y******n
发帖数: 8667 | 1 “阴影在右肺上叶前段与后段交界部,大小1.9厘米1.5厘米.先检查说"建议进一步检查
除外周围型肺癌".再检查说:"右肺上叶占位伴葡萄糖代谢增高,多考虑为肺癌:右肺上叶
阻塞性炎症.右肺上叶点状结节,建议随访观察”
做过很多检查，包括全身检查和pet-CT，都不能确诊。还没有做活检。
这里有肿瘤科的医生没? 能否给个意见？是否要动手术？这个部位切除阴影，会切多大
？对身体有多大伤害？假设用微创手术或镜腔手术？
这个阴影是否已经不小了？
谢谢了。 |
j****d
发帖数: 123 | 2 99% 确定是肺癌，90%肺腺癌
找顶级水平的胸外科去，苦早期有治愈可能的
别在这里浪费时间 |
j****d
发帖数: 123 | 3 有个盲人在封杀我的言语，你若是有疑问可以私信给我
我是有十年肺癌经历多年医学院做研究的病人
与我密切联系的病友都得有五六十之众 |
d*w
发帖数: 384 | 4 the radiologist should give you a very clear diagnosis.
do both a plain and a contrast CT, read the Hounsfield values of the mass on
both, if they correspond to soft tissue values for the two conditions
respectively, then it's almost certain it's a lung carcinoma. In East Asians
, for this location, statistically there is a >70% chance it's an
adenocarcinoma and the majority of adenocarcinoma would have the
pathological type of micropapillary growth patterns.
i don't think you can spare open chest surgery for this size of a tumor. if
have access to such facilities, the first step for surgery should be a
mediastinoscopy to survey lymph nodes and remove enlarged ones.
【在 y******n 的大作中提到】
: “阴影在右肺上叶前段与后段交界部,大小1.9厘米1.5厘米.先检查说"建议进一步检查
: 除外周围型肺癌".再检查说:"右肺上叶占位伴葡萄糖代谢增高,多考虑为肺癌:右肺上叶
: 阻塞性炎症.右肺上叶点状结节,建议随访观察”
: 做过很多检查，包括全身检查和pet-CT，都不能确诊。还没有做活检。
: 这里有肿瘤科的医生没? 能否给个意见？是否要动手术？这个部位切除阴影，会切多大
: ？对身体有多大伤害？假设用微创手术或镜腔手术？
: 这个阴影是否已经不小了？
: 谢谢了。
|
d*w
发帖数: 384 | 5 i want to emphasize if the nodule is solid on CT and consistent with what i
said in the earlier post, the CT diagnosis is sufficient indication for
surgery, there is NO need to do a biopsy either percutaneously or
bronchoscopically. Frozen sections can be done during surgery.
【在 y******n 的大作中提到】
: “阴影在右肺上叶前段与后段交界部,大小1.9厘米1.5厘米.先检查说"建议进一步检查
: 除外周围型肺癌".再检查说:"右肺上叶占位伴葡萄糖代谢增高,多考虑为肺癌:右肺上叶
: 阻塞性炎症.右肺上叶点状结节,建议随访观察”
: 做过很多检查，包括全身检查和pet-CT，都不能确诊。还没有做活检。
: 这里有肿瘤科的医生没? 能否给个意见？是否要动手术？这个部位切除阴影，会切多大
: ？对身体有多大伤害？假设用微创手术或镜腔手术？
: 这个阴影是否已经不小了？
: 谢谢了。
|
y******n
发帖数: 8667 | 6
i
谢谢。从您的建议来看，如果确实有小节结，就应该首选手术切除了？
【在 d*w 的大作中提到】
: i want to emphasize if the nodule is solid on CT and consistent with what i
: said in the earlier post, the CT diagnosis is sufficient indication for
: surgery, there is NO need to do a biopsy either percutaneously or
: bronchoscopically. Frozen sections can be done during surgery.
|
d*e
发帖数: 999 | 7 从你的回答来看，您应该是专业人士。所以有两个问题向您请教。
1）PET/CT正常，您为什么还这么确定是肺癌？
2）即便是肺癌，1.9X1.5是个很小的瘤子，属于一期。您为什么以为需要开胸手术。据
我所知，国内大医院，整个肺叶切除都可以在胸腔镜下完成。
i
【在 d*w 的大作中提到】
: i want to emphasize if the nodule is solid on CT and consistent with what i
: said in the earlier post, the CT diagnosis is sufficient indication for
: surgery, there is NO need to do a biopsy either percutaneously or
: bronchoscopically. Frozen sections can be done during surgery.
