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What follow up should patients have after surgery for early lung cancer?

August 10, 2008 - 8:12 am

   This is my first post on this wonderful site.
   Recently I saw a patient who had undergone surgery for stage II Non-Small Cell Lung Cancer and was receiving chemotherapy with another cancer doctor. He came to me for a second opinion. Among the questions he had was what tests should he get after completing all his […]

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Pre-Operative Chemotherapy as an Alternative to Post-Operative Chemo: Evidence of Stage-Dependent Survival Benefit

July 13, 2008 - 8:08 am

  In contrast with post-operative chemotherapy, which has become a standard treatment approach to reduce the probability of recurrence of resected stage II and IIIA NSCLC (still pretty controversial for stage IB), pre-operative chemotherapy (also known as neoadjuvant, or induction chemotherapy) is less well studied and isn’t a typical approach.  However, a recent study called ChEST, the […]

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Long-Term Risk with Adjuvant Chemo

July 11, 2008 - 7:07 pm

   Over the past few years, the role of post-operative, also known as adjuvant, chemo has become increasingly accepted as a standard of care.  Several trials have shown an improvement in survival at about 5 years that is in the 5-15% range for recipients of chemo.  However, the evidence indicates that the people at higher […]

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Removing Lymph Nodes During NSCLC Surgery: “How Does It Play in Peoria?”

June 17, 2008 - 1:57 am

   In the past couple of posts we’ve seen that based on evidence from Japan and Rome, number of lymph nodes resected and also the absolute number of positive nodes and/or proportion of positive nodes may be important prognostic variable.  A third abstract I reviewed on the same subject came from Peoria, IL, and illustrated […]

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Adjuvant! Online Tool for Decisions on Value of Post-Operative Chemo

December 29, 2007 - 10:03 pm

   There’s a website called Adjuvant! Online, developed by oncologist Peter Ravdin, that is best known for its use after surgery for breast cancer in assessing the value of post-operative chemo.  Because I don’t really treat breast cancer, I haven’t spent time on the website, but I do know that it’s a valued resource among practicing oncologists who […]

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Surgery for BAC: Special Considerations

December 10, 2007 - 11:08 pm

   While there is a lot of variability in the clinical behavior of bronchioloalveolar carcinoma (BAC), there are some commonly observed findings that are now leading lung cancer experts to consider it as a distinct clinical entity worthy of special consideration for management.  Among the important areas for potentially special clinical management is in surgical management of […]

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Noguchi Classification of Bronchioloalveolar Carcinoma (BAC)

December 8, 2007 - 10:55 pm

   I had previously written about a spectrum from pure bronchioloalveolar carcinoma (BAC) to invasive adenocarcinoma in one of my first posts here, but the real credit for this concept goes back to Dr. Masayuki Noguchi from the National Cancer Center Hospital in Tokyo, Japan, who characterized a classification system for peripheral lung adenocarcinomas back […]

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Limited Resection vs. Radiation for Marginal Patients with Early Stage NSCLC

November 15, 2007 - 10:08 pm

   The standard of care for at least stage I and II NSCLC is surgery, sometimes followed by chemotherapy.  We know, however, that not every patient who presents with early stage NSCLC is healthy enough to pursue surgery, whether due to general age-related or other illnesses, or due specifically to a low pulmonary reserves, usually […]

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Imaging Factors Predictive of Higher or Lower Risk for Recurrence of Early Stage NSCLC

October 4, 2007 - 10:16 pm

   Among the many variables that can potentially be helpful in predicting outcomes after surgery are some imaging results.  One of these is cavitation, or hollowing out of the inside of some part of the tumor.   Although most clinicians think of this as a feature of squamous cancers, it can also be seen with adenocarcinomas […]

2 Comments

Beyond Stage & Tumor Size: More Pathology Variables Associated with Risk of Recurrence after Surgery

October 2, 2007 - 12:56 pm

   The decision about pursuing post-operative treatment is often difficult and requires carefully weighing the risks of treatment with potentially challenging and even dangerous chemotherapy against the potential to eradicate micrometastases and actually lead some people to be cured who otherwise wouldn’t be.  It’s important to remember that some people are already cured, while others won’t be […]

4 Comments
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