Pleural Based Nodule

Portal Forums Lung/Thoracic Cancer General Lung/Thoracic Cancer Pleural Based Nodule

This topic contains 14 replies, has 6 voices, and was last updated by  Dr West 1 year, 10 months ago.

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October 27, 2012 at 12:57 pm  #1249613    

double trouble

What does it mean if a nodule is described as “pleural based”?

Debra

Edited to add: I guess I should be more specific… is this still considered “local spread?” And could this be the start of a pleural effusion, or would fluid look different than a nodule? Its only 3mm.

October 27, 2012 at 4:02 pm  #1249618    

catdander forum moderator

Debra, You seem to always have a new set of issues to learn about with each new scan. I’m so sorry.
I thought I noted here earlier but like your earlier post I’ve reached out to a doctor for input several hours ago.
I know you will put the pieces together but I hate you must.
Janine


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

October 27, 2012 at 4:38 pm  #1249619    

double trouble

Yeah… It’s been suggested I stop going to doctors alltogether!!!!! Same day I found out no chemo until I have both eyes operated on!!!

In the immortal words of Emily AKA Gilda Radner… Don’t you know, it’s always somethin!

:wink: Debra

October 27, 2012 at 6:27 pm  #1249620    

catdander forum moderator

Of course I remember Gilda one of my favorites and yes it seems like its always something.
I didn’t remark on the eye operations. It’s just so difficult to wrap my head around all this.
Go get em girl.


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

October 27, 2012 at 9:25 pm  #1249631    

Dr West

“Pleural-based nodule” just means a nodule that is right on or below the lining of the lung, called the pleura. It’s not the same as a pleural effusion, which is a collection of fluid in the space between the outside of the lung and the inside of the chest wall.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

October 29, 2012 at 4:55 pm  #1249707    

Dr Sanborn

Hello Debra–

I am sorry to hear about how much you have been going through. A “pleural-based” nodule is simply a description of the location of the spot being up against the lining of the lung (not fully surrounded by visible lung tissue). This does not necessarily mean that it would be the start of a pleural effusion. When nodules are that small, only a few mm, it is very difficult to tell what they are from. They can be from cancer, but also from inflammation or asymptomatic infections. Most of the time they have to be watched to really understand for sure what they are. They are interpreted within the context of the entire scan, and the ones before.

I hope this is helpful. I am sending thoughts your way.


Rachel Sanborn, MD
Medical Oncologist
Providence Cancer Center

Views expressed here represent my opinion, not those of GRACE or Providence Cancer Center. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

October 29, 2012 at 10:04 pm  #1249714    

double trouble

Thank you for your reply Dr. Sanborn. Good to hear from you again. It is helpful. It takes a while to calm down when there are unexpected new findings. I have to ruminate a bit. Thanks for jumping in.You always make me feel more calm.
Debra

October 30, 2012 at 3:36 pm  #1249736    

judys

Debra – Just wanted to say I’m glad you asked the question since I have three “persistant subpleural soft tissue” areas that are growing. I had found no good explanation of what this means. Dr Sanborn’s comments help. My pleural-based areas are in the 2 cm x 1-2 cm ranges now.

Now that I finished my last taxotere infusion (#6) and will scan in a few weeks, I’m hoping something can be biopsied. Hard to believe since I’m almost 6 years out from diagnosis that I’ve never been tested for EGFR or ALK, but as my treatment options dwindle it’s becoming more important to me to find out what’s what currently.


Never-smoker; Diagnosed 2/2007 at age 64 with NSCLC adenocarcinoma, Stage 3b. Carboplatin/taxol/avastin: 3/07 – 6/07; radiation 8/07 -9/07; Avastin 10/07 – 12/07; Nodules in prev.clear rt lung; repeated carbo/taxol/avastin 1/08 – 3/08; Tarceva 4/08 – 9/11; radiation to soft tissue mass between two ribs 10/11; Alimta 10/11 – 2/12; treatment break; return to Alimta 5/12 – 6/12. Taxotere 7/12 – 10/12; treatment break 11/12 – 1/13; scan showed progression 1/13; restarted taxotere with zometa 2/13

October 30, 2012 at 4:33 pm  #1249739    

double trouble

After 3 1/2 years on Tarceva I wonder if you aren’t EGFR positive. I also wonder if you could re-challenge with Tarceva as a next step? Congratulations on 6 years. That kind of success has to give lots of people something to hope for and serve as proof that statistics are misleading.

Good to hear from you. Please keep us posted on what you do next.

