Expert: Claes-Gustaf Nordquist, M.D. - 3/27/2010

Question
Hello,

I had triple negative breast cancer (right side) spring 2004. I was treated with lumpectomy and lymph node disection with 1 positive node. I also had chemotherapy with radiation at that time.

Spring 2009 a chest x-ray revealed a 7 cm tumor in my right lung. In September 2009 I had a lobeectomy where the lower right lobe was removed and 2 positive lymph nodes. I also had 2 brain tumors which were treated with gamma knife and a 3rd brain tumor which was removed surgically.

I am 6 months out from my lobectomy and a CT scan has revealed that my right hilar node is 3.2 cm, precarinal lymph node is 1.2 cm, right paratracheal node is 1.4 cm, subpleural right upper lobe pulmonary nodule of 8mm and a left or right (I think right) upper lobe pulmonary nodule of 6mm. My brain, liver bones and mammogram are clear. The report favors bronchogenic carcinoma over breast cancer.

My lung surgeon will not operate since he says my disease is now systemic however my cancer is still confined only to my lung. Is surgical resection not reasonable? What about radiation including IORT or stereotactic?

Thank you

Answer
Yes your disease is systemic with these findings, so regardless of being a breast cancer or a bronchogenic one or even both we are dealing with one or two stage 4 process(es). Surgery would in your case be excessive and of doubtful value. Stereotactic radiation may perhaps be possible. Only a more detailed study can tell us that. It should however - if at all possible - be combined with chemotherapy. The results will in this situation be uncertain though. However let both a medical oncologist and a radiological oncologist check this. Good luck!



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