When to see oncologist

Portal Forums Q&A, Ask Us New Questions When to see oncologist

This topic contains 8 replies, has 4 voices, and was last updated by  onthemark 3 weeks ago.

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May 29, 2018 at 9:15 am  #1294493    

gigizabuk

I have been followed since 2011 for multiple lung nodules. In 2014, a cluster of multiple 4mm nodules developed in the RUL originally thought to represent a mucoid impaction. It continued to progress with new nodules forming in a linear fashion. By Oct 2017 they appeared to have consolidated . A EBUS was performed in Dec 2017 and I was diagnosed at as an adenocarcinoma Stage 1A (2.8 cm). It was predominant solid at 40% with 30% micropapillary and 30% acinar. Positive KRAS. PDL1> 95 %.
A total RUL was performed on 1/31/18 and no further treatment was recommended. I had my scans reviewed by an outside facility and a RLL nodule, present since 2016 had progressed from 4×5 mm to 7×9 mm. It has a small solid component and the outside facility highly recommended resection. My local provider took it to tumor board and because of it’s location, they do not feel resection is feasible, nor do they want to radiate it w/o confirmation of malignancy. I am now scheduled for an attempted percutaneous bx and radiowave ablation. I have asked repeatedly when I should see an oncologist and am told it isn’t necessary at this time. Would appreciate your thoughts.

May 29, 2018 at 1:39 pm  #1294498    
catdander forum moderator
catdander forum moderator

Hi gigzabuk,

I’m sorry to hear about the possible cancer growth. I would think it is time to see a lung cancer specialist. Someone who treats BAC regularly. These people tend to be medical oncologists so even if you and your treatment team decide you don’t need systemic treatment (what a medical oncologist does) you are getting the opinion of someone most able to speak about your options. Also if the new growth is cancer your treatment options have gotten more complicated. A large teaching hospital with a large cancer center can take your case to a “tumor board” to discuss all aspects of your case with all the different specialists contributing and prepare plan options that maybe more sophisticated than just one person can prepare.

Often people come back from a 2nd opinion with the same plan. Don’t confuse that with having wasted time, it’s important to get whatever feedback you can even if it just confirms you’re on the right path. Here’s a good blog on the subject, http://bit.ly/2JhK3Uz

I hope this is a CT reading fluke and not cancer growth. Especially with GGOs it’s difficult to put a clear boarder around a mass so 4 mm might be small enough for the CT to have hit a different place and radiologist to see a bit differently.

All best,
Janine

May 29, 2018 at 2:37 pm  #1294499    

gigizabuk

I am at a major cancer center, Cleveland Clinic and see a lung cancer pulmonologist. I have asked about seeing an oncologist but they didn’t think it was necessary. They just presented my case at tumor board which is why they decided no further surgery but ablation. However, if the nodule in my lower lobe also proves to be malignant, then I assume my original staging of a 1A would be changed to possibly a 3A? I would guess for sure I would need oncology a that point. Thank you for your response.

May 29, 2018 at 4:18 pm  #1294501    

onthemark

Hi gigizabuk,

Your staging will depend on whether there is a lepidic component in the biopsy of these nodules. In can be stage 1 with multiple nodules if each one has a lepidic component that usually appears as ‘ground glass’ on ct scans. Do you have ct scan reports for the appearance of these nodules?


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2018 Next scan.

May 30, 2018 at 7:20 am  #1294503    
JimC Forum Moderator
JimC Forum Moderator

Hi gigizabuk,

One point that I’d add is that at a major center such as the Cleveland Clinic, the tumor board would include a medical oncologist who would have provided his/her input on your situation.

Also, if this is viewed as BAC, the treatment options would not be the same as those for a typical stage IIIA lung cancer, as there would be a concern that you could over-treat a relatively indolent cancer.

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

May 30, 2018 at 8:01 am  #1294504    

gigizabuk

Thank you for your response. The initial RUL 2.8 cm nodule was an adenocarcinoma. The growing one in the RLL states it is an opacity and I was told has a very small (2mm) solid component.

May 31, 2018 at 8:41 am  #1294516    

onthemark

Hi Gigizabuk,

From what I understand the RLL nodule in question grew from 4×5 mm sometime in 2016 to 7√ó9 mm sometime in 2018. It has a very small solid component now which is 2 mm. So I am assuming the rest is a ‘ground glass opacity’ or ‘non-solid opacity’.

This is relatively indolent or slow overall growth and as long as the solid component is less than 5mm gives a favourable long term prognosis.

Lepidic growth is often associated with the non-solid part of the opacity. Even if it is cancer it is a relatively indolent kind and not an imminent threat. It has been mentioned often that these “BAC type” lesions are often over treated, if that is what it is.

An advantage of ablation is that it preserves lung function in the surrounding tissue.

I am a little bit unsure about your situation. Is the plan to wait to get biopsy results before doing an ablation, or is the biopsy and ablation a single surgical operation?

If you get a positive biopsy why not wait for that and get radiation treatment?

You have time to get a second opinion with an oncologist if you have questions about your treatment options.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2018 Next scan.

May 31, 2018 at 9:21 am  #1294518    

gigizabuk

The above info is correct. The reason they are favoring ablation vs radiation is that they are somewhat doubtful that they will be able to get a good pathological specimen due to its small solid component. They are planning to do the ablation as a single procedure with the bx . The only thing that would change the plan is that when they do the bx, they will look at the specimen immediately and if there is any indication it is benign, they wouldn’t do anything further. Thanks so much for your ongoing responses.

May 31, 2018 at 9:43 am  #1294519    

onthemark

Hi gigazabuk,

That sounds like a sensible plan. Another option is to wait and scan in 3 months and see if the solid component on ct grows larger and then biopsy at that point.

If this were your first nodule of concern that might very well be the recommendation since it is less than 1 cm and has a solid component less than 5 mm,

but since the tumour that was surgically removed was larger and had a ‘solid component’ on pathology… not to be confused with ‘solid’ on a ct scan, they are going to want to be more aggressive than wait and see.

It seems to me you are in good hands with their treatment recommendation.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2018 Next scan.

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