Meeting Thursday, March 26, 2015, with Dr. Jaffer,
Pulmonologist
In response to "how have you been," Yvonne stated
she is having some difficulty breathing deeply / on deep breaths since the
biopsy. Dr. J said she had had a pneumothorax, a little bit of air in the lung
(or lung lining?) but that was on the left side. He briefly discussed doing
another chest x-ray today to see if that had cleared up, then looked at the
scan again and said it was really small and wouldn't show up on an x-ray. He
didn't really address the pain in her RIGHT side.
Dr said that Yvonne has squamous cell carcinoma, a kind of
non-small-cell lung cancer. It doesn't look as though it's spread to other
areas of the body, and none of the lymph nodes are showing up ("lighting
up," as he said) on the PET scan. He explained that there's a possibility
that they're cancerous anyway, but that it's hard to tell, and if he does
another biopsy it probably wouldn't change the course of treatment.
There was something "lighting up" near Yvonne's
chin on the PET scan. He said this was probably her dental implant or bridge.
He briefly examined her mouth and chin and didn't see anything.
Dr. described the results of Yvonne's pulmonary test
(breathing test)? from earlier today and said she breathed out 1.29 liters in
the first second, which is only 49% of baseline; she has a "significant
airway obstruction." He said she must be very tough, and showed us on the
scan that she already has some emphysema which is causing this decreased lung
function.
Because of this borderline lung function, a
"resection" of the lungs would be difficult and he doesn't recommend
surgery. "This is pretty complicated."
Dr. describes that pathologically, the masses look like the
same thing: they are the same kind of cancer. Whether they are two independent
tumors or whether one started first, then became metastatic and moved to create
the other one is the big question. He said it makes sense that it is
metastatic, but because there's no cancer anywhere else, he's not sure.
Dr. recommends brain MRI to ensure that no cancer has spread
to the brain (it wouldn't show up on PET scan). If there are tumors there, that
means the cancer has metastasized and Yvonne is in Stage 3a (he earlier said
Stage 4 but switched when Nurse Kathy came into the room). If not, there's
still no determination of whether the cancer is metastatic, but he wants to
proceed as if it is not: aggressively and tackling the tumors in a targeted
way. If there are brain tumors, he said, radiation would be "palliative,
not curative." If there are no brain tumors, we would wait until another
CAT scan was done (probably after chemo, in a few months from now) to see
whether the tumors are spreading.
We asked about the side effects of radiation and how long
the course might last. Dr. said he's not the expert but maybe 1x / week for 6
weeks? and that main side effects to worry about (given the placement of the
tumors) are scarring and fibrosis. With chemo, it's nausea, vomiting,
immunosuppression. She would probably be doing a cisplatinum type of chemo. (My
medical dictionary says this is "used to treat cancers, especially solid
tumor such as testicular and ovarian carcinoma" and also lists renal
failure as a possible side effect.)
So: brain MRI, then meeting with radiation oncologist, and
meeting with medical oncologist (chemotherapy doctor). Dr. J will discuss this
course of action (and the question of not biopsy-ing the lymph nodes) with the
"chest conference" team of doctors on Monday morning. Kathy added
later that this team includes a pathologist, a radiologist, etc.
We then met Nurse Kathy Millson, the "nurse
navigator" for lung cancer at the PeaceHealth Cancer Center. Her job is to
coordinate and support lung cancer patients. Dr. J. said "she knows more
about cancer than I do." (He mentioned that he usually has her in the room
when he has one of these appointments and wasn't sure why he hadn't called her;
but she happened to be in the office.)
Kathy reiterated much of what Dr. J had said (she did say it
was adinocarcinoma, not squamous, but said they are similar). She explained
that she had been working behind the scenes and had helped coordinate the
biopsy Yvonne had on Monday, and was central in bringing in Dr. Jensen who
apparently performed the biopsy. She said that biopsies on both sides at the
same time are "really really risky" but that Dr. Jensen is something
of an expert in the field and had "felt confident" that he could do
it.
Kathy will work on getting approval (I assume from Medicare)
for the brain MRI and appointments with the two oncologists. She thought she
could get the MRI scheduled within a week. She gave Yvonne a bunch of
information to read.
At one point I asked, and I think this is the bottom line to
remember now: "So nothing major is going to change in the next couple of
months, it looks like?" and the doctor confirmed that. We just need to
take things one step, one day at a time.
