The upper lobectomy in my right lung was done through thoracotomy on May 14, 2013 due to having a tumour that was benign in nature confirmed by FNAC in 2008 but finally diagnosed as Non-small cell lung cancer stage 1B in histopathology report after the operation. This tumour was first diagnosed in 2003. However, though the tumour size is 2.5 cm, yet it is stage 1B because of pleural invasion. It is a NSCLC (adenocarcinoma) of T2N0Mx.
My Respiratory physician and the surgeon both advised me that no further treatment (even adjuvant therapy) is required as the cancer was localised and there is no sign of lymph node involvement and metastasis even. But so far I came to know that in some cases of NSCLC stage 1B adjuvant therapy is advisable to kill the cancer cells if they remain in the body.
As it is the question of life and death, so my humble query to you:
Is any adjuvant therapy required for me considering the pleural invasion in order to prevent the recurrence of the tumour?
Regards,
Sabir
Reply # - June 14, 2013, 09:05 AM
Reply To: Non-small cell lung cancer stage 1B
Hi Sabir,
"Necessary" is probably too strong a word, since there is room for disagreement in these decisions, but Dr. West did list pleural invasion as one of the factors which makes adjuvant chemo a consideration after stage Ib surgery, as it raises the risk of recurrence: http://cancergrace.org/lung/2007/10/02/factors-for-adj-chemo-in-borderl…
JimC
Forum moderator
Reply # - June 14, 2013, 10:10 AM
Reply To: Non-small cell lung cancer stage 1B
We rarely favor chemotherapy for a node-negative NSCLC tumor that has been resected and is less than 4 cm, let alone 2.5 cm. If we know that a cancer goes back many, many years and took so long to progress, that would only lead to even less enthusiasm for giving post-operative chemotherapy. I would say that the vast majority of lung cancer specialists would not favor post-operative chemo in such a situation -- the prognosis is too favorable without chemotherapy to accept the short-term and potentially longer-term side effects of challenging chemotherapy.
Good luck.
-Dr. West
Reply # - June 14, 2013, 08:29 PM
Reply To: Non-small cell lung cancer stage 1B
Dear Dr. West,
Thank you very much for your quick response and valuable opinion regarding my case. I am now pretty much optimistic about the prognosis of my disease; however, have you considered my pleural invasion because it is one of the important factors regarding the prognosis? I know, I don't have any node involvement and it is a good sign and based on this negative nodal involvement do you think that no adjuvant therapy is required for me?
Awaiting your response.
Thank you once again for your support.
Regards,
Sabir
Reply # - June 14, 2013, 08:43 PM
Reply To: Non-small cell lung cancer stage 1B
Dear JimC,
Thanks for your response and I am really impressed.
Regards,
Sabir
Reply # - June 14, 2013, 08:52 PM
Reply To: Non-small cell lung cancer stage 1B
Yes. Pleural invasion is a factor, but a relatively minor one. I don't intend to provide a medical recommendation for you, but rather to say that pleural invasion doesn't necessarily vault a <3 cm node-negative cancer into the range for which chemo would be advised. The prevailing standard of care for a <4 cm node-negative resected lung cancer is no chemo, whether there is pleural invasion or not.
-Dr. West
Reply # - June 14, 2013, 10:05 PM
Reply To: Non-small cell lung cancer stage 1B
Dear Dr. West,
Thank you so much for providing me your valuable opinion and I hope it would be helpful for me to discuss with my specialists regarding my management plan. If needed, I will seek advice from you again.
Thank you once again.
Regards,
Sabir