|
y******n
发帖数: 8667 | 8
您的建议是什么？医生在做了很多CT，全身检查，最后的pet-ct后，也只是说可能是。
现在为是否动手术伤脑筋。如果伤身不大，做了也安心。要是一做手术就要肺叶切除，
就太恐怖了，因为也没一定说不是炎症。要是能只切一小部分，我就肯定要求做了。
【在 d*e 的大作中提到】
: 从你的回答来看，您应该是专业人士。所以有两个问题向您请教。
: 1）PET/CT正常，您为什么还这么确定是肺癌？
: 2）即便是肺癌，1.9X1.5是个很小的瘤子，属于一期。您为什么以为需要开胸手术。据
: 我所知，国内大医院，整个肺叶切除都可以在胸腔镜下完成。
:
: i
|
d*e
发帖数: 999 | 9 我不是医生。和你一样，我是病人家属。因为家里有人得了这个病，所以有些了解，也
在网上查过一些资料，觉着这位专业人士的很多说法和我了解的不太一样，所以想问问。
还要劝你一句，这么大的事儿，真不能在网上寻求意见，还是要和主治医生仔细讨论。
从我个人的经历来看，国内大医院的医生，医术和视野都不差。
【在 y******n 的大作中提到】
:
: 您的建议是什么？医生在做了很多CT，全身检查，最后的pet-ct后，也只是说可能是。
: 现在为是否动手术伤脑筋。如果伤身不大，做了也安心。要是一做手术就要肺叶切除，
: 就太恐怖了，因为也没一定说不是炎症。要是能只切一小部分，我就肯定要求做了。
|
y******n
发帖数: 8667 | 10
问。
比如在医院，他们都说，把这些检查做了，然后就知道结果了。然后做了很多检查，还
住了一段时间院，然后就说，我们不能确诊。我们不能说是，也不能说不是，你到另一
个医院去检查吧。然后换了个大点的医院，一去就强烈要求做pet-ct，说能查出来，然
后又说不能确诊。
当然都会强烈建议你开刀的，但你是否又会怀疑他们开刀是为了挣更多钱。好医生难遇
见啊。
【在 d*e 的大作中提到】
: 我不是医生。和你一样，我是病人家属。因为家里有人得了这个病，所以有些了解，也
: 在网上查过一些资料，觉着这位专业人士的很多说法和我了解的不太一样，所以想问问。
: 还要劝你一句，这么大的事儿，真不能在网上寻求意见，还是要和主治医生仔细讨论。
: 从我个人的经历来看，国内大医院的医生，医术和视野都不差。
|
|
|
d*e
发帖数: 999 | 11 其实这还是说你母亲的情况有些特殊。当时我家人的CT一出来，大夫就告诉我们百分之
八九十是这个病。她当时那个瘤子也不太大。开不开刀可能还得你们自己拿主意。个人
感觉，切一个肺叶，即使是微创手术，对身体的伤害还是挺大了。如果你母亲年纪轻，
身体好，能承受的住，做了就安心了。
还是去北京上海的三甲医院去看看吧。 |
d*e
发帖数: 999 | 12 另外，有一个网站叫奇迹网，都是肺癌的病人和家属。可以到那儿看看。 |
y******n
发帖数: 8667 | 13
快70了。虽然精神很好。但怕恢复不了啊。
【在 d*e 的大作中提到】
: 其实这还是说你母亲的情况有些特殊。当时我家人的CT一出来，大夫就告诉我们百分之
: 八九十是这个病。她当时那个瘤子也不太大。开不开刀可能还得你们自己拿主意。个人
: 感觉，切一个肺叶，即使是微创手术，对身体的伤害还是挺大了。如果你母亲年纪轻，
: 身体好，能承受的住，做了就安心了。
: 还是去北京上海的三甲医院去看看吧。
|
d*w
发帖数: 384 | 14 the first step is to establish a CT diagnosis. if CT is consistent with lung
carcinoma, then have surgery.
【在 y******n 的大作中提到】
:
: 快70了。虽然精神很好。但怕恢复不了啊。
|
d*w
发帖数: 384 | 15 1. PET has little use in the initial diagnosis of lung cancer. and her 18-
FDG was not normal either.
2. that sentence of mine was kind of sloppy. i didn't intended to say VATS
was not suitable for her, but rather should have said "surgery is necessary
as long as the patient can tolerate it." whether it should be an open chest
surgery or VATS depends on many factors in addition to the size of the tumor
, in this case the most important factors probably would be how close the
tumor is to the two segmental arteries, and whether the centrally located
lymph nodes are completely negative.
