Second primary and maybe third? - 1261620

Hi falstaff, I'm sorry your father is experiencing new cancer. It seems every person's cancer is complicated and individual but your father's seems especially so. Since it does seem (to me) very specific I'll poke Dr. West for input.

All the best to your father, you and your family,
Janine

The 4 year interval and the difference in tumor histology definitely argue strongly that his current cancer is independent and not a recurrence of his old one. As for the intercostal muscle, I'm puzzled by the report that the spot was so small that it was nearly microscopic yet must have been large enough to be very hard -- an incredibly tiny focus of disease doesn't harden the tissue. Regardless, I think you need to see what the pathology is and take things from there. If chemotherapy isn't feasible because of his CLL, then that's a limitation that may well help make the decision of whatever subsequent treatment may or may not be safely done.

Good luck.

-Dr. West

A metastasis outside the lung of primary tumor isn't considered curable but is treatable. If no nodes are thought to be affected then yes cancer is expected to have traveled in the bloodstream and remains in the bloodstream thus is expected to show up somewhere else.

Systemic therapy is the treatment used to keep the cancer at bay; in many cases for a couple to several years. Our faculty doctors are known to repeat themselves to make a point often lost on those who haven't dealt with cancer day to day, Dr. Weiss puts it really well in his blog post, Intro to first line therapy.., "Every cancer therapy has two purposes: to improve duration of life, and to improve quality of life. Every other measure of chemotherapy success, such as response rate or progression-free-survival, is a surrogate to these two true goals. I am using the broken record as my pseudo-apology for repeating this mantra repeatedly on GRACE, to my colleagues, and in my mind every time I make a treatment decision.

"Chemotherapy is the most important treatment for achieving these two goals in stage IV disease. Stage IV means that the cancer has spread and is no longer curable. Incurable is not the same as untreatable. Cure means eliminating every last cancer cell. Treatment means providing real benefit, in the form of achieving these two goals." http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-thera…

http://cancergrace.org/lung/2010/09/18/lung-faq-ive-just-been-diagnosed…

An excellent start to molecular markers, though your dad is highly unlikely to have treatable mutations outside clinical trials since his cancer is squam. http://cancergrace.org/lung/2010/10/10/overview-of-molecular-markers-in…

This should get you off to a good start. I'm so sorry you have the need to come to Grace but we are here to help answer questions and share info.

Best,
Janine

With a squamous cancer in both the lung and chest wall, this is highly suggestive that the cancer has spread via the bloodstream through to the chest wall from the primary tumor in the lung. It would be fair to call it oligometastatic ("literally, "few metastases") stage IV lung cancer

The challenge is that, as you indicted in your question, the presence of one metastases almost always means that there are other micrometastases that aren't visible on scans, but they're likely to emerge later. In terms of what exactly to do after surgery, with no evidence of residual disease, there is no clear answer. You could arguably consider it similar to resection of an early stage NSCLC, in which there is still a risk for micrometastases causing visible recurrence months or years later, but with a very high probability of recurrence expected. There have been patients with a solitary lesion to the brain or adrenal gland who have gone years and years without progression; theoretically, we might expect to see long-term survivors after resection or some other definitive treatment for a solitary bone or muscle lesion or liver metastasis, but I've never seen or heard of such good results in these circumstances, I'm sorry to say.

Chemotherapy, similar to "adjuvant chemotherapy" after surgery for an early stage NSCLC, would be reasonable to recommend in hopes of eradicating the last cancer cell, though that's a very ambitious goal. Radiation might also be done in the area around the chest wall/muscle lesion, but there is no evidence that Cyber knife would be helpful here. That approach is really used to treat disease that remains visible, not typically for treating an area that has been resected already.

On the other end of the spectrum, one could consider this stage IV lung cancer that now has no evidence of disease and may go a very long time before showing any further evidence of disease, for which systemic therapy (such as chemo) could be deferred until "needed".