Why There Is Still a Tumor in My Lung

There seems to be a popular misconception that, having been treated for lung cancer, the tumor in my lung should have been removed. Indeed, when I was initially diagnosed, I was more than a little curious about why the tumor would be left in place. I inquired about surgery -- it was almost pleading, if I'm being totally honest -- because I had heard time and again that surgery was the only real cure for lung cancer. And this is true, in a sense, but only if the cancer is in a very early stage. Mine had metastasized, with possible tumors in my liver, kidneys, lymph nodes, and bones. So it was important to examine what would be gained through surgery, as well as what benefits there might be to leaving the primary tumor intact.

Surgery risks and realities

My oncologist, it should be noted, did not even want to get a biopsy from my lung tumor. Even a fine needle biopsy is considered an invasive surgery and comes with its own risks. Removing a lung -- even a portion of a lung -- is a rather risky procedure. Certainly, if a patient is fortunate to be diagnosed early enough that the cancer is unlikely to have spread beyond a finite area within the lung, surgery becomes very alluring. The risk/reward scale tilts heavily toward reward when considering the probability that the cancer will never return. But such early diagnosis is quite rare with lung cancer.

Weighing the options for radiation

Technology is changing and eradicating a tumor from the lung with radiation may be viable for more patients, reducing the concerns associated with surgery. But even so, radiation comes with its own set of concerns. And in the case of metastatic lung cancer, where the disease is treated mainly with chemicals, it proves exceptionally useful to have a visual reference by which the success of treatment can be measured. There are also other considerations that might make either surgery or radiation less viable options, including the location of the tumor or proximity to the heart. Determining the best treatment is a complex process with many factors that patients may not fully understand, much less anticipate.

Using my tumor as a measuring device

Minimizing exposure to toxins and radiation is also an important part of oncological treatment. Patients must endure flooding their bodies with chemicals and subjecting their bodies to regular scans. By keeping the primary tumor in place, the patient has a built-in measuring device by which to gauge whether those chemicals are doing their job. This may translate to fewer tests and a more accurate assessment of how the patient is responding to treatment.

Chemotherapy, immunotherapy, and targeted therapies all work with varying degrees of success depending on factors unique to each individual patient. There is a chance that one of these treatments, whether administered as an infusion or taken as pills, will dramatically reduce the visible presence of cancer throughout the body. In many cases, outside of the primary lung tumor, there may be no evidence of disease after a few months of treatment. But if the primary tumor remains intact, it serves as a much more reliable means of measurement. Without that tumor to measure, it would be too easy to assume that the cancer was gone from the body when it is difficult to detect in any other way.

PET scans are effective at picking up clusters of heightened cellular activity, but there are limits to what they actually show. Blood tests can reveal clues with regard to cancer activity as well. But these ways of monitoring are not perfect, and the lack of a clear visual reference increases the guesswork involved. So in some cases, the best option is to minimize overall risk while also affording the clearest means of measurement by leaving the primary tumor intact.

The story of my scans

As a side note, over the course of my treatment, I got to know my tumor fairly well. I kept copies of every CT scan that I had, sometimes viewing several versions to compare the shape and size over time. For a long time, it remained the same, familiar shape. At one point, I noticed that it began to change, if only a little. That helped me prepare for the inevitable shift in treatments that would come. Though we all deal with issues like scanxiety differently, I have preferred a proactive approach. And even when I have no idea how to read the new images I am seeing, it is comforting to know that each scan tells a great deal about how my treatment is working and whether it remains the best option for my greater health.

Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.