【在 d*e 的大作中提到】
: 从你的回答来看，您应该是专业人士。所以有两个问题向您请教。
: 1）PET/CT正常，您为什么还这么确定是肺癌？
: 2）即便是肺癌，1.9X1.5是个很小的瘤子，属于一期。您为什么以为需要开胸手术。据
: 我所知，国内大医院，整个肺叶切除都可以在胸腔镜下完成。
:
: i
|
d*w
发帖数: 384 | 16 1. establish a CT diagnosis.
2. if CT diagnosis is lung carcinoma, and her general health is ok, surgery
should be pursued. if the tumor is sufficiently far from the two segmental
arteries, and all centrally located nodes are completely negative, VATS
probably would be suitable.
【在 y******n 的大作中提到】
:
: 快70了。虽然精神很好。但怕恢复不了啊。
|
d*w
发帖数: 384 | 17 as i said, CT is the most useful diagnosis tool in this situation, PET has
almost zero use in the initial diagnosis.
【在 y******n 的大作中提到】
:
: 快70了。虽然精神很好。但怕恢复不了啊。
|
d*e
发帖数: 999 | 18 再请教一下。难道PET结果正常不能排除癌症的可能吗？据说PET连几毫米的瘤子都能发
现。
【在 d*w 的大作中提到】
: as i said, CT is the most useful diagnosis tool in this situation, PET has
: almost zero use in the initial diagnosis.
|
h*********i
发帖数: 41 | 19 借帖子问一下楼上几位病人家属，病人是什么症状下去医院检查的。我自己已经干咳很
长时间了，胸口也隐约不舒服，不知道是不是需要预约个检查。 |
y******n
发帖数: 8667 | 20
是常规年检。没症状。
【在 h*********i 的大作中提到】
: 借帖子问一下楼上几位病人家属，病人是什么症状下去医院检查的。我自己已经干咳很
: 长时间了，胸口也隐约不舒服，不知道是不是需要预约个检查。
|
|
|
y******n
发帖数: 8667 | 21
所以说大医院也骗人啊。Pet检查一次很贵的，还不能保险付，但医生都强烈建议做PET
。
【在 d*w 的大作中提到】
: as i said, CT is the most useful diagnosis tool in this situation, PET has
: almost zero use in the initial diagnosis.
|
d*e
发帖数: 999 | 22 医生说你母亲的PET结果正常吗？又看了一下，你提到“葡萄糖代谢异常”。这是PET报
告里说的吗？ |
y******n
发帖数: 8667 | 23
有可能是。具体的我不清楚。这个代表了是肿瘤吗？
【在 d*e 的大作中提到】
: 医生说你母亲的PET结果正常吗？又看了一下，你提到“葡萄糖代谢异常”。这是PET报
: 告里说的吗？
|
d*w
发帖数: 384 | 24 why do you think PET is that useful? why do you think PET is so useful at
this stage of a patient's workup?
【在 d*e 的大作中提到】
: 再请教一下。难道PET结果正常不能排除癌症的可能吗？据说PET连几毫米的瘤子都能发
: 现。
|
D*******y
发帖数: 189 | 25 My mother is 75, had 3 nodules found in her right lung during routine
checkup in April, CT was done, infection was suspected at small cities in
central China, no effects after 8 weeks of different antibiotics, went to
Beijing in July, told the nodules are almost certain to be cancer, VATS for
right mid lobe removal and upper lobewedge resections, confirmed
adenocarcinoma during surgery, recovered and went home in one week. Told no
need for chemotherapy. This is something I am not sure. |
D*******y
发帖数: 189 | 26 Agree that PET scan is useless for initial diagnosis |
D*******y
发帖数: 189 | 27 My mother had multiple primary adenocarcinoma, 3 nodules in all.
Could dww and Jaydad provide your opinions on chemotherapy? Yes or no and
why? |
d*w
发帖数: 384 | 28 this is not an easy question. it depends on the sizes of the nodules,
locations and pathology. from your description, i assume all the nodules are
pretty small and located close to each other, and all lymph nodes are
negative. i suggest the following:
borrow the tissue blocks from the hospital where she had surgery, and ask a
pathologist working on lung cancers in a major medical center in the US to
read the pathology.
1. if the nodules are of different pathology and all are relatively low
grade, then some cancer centers may recommend chemotherapy, and some may
recommend observation.
2. if the nodules are of the same pathology, then the majority of cancer
centers would recommend chemotherapy.
3. if there is aggressive pathology features such as micropapillary growth
patterns, there is consensus to recommend chemotherapy.
after pathology review is done, ask a medical oncologist for opinion. make
sure you have all the necessary information ready. as long as you don't ask
for a formal written report, many people are willing to review your case for
free.
