At 64, I was diagnosed with lung cancer Aug 22, 2014 via CAT scan, ( which showed an 8 cm mass on my right, lower lung), bronchial washing of the right lobe ( showing squamous cells), and needle biopsy. Since lympth nodes were clear, a thoracic surgeon scheduled surgery for Sept 23. However, a PET scan completed Sept 22 showed a lesion on my bottom rib. The surgeon cancelled the surgery and is making me an appointment with an oncologist. The lympth nodes are still clear but the surgeon is now concerned if cancer is in bone. Is this new discovery of bone lesion, as grim as I am reading? I truly thought since the lymph nodes were clear that I had a small chance of survival in years. But, with bone lesion, am I now looking at months--with or without treatment?
Thank you.
Lung cancer to the rib - 1266123
nita
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Reply # - September 25, 2014, 09:43 AM
Hi Nita,
Hi Nita,
Welcome to GRACE. I am sorry to hear of your diagnosis. I hope that we will be able to provide you with helpful information.
It is true that if the lung cancer has metastasized to the rib, the staging would change from IIIa to IV. Though that means that median and five-year survival rates are lower, it does NOT mean that you are looking at months rather than years, especially with treatment. Though some patients have a cancer which is very aggressive and they do not meet the median survival time of 10-12 months for Stage IV lung cancer, by definition half of Stage IV lung cancer patients live longer than that, some quite a bit longer. As you look around the GRACE site, if you read the profiles of various members, you will see that survival of years rather than months is not uncommon.
Without access to all of your scans and other medical information, it is impossible for us to know how likely it is that the finding on your rib is cancer. When you meet with your oncologist, he or she will be able to give you a better idea about that, perhaps suggesting a biopsy to confirm the suspicion.
Though local treatment such as surgery or radiation is not normally used in the Stage IV setting unless a tumor is causing pain, pressing on a vital structure or other symptoms, there is the concept of the precocious metastasis, in which the cancer appears to have spread to only one distant location. In such cases, radiation or surgery may be recommended. This concept is described in these posts:
http://cancergrace.org/lung/2012/01/29/right-and-wrong-reasons-for-loca…
http://cancergrace.org/lung/2010/09/07/local-therap-for-metastatic-dise…
JimC
Forum moderator
[continued]
Reply # - September 25, 2014, 09:46 AM
[continued from previous post
[continued from previous post]
You may want to discuss this possibility with your oncologist. Otherwise, in the Stage IV setting, chemotherapy or targeted therapy would be the standard practice. With squamous lung cancer, your odds of having an activating mutation, for which targeted therapy might be used, are not high and therefore mutation testing is not normally ordered, it might still be recommended by your oncologist.
Here is a new video Dr. West put out on the subject. http://cancergrace.org/topic/brief-video-on-my-changing-perspective-on-… ” – http://cancergrace.org/topic/anyone-with-squamous-cell-and-egfr-mutatio…
In addition Dr. West has said:
”[EGFR mutations are] probably in the range of 1-2% of patients with squamous cell NSCLC, so not common, but definitely possible. Many cancers show some heterogeneous characteristics, so it’s possible that many cases will have a mix of squamous and adenocarcinoma.
“As I mention in the video, we’re still limited by only really finding mutations where you look for them, so we can’t say that much about mutations in squamous cell NSCLC because we haven’t looked exhaustively enough to really know.”
As an overview of lung cancer, it may also help to read Dr. Weiss' "An Introduction to Lung Cancer" here: http://cancergrace.org/lung/2010/04/05/an-introduction-to-lung-cancer/
Good luck with your meeting and the treatment plan chosen. Please let us know if you have further questions.
JimC
Forum moderator
Reply # - September 25, 2014, 12:54 PM
Jim: Thank you so much for
Jim: Thank you so much for your reply, so soon. I am truly " weak in the knees". I have always professed that I would forgo quantity over quality of life. But it's different now that the " quantity" is at my front door. Thank you again.
Sent from my iPad
Reply # - September 25, 2014, 08:13 PM
Nita,
Nita,
I would underscore that:
1) If the picture doesn't fit well for this being metastatic, such as there being just a solitary lesion as the apparent metastatic disease and no evidence of nodal involvement, it's worth clarifying that the spot is cancer and not an unrelated lesion, such as caused by some trauma.
2) if it's confirmed as stage IV, prognosis changes, but there are many people right here in this community, including looking no further than this page, to see examples of patients with stage IV disease who live for years rather than months.
Good luck.
-Dr. West
Reply # - September 29, 2014, 04:35 PM
Dr. West:
Dr. West:
I want to thank you for responding. I would have written sooner, but my first meeting with the Oncologist was today and i knew I would/might need clarification. He showed me the PET which clearly showed 2 areas-one on the lower right lobe and the other on the 3rd rib from the bottom right. His plan is two months of Abraxane and Carboplatin. (Once a week every 3 weeks ) If the two areas respond, surgery will be explored.