Debra

October 30, 2012 at 6:40 pm  #1249740    

catdander forum moderator

In the link below Dr. West describes some of the research being done at Vanderbilt with resistance including rechallenging people with tarceva after a break.

http://cancergrace.org/lung/2012/06/19/chemo-with-or-without-ongoing-egfr-tki/


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

October 30, 2012 at 9:48 pm  #1249741    

Dr West

I agree a re-challenge in someone who did well for years on a targeted therapy is a very strong consideration, particularly if it has been more than 6-12 months since coming off of that targeted therapy. This is better studied with EGFR inhibitor therapy, but I suspect it would apply similarly to patients with an ALK rearrangement.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

October 30, 2012 at 10:35 pm  #1249742    

judys

My oncologist isn’t jumping up and down about returning to Tarceva……I’ve suggested it and given her the Dr West post mentioned above etc. It hasn’t helped that another onc (LC specialist I saw earlier this year) said he’s not sure I’m EGFR positive since nothing ever did shrink while I was on Tarceva. He thought maybe I just have slow growing LC.

I haven’t minded taking Alimta and Taxotere this past year as they are chemos which have had good results in some. Now that I’ve been there, done that with no great success, it’ll soon be time to move on to something else. A short break right now doesn’t sound too bad though.

Thanks for your comments.


Never-smoker; Diagnosed 2/2007 at age 64 with NSCLC adenocarcinoma, Stage 3b. Carboplatin/taxol/avastin: 3/07 – 6/07; radiation 8/07 -9/07; Avastin 10/07 – 12/07; Nodules in prev.clear rt lung; repeated carbo/taxol/avastin 1/08 – 3/08; Tarceva 4/08 – 9/11; radiation to soft tissue mass between two ribs 10/11; Alimta 10/11 – 2/12; treatment break; return to Alimta 5/12 – 6/12. Taxotere 7/12 – 10/12; treatment break 11/12 – 1/13; scan showed progression 1/13; restarted taxotere with zometa 2/13

December 14, 2012 at 7:55 pm  #1251374    

aunttootsie001

I realize with having The Malignant Pleural Effusion I’m not curable but I’m curious as to why I would be put on Xalkori before doing some Chemo. As I understand I more than likely will be on the Xalkori indefinitely? And if I can’t take it my Cancer Cells could come back worse than before. I’m confused? Is the Xalkori is in essence a maintenance drug?


DX June 2011, Non smoker. Lobectomy August. 2011. Two TX Carbo/Taxol. 31 TX Radiation 2012. Break no treatment 8mo. Malignant Pleural Effusion discovered Oct. 2012. Xalkori started Nov. 2012. Pleurodisis done April 2013. Last CT still NED.

December 14, 2012 at 9:51 pm  #1251382    

double trouble

Aunt Tootsie, I can’t answer all of your questions, but my understanding is that I will be on Xalkori until I progress, then I will still have other options. Eventually my cancer could become resistant to Xalkori, or I may just not respond to it at all, and at that point I would need to explore other options with my team. My oncologist has said we would go to Alimta next, and maybe add Avastin.

The word indefinitely means for an unlimited or unspecified period of time. So in this case, unlimited isn’t the right word, but you would be on Xalkori for an unspecified period of time, since you can stay on it for as long as your cancer shrinks, or remains stable, or until there is too much toxicity for it to be safe to continue. Then you would stop; It would be an unspecified period of time because every patient is different. Some don’t stay on it at all, others stay on it for years.

Also, Xalkori is chemo (oral). Perhaps what you mean is… why would you be put on Xalkori before doing a platinum based drug like Carboplatin or Cisplatin ( given by infusion over a period of time, either alone or in combination with other drugs), which are common first line therapies .These are what you have in your head when you think Chemo… being in a bed or a lounge chair hooked up to an infusion set for hours and puking
and losing your hair.

I believe the answer is that you have the ALK translocation, which means you might respond very well to Xalkori, which has a less challenging side effect profile and shows remarkable efficacy. The goal of treatment is to do the most harm to the cancer while doing the least harm to the patient.

Hope some of this helped.
Debra

December 14, 2012 at 10:16 pm  #1251389    

Dr West

Both chemotherapy and XALKORI are systemic therapies that are given in advanced NSCLC to prolong survival but don’t work indefinitely. The idea is to get the most effective and best tolerated treatment first. In people with an EGFR mutation, that’s an EGFR inhibitor like Tarceva (erlotinib) or Iressa (gefitinib) or afatinib; in people with an ALK rearrangement, that’s an ALK inhibitor like XALKORI (crizotinib); in people with neither of these, that’s typically chemotherapy.

It’s debatable whether these targeted therapies should be continued indefinitely…there just aren’t studies that definitively answer that question right now. Nor is there very good evidence about the question of whether stopping them leads to an acceleration of progression of disease in most patients.

The clear consensus is to use the best treatment first, and in someone with advanced NSCLC and an ALK rearrangement, just about any lung cancer expert would favor starting with XALKORI.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

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