BAC

This topic contains 10 replies, has 4 voices, and was last updated by  lablady 2 months, 3 weeks ago.

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August 19, 2017 at 4:47 pm  #1291265    

lablady

I would like to review Dr. West’s criteria for the treatment of ground-glass nodules. My husband has a one of these nodule which has grown from 4mm to 8mm in a span of 6months.We are on the watch and wait plan for now . We are going for another scan next week after another six month. So would like to be able to discuss this topic with a refreshed knowledge of the latest thinking on BAC.

August 19, 2017 at 5:28 pm  #1291266    
catdander forum moderator
catdander forum moderator

Hi lablady,

Everything remains the same about BAC. It’s a subtype of adeno and treated like adeno except with much more judiciousness in waiting to see if treatment is needed. I hope all goes well.

Janine

August 20, 2017 at 6:55 am  #1291269    

lablady

Thanks catdander for your reply. I read through many of Dr. West posts on BAC yesterday, but was unable to find the chart that he had drawn up and when treatment is needed and when it is not . It is a great summary of current thinking, can you point me in the right direction to this chart.

August 20, 2017 at 1:04 pm  #1291270    
JimC Forum Moderator
JimC Forum Moderator

You can find Dr. West’s algorithm here: http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

August 20, 2017 at 6:22 pm  #1291272    

lablady

Thanks Jim. Exactly what I was looking for! My husband is also a never-smoker. Our nephew who died 10 years ago at the age of 39 years from lung cancer was also a never-smoker. Sadly he left behind a 3 and 5 year old sons.

August 21, 2017 at 3:20 am  #1291274    
JimC Forum Moderator
JimC Forum Moderator

I am so sorry to hear of the tragic loss of your nephew at such a young age. Lung cancer is an awful disease that has taken too many good people from us.

My sincere condolences to you and your family.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

August 21, 2017 at 8:14 am  #1291277    

lablady

Jim, just a personal thought on my part and I wonder if you have had any feelings about this issue and how you have dealt with it.
I find myself very angry at times that all the research being done seems pointed to people who are at high risk to develope lung cancer while little is done for never-smoker, who are most often diagnosed at stage 4 , because the primary case Doctor doesn’t even think about lung cancer. My nephew was treated for 3 months for URI which wouldn’t clear before a chest X-Ray was even done. Now, here in Canada, low-dose CT scan for being offered to people who have been heavy smokers for years.Hopefully this program will pick up early cancers in this group and lead to a lower number of death. As we have national health care the money goes to where it will do the most good.
At the last Lung Cancer Ontario convention that I attended the majority of the speaker were never-smoker who were diagnosed at stage 4.
Yet, no funding or research was in place to develope a screen test for non -smokers, who have lived a clean life-style.
Seems so unfair to me. I have tried to interest the local community in becoming more interested in the case of the Never-Smokers and lung cancer to no avail
Yet, I sense that you have overcome anger if it was an issue for you,to do this very good and needed work as a moderator for Grace.

August 22, 2017 at 9:37 am  #1291280    
JimC Forum Moderator
JimC Forum Moderator

Hi lablady,

I completely understand your feelings on this subject. Most never-smokers who develop lung cancer, along with their loved ones, would like to know what caused the cancer and what might have been done to detect it earlier. But except for a few cases (such as exposure to radon gas), those answers are elusive. As a result, a screening program for non-smokers would likely need to include every non-smoker. As you say, resources are being directed to screening programs most likely to provide early detection of the maximum number of lung cancers. Screening everyone else would not only require large amounts of resources, but it would magnify the down side of such screening programs. The cost is not just money and time, but there is a human burden as well. Many screening scans depict lung nodules, even in healthy patients, leading not only to anxiety but also to ultimately unnecessary medical procedures such as further scans and biopsies, which carry their own set of risks. Even from that aspect (leaving aside the monetary issue), the cost vs. benefit is much less compelling than with high-risk patients, since the percentage of lung cancers detected in the low-risk group will be very small.

For myself and my late wife, we had all the same questions about what could have caused her cancer, but all we could do was speculate. Low-dose screening programs were not in play back in 2008 as they are now, so it wasn’t really an issue for me. I certainly wish that we could have detected her cancer at an earlier, curable stage, but I never felt that something should have been done but wasn’t. I was angry, but I had no place to direct that anger, which made it all the more frustrating. Of course time has provided some healing and lessened that initial anger, but the sadness remains.

[continued]


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

August 22, 2017 at 9:54 am  #1291281    
JimC Forum Moderator
JimC Forum Moderator

[continued]

Your feelings about the lack of research directed toward non-smokers with lung cancer mirrors that of many patients who do not have targetable mutations such as EGFR or ALK. Treatments targeting those mutations receive a great deal of resources and press, even though they benefit only a relatively small percentage of lung cancer patients. What it really comes down to is that researchers are learning more about how to treat lung cancer bit by bit, and once they find something they can target, they pour resources into that path.

Again, from my perspective, in some ways it can be difficult to see the development of new therapies which could have helped Liz, but I am consoled by the knowledge that today’s lung cancer patients have more options and are living longer. I have lost many friends to lung cancer, both in my personal life and my GRACE life, so I direct my energies toward helping today’s patients understand their options so that they can find ways to live longer. Liz fully supported my work on this site, and I know she would want me to continue the fight that she no longer could.

Although I know it doesn’t help in your situation, there are new techniques being used and studied to detect cancer cells in the blood or other bodily fluids, so the day may come when lung cancer screenings could become more widespread. Though I am sorry that such techniques were not in place to help your husband, I am glad that he has more treatment options than we had back in 2008, and that those options will likely increase, as the pace of research has never been greater..

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

August 22, 2017 at 3:22 pm  #1291295    

cards7up

There is research being done on younger, nonsmokers as many new LC diagnoses are young females.
See the link. Sorry you lost your nephew to LC at a young age. My condolences to you and his family.
Take care, Judy
https://www.openmednet.org/site/alcmi-goyl


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

August 23, 2017 at 12:32 pm  #1291308    

lablady

Jim C. Thanks so much for your insightful reply. I can sense that you understand my frustration, which is with the general situation of the never-smokers more than with my husband’s case specifically .
He was diagnosed early at stage 1b . Because our PCP was persistent in tracking down the cause of some shortness of breath episodes. He had robotic removal of his Rt upper lobe, 4 months of chemo and a one year trial of an immuno-therapy drug. He has had regular follow CT scans. His care has been excellent and he is in his 77 year. He is definitely benefited from the advances in the treatment of lung cancer and from the Canadian Health Care System . Our only out of pocket expenses were for parking at the hospital, the rest of the costs were taken care of by OHIP, our provincial health care plan.
We have just returned from our oncologist, and results of yesterday’s CT showed further growth of the ground glass opacity to 12mm and now show a solid area not seen before. So, we will be referred to a thorasic surgeon to discuss options . The oncologist said this is a new lung cancer and not a met of the original lung cancer. She feels that surgery in the near future is very likely.
My frustration is the lack of focus of research money, at least, here in Canada, that is made available to lung cancer when it is the cause of more death than breast, prostate and colon cancer put together. Yet, many people don’t know this. Most women don’t realize that lung cancer kills more women than breast, cervical and ovarian together. The stigma of smoking has really clouded the ability to fund raise for lung cancer. The public seems generally unaware that never-smokers get lung cancer too. Look what fund raising has done for research into breast cancer! We can’t seem to do that for lung cancer.
Well that is my rant for today.
Thanks again, Jim, for sharing your thoughts with me and for giving some new ideas to consider.

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