【在 D*******y 的大作中提到】
: My mother had multiple primary adenocarcinoma, 3 nodules in all.
: Could dww and Jaydad provide your opinions on chemotherapy? Yes or no and
: why?
|
D*******y
发帖数: 189 | 29 Thanks for your detailed reply.
The 3 nodules are all smaller than 2cm in diameter. They have different
pathology, the 2 in the superior lobe have the lepedic growth pattern, the
one in the middle lobe is the solid type, all with moderate differentiation.
Oncologists in China are all against chemotherapy, oncologists here have
different recommendations as you mentioned. We are not sure what to do.
One oncologist recommended targeted therapy as she does had the egfr exon 19
deletion, but the other said no and cited literature showing no effect. So,
she is now doing nothing.
are
a
【在 d*w 的大作中提到】
: this is not an easy question. it depends on the sizes of the nodules,
: locations and pathology. from your description, i assume all the nodules are
: pretty small and located close to each other, and all lymph nodes are
: negative. i suggest the following:
: borrow the tissue blocks from the hospital where she had surgery, and ask a
: pathologist working on lung cancers in a major medical center in the US to
: read the pathology.
: 1. if the nodules are of different pathology and all are relatively low
: grade, then some cancer centers may recommend chemotherapy, and some may
: recommend observation.
|
d*w
发帖数: 384 | 30 where was the pathology read? i don't trust pathology reports from China,
even the biggest hospitals, much. someone wanted me to have a look of his
case, and the path report said predominantly solid, but the only picture on
the report was predominantly micropapillary to me. i asked the blocks to be
sent to a pathologist i work with, and it was confirmed as predominantly
micropapillary. it was from one of the biggest hospitals.
your mom's case is a little difficult to give a consensus recommendation.
EGFR targeted therapy is not suitable at this time. this therapy is
cytostatic. should there be micrometastasis, it may exert selection effects
on the cells, making resistant cells predominant.
the reasoning behind recommending against chemotherapy is to think that that
part of the lung was exposed to some cancer-inducing factors (such as
certain injury, chemicals, etc.) in the past, and other parts of the lung
weren't affected.
the reasoning behind recommending chemo is to think that other parts of the
lung were affected too, and/or micrometastasis is inevitable.
there is some evidence to support the first scenario, and also some evidence
to support the second. there is no clinical tests to show which scenario
applies to which patient.
the decision whether to recommend chemotherapy would be based on the
following factors:
1. does she have access to low dose CT? if yes, then it makes observation
more comfortable.
2. her age, we already know. how good are her general health and pulmonary
functions?
3. how good and accessible is her oncologist?
4. would she have access to stereotaxic ablative radiation therapy should
there be a local recurrence?
if she has really good general health and pulmonary functions, i am inclined
to recommend chemotherapy with a regimen that is easily tolerated. reducing
cancer recurrence is important, tolerance of treatments is important too.
differentiation.
19
So,
【在 D*******y 的大作中提到】
: Thanks for your detailed reply.
: The 3 nodules are all smaller than 2cm in diameter. They have different
: pathology, the 2 in the superior lobe have the lepedic growth pattern, the
: one in the middle lobe is the solid type, all with moderate differentiation.
: Oncologists in China are all against chemotherapy, oncologists here have
: different recommendations as you mentioned. We are not sure what to do.
: One oncologist recommended targeted therapy as she does had the egfr exon 19
: deletion, but the other said no and cited literature showing no effect. So,
: she is now doing nothing.
