I have asked question and received feedback from JimC, the moderator, and Dr. West. I have learned a lot and I appreciate it.
I have one more question but before I ask I will summarize my condition.
I have had multiple lung ground glass nodules in my lungs at least since 2005. None increased in size significantly until my last yearly CT taken in June 2014. That CT showed two had grown from 0.6cm to 1cm. These were in right upper lobe and right middle lobe but they have been removed together with two other lesions. The 1cm tumor in right middle lobe was classified as INVASIVE WELL DIFFERENTIATED ADENOCARCINOMA and the tumor in right upper lobe is classified as INVASIVE MODERATELY DIFFERENTIATED ADENOCARCINOMA. Thanks to JimC and Dr. West I know understand that these are slow growing cancers relatively speaking. I know have about 8 nodules 3-5mm in size spread in both lungs.
My questions are the following:
1) Have studies shown that multiple nodules in a person are all the same or different? Can we assume the remaining nodules in my lungs will behave like those removed surgically?
2) Is there anything known about what may trigger dormant nodules to start growing all of a sudden?
Reply # - September 9, 2014, 12:27 PM
Hi bonaya,
Hi bonaya,
Thank you for your kind thoughts.I may be biased, but I think that Dr. West has created something quite special here at GRACE.
In the past, it was assumed that if you biopsied one nodule you had a good handle on the histology of the other nodules. Although that it is still generally the case, oncologists are now seeing more instances in which a mixed response to treatment (in which some nodules or tumors shrink while others grow) is attributable to differences in the characteristics of the various nodules. It's not practical to biopsy every nodule, but it can be helpful to rebiopsy when progression occurs.
Unfortunately, not much is known about why nodules suddenly seem to grow. Cancer is all about mutations, and at times it is possible to point to a new mutation which has made particular cancer cells resistant to treatment, but that is a developing field which only encompasses a limited percentage of patients, such as those with EGFR mutations.
JimC
Forum moderator
Reply # - September 9, 2014, 12:41 PM
Hi bonaya,
Hi bonaya,
Nodules can begin as the same process but change independent of other nodules. I think the best examples are your slow growing nodules one classified as well differentiated and the other as moderately differentiated.
In the patient conference held last Saturday the doctors discussed repeat biopsies and the importance of understanding the biology of the cancer as it is today not last year as it relates to targeted therapies. However I think it pointed out just how much cancer changes over time even from one nodule to the next.
Dr. West has provided a presentation about how cancer adapts. http://cancergrace.org/cancer-101/2014/03/23/cancer-evolution-adaptatio…. Also there is more on the subject in the drop down menu above titled "General Cancer Info" click and pick the basic cancer info, http://cancergrace.org/cancer-101/
It's certainly of interest to me since my husband may still harbor very indolent cancer.
I hope this helps,
Janine
Reply # - September 9, 2014, 07:53 PM
There is always a small
There is always a small chance, perhaps 1% per year, that a slow-growing cancer will fundamentally change its behavior. This is really because a cancer acting a certain way can suddenly develop a random new mutation that changes it to a fast growing cancer. But if a cancer has been observed for a while and is consistently slow-growing, it's fair to expect it to continue to be slow-growing. And even if there is a very small chance of it changing its behavior, if that risk is lower than the risk of harm from over-treating the cancer, it's worth accepting a small risk and following things over time.
Good luck.
-Dr. West