Adrenal malignant neoplasm assumed to be metastasized from lung cancer

PET Scan shows cancer.
Will have biopsy in 2 days.
Oncologist says to continue with 3 remaining chemo, then adrenalectomy.
Sigh.

@abob, sorry that you are both having to go through this again. Cancer takes us through so many ups and downs. Stay hopeful that he's in good hands, and you'll both get through this. I hope you are able to see the future, without all the surgeries, treatments, and talk of cancer. I'm hoping that this is a bump in the road of your life together.

Hi @abob, I had a nodule show up on my adrenal gland when I was first diagnosed with lung cancer, but I had already started a targeted therapy specific to my cancer type. That nodule was never confirmed as cancer, but it did go away slowly. So, I believe it was related to my cancer. I was fortunate enough to have a cancer that is targetable with an oral medication. Because of that, I never had to have surgery or even a biopsy on the adrenal gland nodule.

Thanks for sharing. Best wishes

CT SCAN: “ New mass left adrenal gland 1.8 x2.2 cm”.
PET : “ New left adrenal nodularity with increased metabolic activity concerning for adrenal metastasis. ”
MRI: “ New left adrenal nodule with restricted diffusion suggesting metastatic deposit.”
BIOPSY: “ ADRENOCORTICAL PARENCHYMA WITH MIXED CHRONIC INFLAMMATION AND FOCAL SCLEROSIS.NEGATIVE FOR MALIGNANCY OR METASTASIS.”

Surgeon: “altho radiologist said he got a good sample, it is possible cancerous mass evaded needle. Finish lung cancer chemo, if mass remains Adrenalectomy.

However, if this mass NOT lung cancer but instead adrenal cancer, then this cancer can spread while we await 6-8 weeks for last 2 chemos and more weeks for testing and surgery.

We’re in quandry bc of the biopsy which provuded no info. Sigh!

Hi. You said: Adrenal nodules can be common, and not always cancerous.

In fact the probability of this being a benign growth is much better than that. And you have some comparative indicators based on growth rate. If it is an adrenal malignancy it tends to be very aggressive in terms of growth rate. Benign nodules tend to grow much more slowly. If you could get an interim image to provide an ability to triangulate growth rate.. maybe it’s better than feeling helpless while you complete the treatment on deck.

I’m very much a Data person. I sometimes land on people in ways that I don’t intend. So I hope I haven’t overstepped.

…
The vast majority of all adrenal tumors in people without any known cancer are adenomas, which are benign. They grow more slowly than malignant tumors. Research suggests the growth rate is between 0.3 and 2.8 mm a year, whereas malignant adrenal tumors may grow between 5.8 and 395.4 mm a year.

May 18, 2023
https://www.medicalnewstoday.com › ...
How fast do adrenal tumors grow? - Medical News

Thanks so much for your interesting, thoughtful, detailed reply.

We don’t think it’s a benign growth bc: Pet Scan lit up adrenal gland, lung cancer often spreads to adrenal gland, and Gardient Reveal blood test does show some (small % of) cancer in the DNA.

We told oncologist our concerns. So yes, next comparative to the 2/14 CT SCAN is scheduled for 4/12, which is 2 weeks after 3rd chemo. Thinking is:

- If mass decreased, then most likely it is lung cancer as suspected, and it’s positively reacting to the chemo and we’re on the right path.

- If mass increased, then it’s probably adrenal cancer and perhaps surgery should not wait due to possible metastasis since this chemo is for lung cancer.

- If mass size has not changed, then what ????? Finish the 4th chemo, and then do Adrenalectomy to be over/done with cancer, except for monitoring?????

Ah. Well I didn’t add much - missed the Critical piece of intel that it lit up in PET. But the logic you describe is brilliant - so I will send good Juju your way!!

@abob, I agree with Pam, this plan sounds reasonable and addresses your concern about waiting longer. The questions around your third statement, if the mass hasn't changed, may be clearer at that point in time. We tend to focus on the what-if, to prepare for what's coming next. I don't like surprises and like to be prepared too. I've had to learn to let go of some of that control, and to focus on what I know today. I don't mean to diminish your concerns at all, I just know how hard it is to get through this time, and how easy it is to get sucked into the worst-case scenario. Are you able to do things that give your mind a break from all of this?

Thanks for your reply. We too agree that this is the best course of action bc “most likely” lung cancer metastasis..

But surgeon and pulmonologist told us after clean around cut Lobectomy, he’s cancer free, no need for chemo or radiation.

However, we decided oncologist explanation re chemo for possible wayward cancer cells would seal the case.

We were surprised with CT, MRI, PET identifying new adrenal mass. And hoping that biopsy would confirm our course of action.

Now the concern is that cancer may not be over even after Adrenalectomy bc we don’t know if it is adrenal cancer which might be spreading now as we wait.

Sigh. Thanks for listening.