I was feeling a little optimistic until he said " the median longevity is 7 to 11 months." I was so in "ah" that I didn't t ask if this is with treatment or no treatment. My question, is the above combination of chemo favorable for improving my odds in going beyond the one year? I am aware there is no cure but having trouble again with the quantity.
I truly appreciate your time. Nita
Reply # - September 29, 2014, 06:32 PM
Hi Nita,
Hi Nita,
As Dr. West said, if it appears that the apparent bone lesion is the only factor which makes your cancer Stage IV, then it is worthwhile to make certain that it actually is cancer and not something else. The two spots may be "clearly shown" on the PET scan, but all that scan is telling you is that there is something there which lights up on the scan. In Dr. West's example, a bone lesion could be from trauma. Only a biopsy would confirm that it's cancer.
Medians are only that - half of the patients do worse and half do better, so it's good to think of yourself in that group which does better. And the chemo regimen you have chosen certainly can get you there. The fact that your cancer has not spread widely is also a positive factor, along with generally good health.
Good luck with your treatments; please keep us updated.
JimC
Forum moderator
Reply # - September 29, 2014, 09:30 PM
To address your specific
To address your specific questions, the 7-11 month median survival is with chemotherapy, but it would not be uncommon for patients to live beyond a year, and some patients do live well beyond a year. Chemotherapy would very significantly improve the odds compared with not doing chemotherapy.
Good luck.
-Dr. West
Reply # - October 11, 2014, 04:32 AM
Dear Dr. West and Jim
Dear Dr. West and Jim
Chemo was scheduled to begin Oct. 6. However an MRI of my brain completed the previous Friday showed a small lesion ( right side). I was immediately ( same day) referred to a neurologist who assured me this was not in an area that caused adverse cognitive effects.(my initial concern) He referred me to a radiologist where we completed another MRI with more detail ( slice?). He will call this week with the results and to set up an appointment for Cyberknife. He feels (based on the 1st MRI) one Cyber knife procedure will suffice. My question/comment: since my first chest x Ray in August I have seen 7 specialist and I can't help but feel by the time we get around to the treatment stage, my original 8 cm lung mass will have grown beyond the chemo or surgery's benefit. I am humbly grateful for their expertise. But is this the normal procedure for diagnosis and treatment?
Thank you again.
Nita
Sent from my iPad
Reply # - October 11, 2014, 05:33 AM
Hi Nita,
Hi Nita,
It's typical for lung cancer workup to feel as though it's taking forever, but your timeline is not unusual, especially since your initial diagnosis changed over the course of that workup. Dr. West has written a post on the timeliness of lung cancer workup, in which he stated:
"Even a timely, expedited workup is a journey that is likely to take a minimum of 3-4 and likely up to 6 or 8 weeks, just do get through all of the necessary steps, even without anyone dragging their heels and with good access to tests and specialists." - http://cancergrace.org/lung/2008/09/12/time-line-for-lc-workup/
The main concerns in any delay would be that an early stage cancer progresses to a later stage, or that a patient's overall condition worsens to the extent that they are no longer healthy enough for chemo. Neither of those issues appear to apply to your situation, so delaying chemo by a couple of weeks is not likely to make a significant difference.
Good luck with the radiation therapy and chemo.
JimC
Forum moderator
Reply # - October 20, 2014, 04:45 PM
Dear Dr. West and Jim:
Dear Dr. West and Jim:
I completed my Cyberknife treatment today. Based on the neurologist, I will not need additional treatments, at this time.
The appointment with the oncologist, I am learning is always disheartening. According to him, the plan for surgery "is no longer an option" since the brain mets. Chemo will begin Monday with Carboplatin with Gemcitabine ( instead of Abraxium). We will evaluate the effectiveness of this combination in 2 months and plan accordingly.
My question, and didn't think to ask, why would the brain mets not allow surgery on the lung areas? Wouldn't surgery, followed by chemo be effective for quality and quantity?
My husband read this as " no surgery" means you are too advanced for it to be of any benefit. He even teared up in the car. I am trying to prepare my family with optimism but I don't want them to have false hope.
Again, thank you. I truly appreciate any comments and/or advice you could provide.
Nita
Reply # - October 20, 2014, 07:02 PM
My read from what you've
My read from what you've described is that there is evidence of a brain metastasis and a rib metastasis. In the setting of metastatic lung cancer, especially if there is more than one metastatic lesion, surgery would not be expected to have a meaningful chance of being curative. It simply would not be helpful and would only cause the challenges of surgery with no counterbalancing chance of cure, I'm sorry to say.
-Dr. West