Dr. Karen Reckamp, City of Hope Cancer Center, reviews her thought process in recommending a repeat biopsy at initial diagnosis or after progression for patients with advanced lung cancer.
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Hi, Dr. West:
I have three reports : EGFR Negative.
KRAS. Positive for a new mutation p.l 19 F(c.57G>C) in exon2 of the KRAS gene
Do I need to do a repeat biopsy at some point in the future? In case they change… I wish.
I hope I am not asking you a silly question.
Thank you for you help.
I think repeating biopsy means double check, if I am right.
Repeat biopsy means “if the first biopsy didn’t yield enough tissue to do molecular testing, would you request another biopsy just to send off molecular testing?” Alternative, it can mean “if the cancer was previously EGFR mutation-positive, responded well to an EGFR inhibitor, then progressed, would you favor another biopsy of the progressing cancer to see what that showed?”.
I don’t know of any oncologist who is recommending a repeat biopsy if the tests were sent off and showed no mutation, just to double check that it’s really, truly negative.
Thank you. Dr. West.
Today my CT Scan reported there are two lesions on my right lobe liver( one is 9mm, the other has no measurement . My oncologist told me not worry about it) We have to finish our 4 cycles chemos first. Today i had my second cycle having 800 mg Alimta and Cisplatin ? mg.
I worry as I understand time is everything.
I want to get rid of them ASAP. May I have a surgery without going through biopsy as they could be too small to catch. Thank you for your help.
I’m sorry, but I don’t see any way that surgery would be of value in this setting. Is there something in what we’ve said or written here that would lead you to believe that surgery would be a good choice in the setting of metastatic lung cancer?
Thank you, Dr West for your timely reply.
My oncologist told me today that the chemo I have (Alimta & cisplatin) now can’t cure liver cancer, even if they are from my lung. Is it right?
If the two tiny lesions on my right lobe of liver are the only spread cancer, secondary cancer, from my lung cancer.There is a big if. Don’t you think it is worth to try?
I understand that I have to have a pet CT from head to toe to make sure I don’t have any other spread cancer.
Dr. West I understand at some point you can say nothing but sorry for a person you really wish you could do…
You’re right that I’m sorry I can’t suggest more. Importantly, this isn’t liver cancer — it’s lung cancer that has spread to the liver. But no, there isn’t any value in doing surgery for a cancer that is metastatic from the lung to the liver. That’s especially the case if it has grown on chemotherapy. There would be no anticipated value to surgery, since the overwhelmingly most likely scenario is that new spots would appear before or right as you recover from the surgery. The cancer got to the liver by spreading through the bloodstream, so cutting or radiating all of it wouldn’t eliminate all of the disease, with cancer cells traveling through the bloodstream.
We discuss this more here. It’s a discussion link because yours is a very common, understandable question.
For that matter, here’s a link on why your cancer in the liver isn’t liver cancer:
No word can express my appreciation to you, who create this unbelievable world for cancer patients. I came too late unfortunately. I will let you know how everything goes with me.
Thank you, Dr. Reckamp!
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