21 2013 at 7:54am
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote sherrmorr Quote  Post ReplyReply Direct Link To This Post Posted: Nov 21 2013 at 3:55pm
Thank you Donna. I will see if I can get her to do that. Great idea.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: Nov 21 2013 at 4:40pm
Sherrmorr,
It's never great to be stage IV, but one spot on the bone is about as good as it gets in this category.  People can live with bone mets for a long, long time (some survivors have them chronically for 20 or more years).  Also, with a single met, she might be in that rare group of oligometastatic patients that is actually curable.  It is rare but it does happen.     She may very well live a long time and die of something else.   It is hard to get used to the idea of having a likely incurable disease, but once you both get over the shock I think you'll find that life is good even in long-term treatment.

Another thing to keep in mind is that she is in the drivers' seat.   It would be reasonable to just take bone drugs after initial chemo and surgery to remove the breast tumor (if that hasn't already happened).   It could be that her cancer has a slow tempo, so she might have a year or more before there's enough progression that she wants to try another treatment.     I would probably give that a try rather than just taking non-stop chemo the way people do, as it's possible that her beast is sluggish and life is definitely easier and more fun without chemo.

Anyways, time for second and third opinions, including from alternative or complementary medicine types who won't want to hook her up to a drip without looking up from their desks.


DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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