Dr. Kristin Manning: Introduction to Imaging for Lung Cancer

A radiologist, the person who specializes in reviewing imaging studies in medicine, is often someone you notice if they’re unusually bad or unusually good.  They perform a service and you presume that they’re good at it, but a few are so sharp that the other doctors they work with notice it at every tumor board [...]

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Incorporating Tumor Cavitation into Response Assessment

   As I described in a post last year, one of the common features of angiogensis inhibitors is that lesion often cavitate, shrinking not only from the outside in, but hollowing out and dying from the inside out.  One of the concerns has been that cavitating lesions may be at higher risk for bleeding, but [...]

Debate Over the Value of Progression-Free Survival Affects Clinical Decisions Now

      Continuing on the introduction to the concept from a recent prior post, the issue of whether it’s important to see an improvement in progression-free survival (PFS) if there is no improvement in overall survival (OS) after additional therapy is going to be a central issue in lung cancer management, relevant in several key issues [...]

What I Really Do: Mild or “Subclinical” Progression

   One of the topics that frequently occurs in the clinic, and that patients often ask about, is the situation in which there is some suggestion of slight progression.  This can take the form of many different situations:  a rising tumor marker (see prior post), a slight increase in the uptake on PET (see prior [...]

Do Patient Symptoms Correlate with Response and Survival?

   Intuitively, you’d think that people who are doing worse while getting treated for lung cancer are not going to do as well as people who have improvement in their symptoms after treatment starts.  But how much do patient symptoms count in our current medical system for deciding whether a treatment is working or not, [...]

Lung Nodule Growth Rate: An Important Factor in Assessing Risk of Cancer

   A cancer has to grow faster than the tissue around it to become a tumor.  Progressive growth is therefore a central feature of a cancer and a critical factor in distinguishing cancerous nodules from benign ones.  There is a characteristic “volume doubling time” (VDT), the interval it takes for a nodule to double in volume.  [...]

Imaging Features of Nodules: What Makes a Lung Nodule High Risk for Cancer?

  As you might suspect, there are features of different spolitary pulmonary nodules (SPNs) that makes us more or less suspicious for cancer.  The first is the size of the nodule.  Looking at multiple series of SPNs, the likelihood of cancer among nodules that measured under 5 mm is generally in the 0-1% range.  Nodules [...]

PET Scans for Follow-up of Patients After Surgery or Chemo/Radiation

   We know PET scans can provide additional metabolic information that can be more sensitive and specific for cancer than chest x-rays and even CT scans in the initial staging of lung cancer (see prior post on introduction to PET scans). PET scans are now nearly universally employed in the initial workup, at least of [...]

Recurrence and New Cancers after Curative Treatment of Lung Cancer

   Among the key issues in following patients with a history of treated lung cancer is the pattern of recurrence. We need to have a sense of when the risk is highest and where people are more likely to demonstrate new evidence of disease. Fortunately, there are several studies that can help us with these [...]

PET Scans for BAC

   PET scans are an important way to discriminate between metabolically active nodules, suggestive of cancer but sometimes representing inflammation or infection, and non-PET-avid lesions that are felt much likely to represent cancer. They are also a cornerstone of “clinical” staging by imaging and patient exam (vs. “pathologic” staging by surgery to clarify where cancer [...]