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Stage 4 Lung mets
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Stage 4 Lung mets

› Forums › General Melanoma Community › Stage 4 Lung mets

  • Post
    • April 15, 2020 at 8:43 pm
    BRR
    Participant
      Hello,

      My father was diagnosed in february with two lung mets (18mm and 8mm). He had VAT surgery. He is in pain, on scale 8/10. Still didnt recieve any therapy, he is supposed to have a CT in two months starting from today.

      I have two questions:

      1. Is it normal for him to be in this much pain one month after the VAT procedure?

      2. Do you know of any case that a patient had VAT surgery and didnt recieve therapy afterwards?

      He is 71 years old.

      Thank you
      This is so stressful time for all my family.

    Viewing 1 reply thread
    • Replies
        • April 16, 2020 at 1:20 am
        MelMel
        Participant
          I think you will find the following link helpful

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006121/

          Risk factors of neuropathic pain after thoracic surgery

          “This study aimed to clarify the incidence and risk factors of neuropathic pain after thoracic surgery, focusing especially on patients who underwent complete video-assisted thoracoscopic surgery (VATS).
          Method
          We retrospectively identified 185 patients who underwent thoracic surgery at our hospital over a 2-year period. Logistic regression analysis was used to analyze the association of various factors with postoperative neuropathic pain.
          Results
          Forty-eight (25.9%) patients developed postoperative neuropathic pain, and 9 (18.8%) of these patients reported persistent pain 1 year postoperatively. The median interval from surgical treatment to the onset of neuropathic pain was 7 days, and the duration was 50 days. Multivariate logistic regression analysis revealed a significant positive correlation between postoperative neuropathic pain and preoperative use of hypnotic medication [odds ratio (OR), 5.45; 95% confidence interval (CI); 2.52–12.17] and duration of surgery ≥2.5 hours (OR, 2.72; 95% CI, 1.27–6.09), and a significant negative association with the complete VATS approach (OR, 0.18; 95% CI, 0.073–0.42).
          Conclusions
          Preoperative use of hypnotic medication, the thoracotomy approach, and duration of surgery ≥2.5 hours are associated with increased risk of neuropathic pain after thoracic surgery. The complete VATS approach could decrease the incidence of postoperative neuropathic pain, regardless of the duration of the surgery.”

          As you can see from this study, the neuropathic pain duration was 50 days. Being that your father had the surgery in Feb. it is highly probable that he still experiences strong pain. It is also important to note that nerves take the longest to heal.
          As for your second question, I would expect the removed tissue samples to be biopsied and further treatment would be based on the result of the biopsy as well as the surrounding fluid.

          Best wishes for your father’s speedy recovery.

          Melanie

            • April 16, 2020 at 1:05 pm
            BRR
            Participant
              Thanks a lot Melanie.
              Biopsy confirmed melanoma metastases in left lung (one hilar node 8mm and tumor in left lower lobe 18mm). Braf status negative…
              Therapy is not offered now, just CT in two months. I am not sure it is ok.
            • April 16, 2020 at 2:29 pm
            Bubbles
            Participant
              Was a reason given for no systemic therapy?
                • April 16, 2020 at 3:34 pm
                BRR
                Participant
                  Just because the metastases were removed by VAT surgery and that no more therapy is needed now than if the metastases recur.
                  Note that these are the only melanoma specialists in the country.
                  After all I’ve read I’m not sure surgery is enough in treatment now that new therapies are available.
                  Has anyone had this situation, just surgery?

                  Sorry and thank you all.

                  • April 16, 2020 at 4:51 pm
                  Bubbles
                  Participant
                    Where is your father located?
                    • April 16, 2020 at 5:45 pm
                    BRR
                    Participant
                      Balkans
                      🙁
                      • April 21, 2020 at 8:47 pm
                      BRR
                      Participant
                        So can anyone answer me, is surgery enough?
                        Please.
                        This is so hard.
                        His first diagnosis was stage 2c (on his back, breslow 5.1 mm), slnb negative, now stage 4 with lung metastases.
                        • April 21, 2020 at 11:39 pm
                        Bubbles
                        Participant
                          I was first diagnosed in 2003. At that point surgery was really the only effective treatment we had for melanoma. Radiation as a single therapy is not particularly effective in melanoma, though when combined with either targeted or immunotherapy it is better than any of those alone. Patients with less than Stage IV could be treated with interferon – which we quickly learned made no significant difference in survival. Stage IV patients were treated with surgery and/or old school chemo (which is not really effective against melanoma), drugs like temodar – also with very minimal effect against melanoma, and IL-2 which is a very harsh treatment but can have about a 6% response rate, with some responses being durable. We have learned that removing melanoma lesions via surgery can certainly prolong life as opposed to leaving it in place. However, we have also learned that it cannot always stop progression.

                          With no available treatment, diagnosed as Stage III from the start – like your father, I had my lesion and positive node removed via surgery. However, also like your father, despite that surgery, I progressed to Stage IV. I had surgery then as well. But, I am certain that gaining access to a phase 1 trial of what is now called Opdivo, saved my life. Systemic therapy – whether via targeted therapy for BRAF positive patients or immunotherapy – both FDA approved since 2011 in one form or another – has been a life saving game changer for melanoma patients. Here is a primer that describes current melanoma therapies: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/08/melanoma-intel-primer-for-current.html

                          I would try to see if your father could gain access to some systemic therapy. It is now considered “standard of care” for Stage IV melanoma patients. If it is absolutely impossible in your medical system, I would reach out to the manufacturers to see if they would ship you the needed supplies under the terms of “compassionate use”. Both ipilimumab/Yervoy and Nivolumab/Opdivo are made by Bristol Myers Squibb – https://www.yervoy.com/ Pembrolizumab/Keytruda is manufactured by Merck – https://www.keytruda.com/

                          I wish I could give you a different answer. I hope this helps. Celeste

                          • April 21, 2020 at 11:53 pm
                          Bubbles
                          Participant
                            I am not really clear about the country your father is in, nor the services available in the Balkans generally. Greece certainly does a lot of research about and care of melanoma patients, though I do not know if that is an option for your dad.
                            • April 22, 2020 at 12:09 am
                            Bubbles
                            Participant
                              Finally, I underwent VAT’s surgery in 2010, as a very active healthy (despite Stage IV melanoma) runner aged 46. Recovery is very slow and painful. I wish you and your father my very best. c
                              • April 23, 2020 at 4:18 pm
                              BRR
                              Participant
                                Thanks a LOT.
                                In my country (Serbia) you cannot get therapy even if you are stage IV because they think surgery is enough at this point, only CT for 2 months.
                                And I know it’s not.
                                Thanks a lot again.
                                • April 23, 2020 at 8:05 pm
                                Bubbles
                                Participant
                                  Surgery really is SOMETHING!!! We can hope that it alone will serve your father well. Here is research that provides hope in that regard: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2019/07/cut-it-out-prolonged-overall-survival.html

                                  Will be holding you and your father in my heart. Yours, celeste

                                  • April 24, 2020 at 9:19 am
                                  BRR
                                  Participant
                                    Thank you!!!
                                    I wish you and everyone here all the best.
                                    ❤
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