:
|
|
|
m**********r
发帖数: 2099 | 31 一看到葡萄糖就知道一定是PET检查。病人肺里面有个东西，很活跃的用葡萄糖在那里
茁壮成长，热火朝天的在那里捣鼓什么东东，捣鼓什么我们从PET上看不出来: 这么活
跃成长的东西，第一是脑子，第二是肿瘤，第三是骨折，第四是感染。如果CT上可疑，
还是得做。
关于是不是手术: 这个看你想让病人活多久。简单的说是人体内有个炸弹，一定会炸，
要么切开皮肉剜出腐肉，要么就这么等死。现在的问题是你想让病人活多久？
肺癌切除术也不是个天大的难度很大的手术。中国的成人综合医院分四种。第一种是只
能做胆囊，胃大部切，弄个肝脏要N多人开会一上午的。第二种是可以做肺叶切除，食
管癌这种。病人可以术后恢复得出院而不是众多并发症在ICU躺一个多月。第三种是可
以做Whipple动胰腺，哪怕全院只有一个大夫可以做。第四种就是可以做肝移植，心肺
移植，这两种手术死亡率也不高的。
每个人的人生观不同。有人喜欢掩耳盗铃，当然这不是贬义。有没有可能误诊？绝对有
。有没可能医院大夫合起来想赚你的钱？铁定的，人家也有老婆孩子，谁过年不吃顿饺
子呢？是不是癌？掩耳。因为医生医院都是恶魔，因为检查有假阳性所以我不可能是癌
。这么想没什么不对的，就是心态而已。侯跃文就是这么死于心脏病: 因为否认自己有
致命的病，不敢承认自己有病。
同样的，不是你不想肺叶切就可以不肺叶切的。肺就是一串大气球，现在有一个气球有
个2cm大的毛病必须切。你要求: 只切有毛病的那块，气球一个都不能少。那漏气怎么
办？你自己拿刀切个气球试试？你自己不要想这个想那个的，有用吗？
【在 y******n 的大作中提到】
:
: 有可能是。具体的我不清楚。这个代表了是肿瘤吗？
|
D*******y
发帖数: 189 | 32 Thanks again for your helpful reply.
1. does she have access to low dose CTI will say no. if yes, then it makes
observation
more comfortable.
I am going to say yes though I don't know what dose is regarded as low dose
for CT. She does have access to a hospital with lousy doctors but with 5
different CT machines, all brand new. The oncologist here the US recommended
ct every 6 to 8 weeks but everybody in China thinks it is excessive and
wanted to do it every 6 months.
2. her age, we already know. how good are her general health and pulmonary&#
160;
functions?
Her General health is not bad for her age. She recovered quickly from the
surgery, but did take a toll. She took a 3 k daily walk before surgery with
no difficulties. Now she had to cut the walk to one k. She has mild CHD.
3. how good and accessible is her oncologist?
She has no good access to a good oncologist. I went back a few times last
year and had to bring her to Beijing for oncology consultation.
4. would she have access to stereotaxic ablative radiation therapy should&#
160;
there be a local recurrence?
I am not familiar with this and do not know if this is available in China. I
am going to say no.
5. if she has really good general health and pulmonary functions, i am
inclined
to recommend chemotherapy with a regimen that is easily tolerated. reducing
cancer recurrence is important, tolerance of treatments is important too.
Is it possible for you to make a recommendation for a sensible regime? I
also work in a major hospital though I am not a physician, and know how it
works. You may send me a private message if OK.
Thanks
on
be
effects
【在 d*w 的大作中提到】
: where was the pathology read? i don't trust pathology reports from China,
: even the biggest hospitals, much. someone wanted me to have a look of his
: case, and the path report said predominantly solid, but the only picture on
: the report was predominantly micropapillary to me. i asked the blocks to be
: sent to a pathologist i work with, and it was confirmed as predominantly
: micropapillary. it was from one of the biggest hospitals.
: your mom's case is a little difficult to give a consensus recommendation.
: EGFR targeted therapy is not suitable at this time. this therapy is
: cytostatic. should there be micrometastasis, it may exert selection effects
: on the cells, making resistant cells predominant.
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d*w
发帖数: 384 | 33 1. low dose CT and post-treatment surveillance: the current trend is to
adopt low dose CT for surveillance after definitive treatment, even though
guidelines from some medical groups have not adopted this yet. if she has
access to low dose CT, i think 2 months is a reasonable internal. she has
considerably increased chance of developing new cancers in the lung compared
to normal population. it's not just the machine, but also the training of
radiologists.
2. there aren't many studies on lung cancer treatment in patients over 75.
among the major regimens for definitive treatment, cisplatin + pemetrexed is
the best tolerated, in my view. the patient needs to have good kidney
functions to have cisplatin.
you can easily find the best machines in hospitals in China, but whether
they are used properly is another question.
dose
recommended
&#
【在 D*******y 的大作中提到】
: Thanks again for your helpful reply.
: 1. does she have access to low dose CTI will say no. if yes, then it makes
: observation
: more comfortable.
: I am going to say yes though I don't know what dose is regarded as low dose
: for CT. She does have access to a hospital with lousy doctors but with 5
: different CT machines, all brand new. The oncologist here the US recommended
: ct every 6 to 8 weeks but everybody in China thinks it is excessive and
: wanted to do it every 6 months.
: 2. her age, we already know. how good are her general health and pulmonary&#
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y******n
发帖数: 8667 | 34 感谢大家的回帖。
过去两三个月了。母亲不愿意做手术，只好继续复查。最近复查结果，没变化，或许小
了些。感觉是虚惊一场。
继续2-3个月查下胸透。 |
