Adrenalectomy (Laparoscopic Surgery) - Metastases from Lung Carcinoma

[Anthony590]

In January 2008, I was diagnosed with a primary lung carcimoma.  Right lower lobe that measured approximately
1.8 x 1.6 cm.  After CT Chest Scan and PET/CT tests confirmed the diagnosis, I underwent surgery in February 2008
Right Lower Lobe Lobectomy.   It turned out to be an adenocarcimoma.  The PET/CT before surgery showed the adrenal glands to be "mildly prominent due to hypertrophy" .    A CT Chest Scan that was (3) three months postoperative showed postoperative conditions and an incidental note of a left adrenal adenoma.  A CT Chest Scan that was (6) six months postoperative showed a NEW RIGHT ADRENAL MASS SUSPICIOUS FOR METASTATIC
DISEASE that measured approximately 3.2 x 2.0 cm.    I recently took another PET/CT after surgery and the test was showing "consistent with meatastases".   It actually grew in size in between the (6) six month postoperative
CT Chest Scan and this recent PET/CT Scan, approximately 4.5 x 2.2 cm.    I have read on many medical internet sites that removal of a metastatic right adrenal tumor by adrenalectomy is not recommended (with a few exceptions).
In this scenario, what are my best options.   There are differences of opinion.    Surgeons want to operate and I am
wondering what the best course of action is.    WHAT ARE MY OPTIONS?   Any information that you may be able to provide will be greatly appreciated.   Thank you.    Anthony590

[Anthony590]

Lung Cancer Metastasis to Right Adrenal Gland

I just received a (2) two page copy/written report of a PET SCAN taken at NYU

1.  Intense activity in the right adrenal mass is consistent with metastasis.

2. Moderate activity in the right lower lobe pleural based nodularity, likely post
     surgical inflammation although residual viable malignancy cannot be
     excluded.

3. Intense activity in right hilar node is inflammatory verses malignancy.

  I also include notes from the body of this written report.

  CHEST:

  There is intense activity in right hilar node, Image 142, SUV max 3.2, inflammatory
   process verses malignancy.  There is moderate activity in the right lower lobe
   posterior pleural based micro nodularity/thickening in the region of the post
   surgical clips, SUV max 3.3.    They  may be post surgical inflammation,
   although residual malignancy cannot be excluded.  There are surgical clips
   in  the mediastinum within the right hilar/subccarinal region.  

  ABDOMEN/PELVIS:

   There is intense activity in the right adrenal mass, measuring 4 x 2.5 cm, with
    SUV max 9.3.  

    I am considering having surgery (laparoscopic surgery) involving the right adrenal.

    Does this written report show irregularities with the lung surgery (lobectomy)????

    Anthony590

[Anthony590]

Hi  

Thanks for responding.   The higher risk for surgery and the chance for a cure would be the way I would probably go.    The recent Pet Scan showed all other organs to be negative.   Liver, Kidneys, etc.    The uptake on the Pet Scan for the adrenal tumor was 9.3.    This mass is so aggressive that it actually grew in between tests.   It was (on the cat scan) 3.2 x 2.0 cm.    On teh Pet Scan it was 4.3 x 2.5.    The oncologist that I saw at NYU said while it is very aggressive, it is also very unusual.   No uptake was noted in the heart or lymph nodes near the heart.   A right hilar region is described as inflammation.   Uptake 3.3 on the Pet Scan.    If the surgery is a cure, does this mean the 5 year survival outcomes are higher than 10 to 23%.    I was told that after the surgery, I would need chemotherapy.    I see your figures if surgery is not performed.
Stage 4.     If after surgery it is determined that I have Stage 1, does that make a difference as far as 5 year survival rates with chemotherapy?

[HeinrikMD]

Hi,

I understand the frustration of undergoing surgery only to have to make more important decisions shortly after. Your case does not really occur that commonly and hence, there really isn’t much experience to tell which way to decide. At the end of the day, the decision may be based on a value judgment. The surgery would offer a chance for cure, and hence, while there may be a higher risk with this approach – the benefit would be substantial. On the other hand, if the decision is to forego surgery, then the goal becomes extending life and symptom control.

Patients who underwent removal of the adrenal metastasis have reported 5 year outcomes of 10 to 23%. That doesn’t seem like much, but for patients who do not have surgery, this would be stage 4 disease, conferring a 1.6% 5 year survival rate.  Some features that seem to favor better outcomes in these patients is the absence of cancer in the nodes near the heart. If you are such a case, then you may choose to undergo surgery