Cisplatin & Pemetrexate OR Carboplatin & Alimta - Keytruda

Ok, one oncologolist advises cisplatin and pemetrexate every 3 weeks x 4 times. Other one advises Carboplatin and Alimta same---every 3 weeks x 4. Then both say IV Keytruda for a year. Any thoughts? I will add my biopsy results in case any of you know how to read them. I don't and can't get any answers. Both seem to want to drop me and guess it doesn't matter. Got letter from Anthem yesterday that the Keytruda and Alimpta have been denied unless blah blah blah. So exhausted from all this. thanks for any help! you guys are the only ones giving me good answers! adenocarcinoma. Had upper right lobe removed 3 weeks ago and it was in lymphs.So not 'CURED'. any why are they still sayiing can be 'cured' with the above regime??? this is not curable!!! right?? sorry this is so long--I don't know which parts are relevant. Shaking just looking at it. thanks for any advice! afraid this is spreading as i sit here.

CLINICAL INFORMATION: Lung nodule.

OPERATION: Robotic-assisted thoracoscopic right upper lobectomy robotic
assisted thoracoscopic lymphadenectomy intercostal nerve injections. A.
Level 10 lymph node. B. Level 11 lymph nodes x 3. C. Level 9 lymph node. D.
Level 7 lymph nodes x3. E. Level 4 lymph nodes. F. Right upper lobe.

(Clinical Information and Operation obtained from the Requisition submitted
with specimen)

DIAGNOSIS:
A. Level 10 Lymph node:
- One lymph node, positive for metastatic carcinoma (1/1).
- Size of metastatic carcinoma: 1.2 mm in greatest dimension.
- No extranodal extension identified.

B. Level 11 Lymph nodes:
- Three lymph nodes, negative for carcinoma (0/3).

C. Level 9 Lymph node:
- One lymph node, negative for carcinoma (0/1).

D. Level 7 Lymph Node:
- Three lymph nodes, negative for carcinoma (0/3).

E. Level 4 Lymph Nodes:
- Two out of four lymph nodes, positive for metastatic carcinoma (2/4).
- Size of metastatic carcinoma: up to 3.2 mm in greatest dimension.
- No definite extranodal extension identified.

F. Lung, Right Upper Lobe, Lobectomy:
- Adenocarcinoma of lung, acinar type, moderately differentiated.
- Size of invasive carcinoma: 2.4 cm in greatest dimension.
- Pleura is not involved by carcinoma.
- Margins are negative for carcinoma.
- Foci of lymphovascular invasions identified.
- Pathological staging: pT1c N2.
- Please see attached synoptic report.

Report Name: Lung - Resection, Version: 223.0.0.0, Inst#: 1

Specimen
Procedure: Lobectomy
Specimen Laterality: Right
Tumor
Tumor Focality: Single focus
Tumor Site: Upper lobe of lung
Tumor Size
Total Tumor Size: 2.4 Centimeters (cm)
Histologic Type: Invasive acinar adenocarcinoma
Histologic Patterns Present: Acinar
Visceral Pleura Invasion: Not identified
Direct Invasion of Adjacent Structures: Not applicable (no adjacent
structures present)
Treatment Effect: No known presurgical therapy
Lymphovascular Invasion: Present
Margins
Margin Status for Invasive Carcinoma: All margins negative for
invasive carcinoma
Closest Margin(s) to Invasive Carcinoma: Parenchymal
Distance from Invasive Carcinoma to Closest Margin: 1.9 cm
Margin Status for Non-Invasive Tumor: All margins negative for
non-invasive tumor
Regional Lymph Nodes
Lymph Node(s) from Prior Procedures: Not included
Regional Lymph Node Status: Tumor present in regional lymph node(s)
Number of Lymph Nodes with Tumor: 3
Nodal Site(s) with Tumor: 4R: Lower paratracheal; 10R: Hilar
Extranodal Extension: Not identified
Number of Lymph Nodes Examined: 12
Nodal Site(s) Examined: 4R: Lower paratracheal; 9R: Pulmonary
ligament; 10R: Hilar; 11R: Interlobar;
7: Subcarinal
Pathologic Stage Classification (pTNM, AJCC 8th Edition)
pT Category: pT1c
pN Category: pN2

CAP eCC 2022 Q3 Release

GROSS PATHOLOGY: A. Level 10 lymph node - Received in formalin. It
consists of a 1.5 cm fragmented piece of lymphoid tissue with attached soft
tissue, submitted all A1.
B. Level 11 lymph nodes x3 - Received in formalin. It consists of
three 0.5-2.1 cm hemorrhagic lymph nodes differentially inked green, blue
and black. Two whole lymph nodes black and blue submitted B1 with the
largest lymph node inked green, sectioned.
C. Level 9 lymph node - Received in formalin. It consists of a 0.7 cm
piece of lymphoid tissue with minimal soft tissue attached. The specimen
is entirely submitted whole C1.
D. Level 7 lymph nodes x3 - Received in formalin. It consists of
three 1.0-1.3 cm lymphoid fragments differentially inked green and blue.
Two whole lymphoid fragments are submitted in D1-D2, sectioned lymph node,
single.
E. Level 4 lymph nodes - Received in formalin. It consists of four
possible lymph nodes ranging in size from 1.0-1.7 cm in greatest diameter.
The cut surfaces are tan to hemorrhagic. Also is consists of a 3.0 cm in
greatest diameter piece of fatty soft tissue. E1 - one lymph node
sectioned; E2 - three possible whole lymph nodes. LT:jfj
F. Right upper lobe - It consists of a 13.7 x 10.2 x 3.0 cm, 173 gram
lobectomy. The pleural surface is tan-purple and glistening and smooth,
with a parenchymal margin inked green. Sectioning reveals an ill-defined
mass measuring 2.4 x 1.7 x 1.6 cm in the periphery. The cut surface of the
mass is tan-white to tan-yellow, hemorrhagic, friable to firm. The mass is
to the parenchymal margin at 1.9 cm and possibly grossly involves the
pleural surface (inked blue). The mass is to the nearest vasculature and
bronchial margins 3.1 cm and 4.5 cm, respectively. Additionally, there is
a possible secondary mass deposit with a tan-white coloration measuring 0.7
cm in greatest diameter. This possible deposit is 6.6 cm from the primary
mass. The remainder of the parenchyma is hemorrhagic, red-brown to
blue-brown with focal areas of consolidation measuring 2.2 x 1.3 x 0.7 cm.
Representative sections are submitted as follows: F1-F2 - mass to possible
pleural involvement, F3 - mass to nearest parenchymal margin,
perpendicular, F4 - additional section of mass, F5 - vasculature and
bronchi al margins, en face, F6 - possible deposit, entirely, F7 - area of
consolidation and uninvolved parenchyma. LT:mj

MICROSCOPIC PATHOLOGY: A-F. All microscopic slides are reviewed and
support the diagnosis. ZW:jfj

Final Diagnosis performed by ZHENGLONG WANG, MD. Electronically signed
8/12/2024 11:12:13 AM 4011 Gateway Blvd NEWBURGH, IN 47630 812-450-3919

ADDENDUM:
F. Lung, Right Upper Lobe, Lobectomy: Immunostains of TTF-1, napsin A, p40,
and p63 are compatible with rendered diagnosis. Controls are adequate.