Lung cancer biopsy

[johnson36]

My thai wifes father had an X-ray last Monday 26th March and got the result on Wednesday. It is believed he has Lung cancer. He now has an appointment for the 27th April to get a Biopsy at a Udon Thani hospital. Me and my wife are living in the UK at the moment so for me to get an answers I have to ask my wife who doesn't always ask the question like I said it. If it was my father I would have rang the hospital where he is going and asked myself, but as this is thai language I can't.

So I am asking here to see if any of you guys know.

I believe this lung biospy will be done by inserting a needle into the chest to obtain a sample of tissue from the lung under local anesthetic.

Questions:

How long will he have to wait for a result ? same day ? a few days ? or weeks ?

If he does have Lung cancer will this test be able to tell whether it is stage 1,2,3 or 4 ?

[Sheryl]

1. The procedure will depend on where in the lung the mass is located. If it is accessible by needle biopsy through the chest wall then they will do it that way. in some cases it is better to do an endoscopy (down the throat, through the bronchi) to extract tissue. In other cases it requires an open incision, for example if the mass is very central.

 

2. Biopsy report will take at least a week, maybe more.

 

3. If it comes back malignant they will likely do some scans (CT or MRI) to check for metastasis beyond the lung, which is what defines stages III/ IV.   That distinction is important as it affects treatment decisions. For stage I and II in both cases surgical removal is indicated (often of the whole lung or lobe of the lung) in which case definitive staging between I and II (which in turn have subpstages) will be known after the surgery.

 

4. The provincial hospital in Udon Thani is a regional level facility and thus offers high level of care. In addition, if it proves to be malignant, there is a specialized government cancer hospital in Udon Thani.

 

5. Calling the hospital would not be useful - you would probably never get through and if you did nto to anyone able to give any info. the only way to get info by phone would be to call the patient at the exact moment the doctors are with him, in which case might be able to chat very briefly with them if he passes the phone, but this sort of thing is really not customary in Thailand plus they would be speaking in front of the patient. So don't blame your wife, her approach reflects the way things are done here.

 

6. Be aware that Thai doctors rarely tell patients their prognosis and will continue to treat aggressively even when the outlook is terminal and the treatment causing suffering, unless the patient or family takes the initiative to request otherwise. There is virtually no concept of hospice type care or approach here. I mention this because unless caught very early, prognosis tends to be poor for lung cancer. Obviously not something to discuss or mention to your wife at this stage, but keep it mind as things progress.

[johnson36]

Thankyou Sheryl

 

My wife told me on Wednesday that he had already been told that he had Lung cancer.

He had an X-ray on Monday and I am not sure about blood tests.

Could they know from a blood test ?

Can they know for sure from X-ray or have they told him too soon. No biopsy till 27th April.

 

Another question Sheryl. Do thai people have to pay for this treatment ?

 

Edited April 1, 2018 by johnson36

[Sheryl]

No, they do nto have to pay for anything unless a special drug is required that is not on the Ministry of Public Health list, which is nto likely with lung cancer.  However when CT scans/MRIs are needed the wait for them at govt hospitals is so long that people often have to get that done privately.

 

Families have to bear all travel costs associated with getting care, which can be considerable if he lives far from where he gets treatment.

 

Blood test does not tell if a lesion is malignant. They can determine from Xray (and also history of risk factors like smoking) that there is a very high probability of cancer but absolute certainty requires biopsy. The more the cancer has spread, the more certain preliminary diagnosis will be so it is not a good sign that they have already been able to tell  him this, I'm afraid.

[johnson36]

Sheryl

 

Yes he is a smoker and 58 years old.

 

I asked my wife what prompted him to go to the doctor / hospital. She said he had been coughing and feeling ill. Probably for a while because I know he would be pretty tough. I doubt he went after just a few days of coughing.

 

It seems like there is going to be a bit of waiting around now. 26 days till biopsy then a week or so for results. Then scans and wait again.

From the small amount of information I have now what is the best and worst that I can expect ? Me and wife are living in UK and I would hate for something to happen now and him die quickly without seeing her again. Are things likely to go downhill fast ? I am worried that the biopsy aggravates a tumor and makes it grow faster, is that right ?

 

 

 

 

 

Edited April 1, 2018 by johnson36

[Sheryl]

No, biopsy will not aggravate it or hasten its spread.

