Husband was diagnosed with rcc in 1998 and had a recurrence in 2009, with spinal metastasis for which he had an operation. Shortly afterwards a CT scan picked up a nodule on his right lung which had grown to 1.5 cm in 2012 and 3.5cm by June 2014 and a much smaller nodule on his other lung, 5mm in 2012 and 1.5cm in June 2014. These nodules were assumed to be metastatic kidney cancer but when the decision was taken to ablate the larger one in June a biopsy showed that it was in fact primary lung cancer - adenocarcinoma. A PET scan was subsequently done which showed uptake in 3 mediastinal lymph nodes, following which a bronchoscopy was carried out. The cancer is now judged to be Stage IV. My question is : if those nodules were biopsied and treated in the summer of 2012, how likely is it that there would have been mediastinal lymph node involvement now and therefore Stage 4 (for which the only treatment is chemo) ?
Renal cell & lung cancers - 1266025
valentina
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Reply # - September 18, 2014, 07:41 AM
Hello valentina,
Hello valentina,
I am sorry to hear of your husband's lung cancer diagnosis. Unfortunately, lung cancer that has spread to the other lung is Stage IV, so that when the two nodules were discovered in 2012 the lung cancer cells had already reached his bloodstream eventually reaching the lymph nodes. One factor in his favor is that his cancer does not appear to have grown at a particularly aggressive rate.
I hope that treatment is effective and that your husband tolerates it well. Please let us know if you have further questions.
JimC
Forum moderator
Reply # - September 18, 2014, 07:59 PM
To be clear, having
To be clear, having mediastinal nodes involving lung cancer doesn't make it stage IV, but rather stage III. Kidney cancer spreading to mediastinal nodes or the lung would be stage IV kidney cancer.
When there is any doubt about whether enlarged nodes or metastases are from one cancer or another, we often do biopsies of the area in question to clarify. It canbe quite confusing, as you've learned.
Good luck.
-Dr. West
Reply # - September 19, 2014, 10:32 AM
Thank you, JimC and Dr West,
Thank you, JimC and Dr West, for taking the time and trouble to reply to my query so promptly. It is much appreciated. Dr West, the biopsy done after the bronchoscopy showed that the mediastinal lymph nodes are metastatic adenocarcinoma of the lung. Whilst the tumour in the left lung has not been biopsied, the Drs say that, because of the "pattern of disease", they also consider it to be lung cancer. It has been visible on scans almost as long as the one on the other lung, albeit very much smaller. On the other hand, there was no sign of enlargement of the lymph nodes until very recently.
He is not on any treatment for his kidney cancer at the moment as the spinal tumour is stable and there are no other sites of metastatic kidney disease. The treatment for the lung cancer is going to be a chemo combo : Permetrexed/Carboplatin. Our understanding is that no other treatment is possible and that the chemo might not work at all or, at best, just give him a bit of extra time. Still, it is true, as JimC said, that the lung cancer does not seem to be particularly aggressive and he is still around nearly 16 years after the kidney cancer diagnosis and subsequent nephrectomy, so maybe the picture isn't quite as bleak as we perceive it to be at the moment.
With renewed thanks and kind regards,
Valentina
Reply # - September 19, 2014, 04:28 PM
Valentina,
Valentina,
The carboplatin/pemetrexed combination is a good one for many patients and tends to be very well tolerated by most. While treatment for stage IV NSCLC isn't curative, many people do get benefits that extend several months and sometimes into years. Accordingly, if a treatment is well tolerated and can confer a survival benefit of months to potentially years, it can be very worthwhile even if it can't be considered miraculous.
Good luck.
-Dr. West
Reply # - September 21, 2014, 04:24 AM
Thank you, Dr West. I wonder
Thank you, Dr West. I wonder if I could ask your opinion on another couple of points in order to complete the picture ?
1. Has the lung disease progressed beyond the stage where it could be dealt with by SBRT (eg Cyberknife) or RFA ? Could the 3 lymph nodes be excised ?
2. Would the outcome have been changed if the two lung tumours had been treated 2-3 years ago ?
Thank you again,
Best regards,
Valentina
Reply # - September 21, 2014, 07:11 AM
Hi Valentina,
Hi Valentina,
The general principle is that local treatment such as radiation or surgery (or RFA) is not used when lung cancer has spread to the bloodstream. You can read about this principle here: http://cancergrace.org/cancer-101/2011/01/01/cancer-101-faq-i-have-meta…
This would have been the same thinking when the tumors were first discovered, since the cancer cells would have reached the other lung through the bloodstream, indicating that the cancer could appear anywhere in the body as described in the FAQ above.
JimC
Forum moderator
Reply # - September 21, 2014, 09:24 AM
If he had metastatic disease
If he had metastatic disease years ago, as you say he did, it wasn't curable then, just as it isn't now. SBRT is really appropriate primarily for a node-negative smaller tumor -- once there are lymph nodes involved, SBRT is really not the ideal approach. And there is no setting in which RFA has been shown to be an appropriate strategy in lung cancer. In 15 years of having a primary specialty in lung cancer, I've almost never had a case where RFA was a strong consideration, and I've had exactly zero who seemed to be strong candidates and could also get it. With SBRT becoming more widely available and the world getting more experience with it, I have trouble seeing any reason to ever consider RFA -- SBRT is often the right tool for the job, just not the right tool in this case.
-Dr. West
Reply # - September 22, 2014, 04:16 AM
Thank you so much, JimC and
Thank you so much, JimC and Dr West. Those replies are very informative and very helpful. I'm very grateful to you both. What a great site this is !
Kind regards,
Valentina