liver ttf1 positive - lung cancer - 1257776

Hi Terry, First please don't apologize, your english in very good, better in fact than many native speakers.
Welcome to Grace, I'm very sorry your dad and you are going through this.

I will ask a doctor to comment on your post.

All the best hopes,
Janine
forum moderator

I'm sorry about your father's recent findings.

The fact that the cancer is positive for TTF-1, or thyroid transcription factor-1, strongly suggests that the cancer originated in the lung or possibly the thyroid. Some other markers may help clarify lung or thyroid origin, but lung cancer spreading to the liver is far more common.

I agree that a PET-CT scan makes sense to see if a hypermetabolic (i.e., suggestive of cancer) lesion is present in the chest. If so, that would clearly fit with this actually being a separate lung cancer that has spread to the liver. In fact, even if a chest lesion is not found, treating it like a metastatic lung cancer would be a very appropriate strategy, especially since some of the same drugs will work for many metastatic cancers.

Good luck.

-Dr. West

Hi Terry

i echo Janine, your English is excellent and i'm sorry about your dad.

In general most doctors like to use one diagnosis to explain as many abnormalities as possible - why say your dad has two cancers when we could explain it all by one? and this is usually true in biology.

first - liver cysts are common, usually they don't need to be biopsied.

you have brought up some complicated questions that make me wonder if there may be two things going on.
1. the way pathologists (and i am NOT a pathologist) decide what kind of cancer they are looking at is primarily by what it looks like under the microscope. there are patterns that are common for different cancers and these depend on the cell of origin (where the cancer started - lung, colon, breast, etc). if they are less sure, or sometimes just as a routine, they will add on some "immunohistochemical" (IHC) stains - this can help narrow down a diagnosis or point the clinicians in a particular direction. most of the time they say that these IHC tests "suggest" a particular origin, but the IHC tests are not more definite that what the cells just look like without those stains.
2. TTF1 is often positive in lung cancers, i don't know if it's sometimes positive in colon cancer, but there would be other IHC tests that might also help distinguish between these two cancers, they likely did several IHC tests of different kinds. and of course sometimes an IHC test can be wrong. so it's interesting but i wouldn't say it definitely means he also has lung cancer.
3. a PET scan is a great idea. especially because he does have a "spiculated" mass in the lung and even though it was biopsied maybe just maybe it actually is a cancer. so the PET will really help and he might need that lung spot biopsied again.

i know it's very stressful to wait for the results of those other IHC tests and the PET scan but it is really crucial that we know if this is one thing or two.

best of luck

Dr Laskin

The original lung lesion sounds like it may have been a primary lung cancer. For spiculated, PET-positive lung nodules that appear suspicious for lung cancer, many thoracic oncologists will skip biopsy and proceed straight to resection with a lobectomy, if it is safe. The problem is that simple CT-guided biopsies may miss the actual tumor, causing an equivocal or a false negative result. It all depends on the context.

In this case, though, it sounds like the lung lesion has metastased to the liver, so surgery is not currently an option. I'm sorry, this sounds like a rough spot for him and your family, to have beat colon cancer only to find out another cancer in an advanced stage. For this type of situation, carboplatin with Alimta is a very good and reasonable treatment to start. In this setting, many oncologists would also do mutation testing for EGFR and ALK on the biopsied liver tumor, although I would not delay chemotherapy for this. Hope this helps. Good luck, and God bless him and your family.

I just wanted to take this opportunity to give a Big Thank You to Dr. Creelan for all his work on Grace as of late.

We're lucky to have you and you're a terrific help!

Janine

Me, too. It's noticed and very much appreciated by me as well, and I'm sure many other people checking in here are excited and gratified to have you providing such thoughtful insights.

-Dr. West