 

But you are almost certainly right that the tumor is not in a very early stage.

 

Depending on its extent and also the type of cancer, he may be advised to have surgery plus chemo or only chemo; surgery plus radiation therapy or radiation therapy alone, or chemo plus radiation etc. 

 

If he is at stage 3 or 4 the prognosis is basically terminal but it will not lead to death quickly nor unexpectedly, especially not in an otherwise fit 58 year old. Unless something unexpected intervenes, there will be ample warning and it will come gradually. 

 

If he is stage III he will likely live 1-3 years but some people (a minority) survive as much as 5 with maximum aggressive treatment. If he is already stage 4 (metastasis to other organs) most people live about 6 months to a 1 year but it does vary considerably according to the location of metastasis and how advanced.

 

Either way I would not worry about not having time to get there to say good bye. The points to worry about are:

 

1 -  speed at which the diagnostic work up progresses. Without knowing what stage he is at I can't say if this will make a difference to his overall prognosis,  it might. There isn't anything you can do to hasten the biopsy through the public health system public channel. Having it done at a private hospital would cost anywhere between 100 - 300,000 baht approximately, depending on the type of procedure which in turn depends on the location of the lesion, which you do not yet  know.  It might or might not be possible to have it done on a private basis at the government hospital in which case cost would be roughly 25 -50,000 baht. This might or might not be any quicker since they would still have to schedule OR time.

 

It would however cost only around 1,000 baht to get a private consultation at a private hospital, and only a few hundred baht to have one through after hours clinic at the same public hospital,  if you can persuade the family to do that. If at a private hospital they would have to get all the medical records and copy of all films from the hospital first - perfectly possible (and a legal right) but entails some red tape and requires some assertiveness.  If at after hours clinic in the same hospital, they'll already have the records. You could perhaps also arrange to call during such a consultation so you could talk directly to the doctor to find out what he thinks. At that point it should be possible for the doctor to tell you  (1) what the biopsy procedure will entail and would it would cost if done privately; (2) suspected stage of the cancer (he won't be able to say if stage IV yet but would be able, from the films, to say if it is at least Stage 3) and (3) whether a 1-2 month delay in starting treatment will significantly affect prognosis. If this consultation is through the after hours clinic of the government hospital you could also ask about the costs of having the biopsy done on a private basis at the same hospital: cost and whether it would be quicker (might nto be since it entails scheduling OR time).

 

With that information, you could make an informed decision as to whether to finance a private biopsy...assuming this is a possibility for you. Actual treatment post-biopsy you would definitely want to do through the government system public channel but getting the initial work up done privately would speed things up. That might or might not make any difference, which is what you'd first want to find out.

 

Keep in mind that it is quite likely he will need CT/MRI to rule out metastasis  and given how long the wait list is for those  it is very probable the family may need help financing these at a private imaging center. Costs for that will be approximately 10-15,000 baht per scan.

 

2, the other point to worry about is decision-making and palliation if he turns out to have a poor prognosis.  Thai doctors will usually just keep treating aggressively no matter what and never discuss options with the family or the patient, depending on how receptive you think he and the family would be, it could be helpful for you to be there in time to intervene by facilitating a frank discussion with the doctor and family conference and then helping them assert their wishes. Bit all this would come later, after biopsy and full staging of the cancer.  

 

There may  be hard decisions to make down the line (not making them being a decision of its own, by default, and usually not the best one for either patient or family).  It helps greatly if the patient's own wishes are known and the best time to have that discussion is while the person is still relatively well, it is hard to do once they are in a weakened state.  IF you think your wife can handle this and IF you think her father and other family members can, visiting sooner rather than later  might be useful. (Sooner meaning timed for around when biopsy results are available)

 

 

[johnson36]

Thank you very much Sheryl for all the information. It is very helpful.

 

At the moment it looks like we are going to wait till after the biopsy on the 27th April before we do anything.

I did mention a flight to my wife but never really got a reply so I will leave it at that.

I always try to do the right thing but my wife will as always do what she is going to do when she wants to do it.  I don't think she has ever understood the word priorities.

No doubt though I will be the one expected to pick up the pieces. She has Schizoaffective disorder and this could cause another relapse.

 

I am on this topic that someone started about bipolar if you want to read my little story. Thanks again Sheryl.

 

Edited April 4, 2018 by johnson36