BAC 1 , TO DO CHEMO OR NOT TO DO CHEMO? - 1254337

smile
Posts:9

Hello, Dr West. They told me you're the specalist and let me here to ask you my question.

My mother is 58 years old. About 3 years ago, she caught a cold and coughed a long time. Since then, she coughed 2 or 3 month in one year and is often in a hoarse voice.

A month ago, a CT scan picked up a lesion. And quickly, my mother did not have a conclusive diagnosis but directly operation. We opted for a VATS lobectomy. It was BAC, 2*2*1.5CM that keep 1mm to the pleura.

So one doctor told us it's stage 1-A,we should not get chemo; but another doctor said it's stage 1-B,we must do chemo. I know chemo would destroy the immunologic system, how could we choice??If we should do chemo, 4 times is enough?

Thank you very much.

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Reply # - March 1, 2013, 10:22 AM

catdander
Posts:

Hello Smile, I'm sorry your mom is in this difficult position. I know how harried you all must be.
Just some clerical work first, Forum guideline #8 is more of a style point pet peeve of Dr. West's than any mistake you've made. So please read over it and it will explain why I edited you post. No biggie.

This is really going to be a difficult question for our faculty to answer. It's difficult enough for those who are seeing your mom and often comes down to a decision between the doctor and the person with the cancer.

Dr. West has recently put out a video on just this type of situation. Give it a listen or 2 and let us know of any follow up questions you have. http://cancergrace.org/lung/2013/02/11/cip-adjuvant-chemo-for-smaller-h…
additional blog post on stage I operable cancer where chemo might be used.

http://cancergrace.org/lung/2007/10/02/factors-for-adj-chemo-in-borderl…

http://cancergrace.org/lung/2012/05/15/modifying-factors-adjuvant-chemo/

I soooo (example of approved of extraneous letter use ;) ) hope your mom is cured,
Janine
forum moderator

Reply # - March 1, 2013, 10:30 AM

catdander
Posts:

Also the immune system does take a beating during therapy but is watched and cared for carefully. It's not as bad as some chemos. It should recover to normal afterward.
4 chemo cycles is shown to be the benefitted amount. Sometimes as many as 6 are given but it isn't really proven to help.

Reply # - March 1, 2013, 04:46 PM

Dr West
Posts: 4735

I would say that, in the absence of any involved lymph nodes, most oncologists would not favor adjuvant chemotherapy for a tumor this size, particularly if it appears to be well-differentiated (which you didn't specify) and/or is largely non-invasive, as BAC typically is.

I think the grounds for recommending chemo here are rather weak.

-Dr. West

Reply # - March 2, 2013, 06:01 AM

smile
Posts: 9

Thank you for Catdander and Dr. West. Very glad to see your reply.
I am sorry to write in some errors because I am in a hurry and not good at English.

They didn't tell me my mom's BAC "differentiated", and when I asked it, the doctor said it's medium-differentiated. And now it appears non-invasive though it's so close to the pleura in 1mm.

I think my doctor also consider this distance and afraid of diffused, so prefer to chomo. Actually, in China, most doctor dare not say that the suffer needn't chemo and most suffers are over-treating.

When the younger doctor said my mom's stage1-A, we could go home; the director said we must go to do chemo. And my family said the director has more experience. Would chemo improve 2% or 5% livability ?

I know chemo sometime is not used for suffer.

Thank you a lot.

And if we havn't do chemo, what other should we do? Thymosin？Or just be care of food and life style?
Should we take something with selenium or other things?

Reply # - March 2, 2013, 07:34 AM

Dr West
Posts: 4735

There is really no evidence that any of those other interventions provide any benefit, so I would say that there is no real role for anything other than good follow-up and interval scans. I typically do scans every 4-6 months in the first year after surgery and then every 6 months out to 4 years, then annually. In the setting of a very early cancer like it sounds like hers is, especially without invasion, the prognosis is very favorable and the timing of any recurrence is very low up front, so I often favor doing no more than every 6 month scans in the first year.

Though I would say that the risk posed by surveillance CT scans is quite low, we don't want to do more scans than are needed, and in someone likely to do well and be followed for many, many years, I think it's appropriate to be very judicious about follow-up scans and not overdo them.

I think that the excellent prognosis is another good reason to be very cautious about chemotherapy. There is some evidence that adjuvant (post-operative) chemotherapy can be associated with worse survival long after surgery and the chemo (beyond 5 years), perhaps because of harmful long-term effects of the chemotherapy, and perhaps because sometimes the chemo doesn't completely cure the cancer but perhaps just delays the recurrence of it for a year or several years. This isn't really well studied, but I describe this issue in more detail here:

http://cancergrace.org/lung/2008/07/11/ialt-long-term-risk-adj-ct/

Good luck. Please remember that there isn't always a value in doing things just for the sake of doing them, whether it's chemotherapy, supplements, etc.

-Dr. West

Reply # - March 3, 2013, 04:53 AM

smile
Posts: 9

Thank you, Dr West. You are too nice.

I read carefully with your words and I will read your other papers, too.

Is there any data to show how long the BAC stage 1 suffers living or not relapse ?

Thanks again!

Reply # - March 3, 2013, 06:36 AM

Dr West
Posts: 4735

The available data show that people with stage I BAC have a lower risk of recurrence than other people with stage I NSCLC. Recurrence also tends to occur later, if at all.

-Dr. West

Reply # - March 10, 2013, 01:26 PM

Dr West
Posts: 4735

I wouldn't consider this a significant factor that would be expected to markedly increase risk of recurrence. There is no evidence that a cancer being near the pleura would be a reason to recommend adjuvant chemotherapy when it otherwise wouldn't generally be favored.

-Dr. West

Reply # - May 23, 2013, 07:37 AM

smile
Posts: 9

Dear Dr. West,

Last time I knew from you and some locate doctor that the definition of "BAC" is no more used, and the big
hospital here had changed and used the new method.

Today I get the new result of my mother and in Egnlish it's called "LPA".

I feel sad that hers is not AIS or MIA.

I found little knowledge about LPA on the internet, do you have more paper about it?

Thank you.

PS: I think we still needn't do chemo?

Reply # - May 23, 2013, 10:11 AM

catdander
Posts:

smile, this is what Dr. West had to say about BAC LPA and terminology, it includes a blog post link, "Here’s a post about the change in terminology:
http://cancergrace.org/lung/2009/08/06/bac-no-more/
It’s not quite as simple as “doctors do not call BAC BAC anymore.” Some doctors do not use the term BAC anymore, but many do, and plenty really don’t care what you call it. I don’t think it’s worth getting hung up on the terminology, when it’s really the behavior that matters. In addition, there is so much variability in the reliability of the pathologic diagnosis that I feel that cases need to be interpreted individually. The main point is that a non-invasive adenocarcinoma, is now called adenocarcinoma in situ to describe what was previously called pure BAC. These tend to be very slow growing and shouldn’t necessarily be lumped into the same prognostic category, size for size, as a more solid, invasive adenocarcinoma." http://cancergrace.org/topic/not-called-bac-anymore

I hope this is helpful,
Janine
forum moderator

Reply # - May 23, 2013, 07:43 PM

Dr West
Posts: 4735

LPA just means "lepidic predominant adenocarcinoma", which is a rebranding of what we generally called "adenocarcinoma with BAC features", a mixture of invasive and non-invasive adenocarcinoma.

-Dr. West

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