Is this Adenocarcinoma??? Or is there any other disease possibility??? - 1267431

Hi raghav93,

I don't think the CEA value tells you much in this situation, as it is generally not a reliable indicator of whether cancer is present or progressing. For some patients it seems to correlate, but for most it does not.

The fact that chemotherapy cleared up the pleural nodules and shrank the lung mass certainly suggests that it was cancer, and even though your mother has had many negative biopsies, she did have one that was suggestive of adenocarcinoma.

Unfortunately it sounds as though this is one of those cases in which the diagnosis is elusive, and I'm sorry that anything we say here would be more in the way of guesswork.

Good luck in getting some answers that lead to effective treatment.

JimC
Forum moderator

I'd be the last person to say it's so unlikely so ignore it because my husband's history is so unusual. (edit to finish the thought, however it's not useful to look for the least of possibilities when treating cancer. Plus) It appears Lymphoepithelioma-like carcinoma (LELC) of lung is treated like nsclc and wouldn't change the treatment. Even so I'm afraid we can't help you guess what may or may not be happening with your mother. The bigger questions maybe whether or not the treatment would change and that answer seems to be no.

If you're doubtful your mother has cancer and the masses shrank because they would have no matter what is a different question and can only be answered by those closely involved with the case including a second opinion if you're in doubt.

On a personal note I understand the worry that your mother may not have an exact diagnosis, my husband may not have either. We did know he had the primary cancer tumor but after that had to do what we thought was the best at the time with what we knew. It was maddening. But knowing more and looking back I'm good with the decisions. Cancer is a horrible disease and will do what it can to under mind our best.

Don't hesitate to ask further questions and we will do our best to help you to come to an understanding that best benefits your mother.

Janine

I would side with Jim's assessment that this is really unknowable right now. It's not rare for an effusion to just not yield a clear result (i.e., cancer cells) even when it's caused by cancer, but effusions are also commonly caused by inflammation or sometimes infection. The CEA is not a reliable marker from which to draw conclusions.

As Jim said, when something that looks like cancer then shrinks on chemotherapy, it's pretty good evidence, but of course we would ALWAYS want a firm tissue diagnosis when possible. Not getting a clear diagnosis after the vast majority has responded just isn't that helpful.

Good luck.

-Dr. West

Lymphocytes represent the body's immune response, so it's certainly possible that the immune system is trying to mount a response against the cancer, and that's perhaps why there's an infiltrate. Or possibly there's an infectious component as well, and the lymphocytic infiltrate is responding to that, which may be right alongside the cancer.

Otherwise, it's definitely possible for a lung cancer to have a combination of adenocarcinoma and squamous components. In fact, about 5% of lung cancers have such a "mixed histology".

-Dr. West

Dr. West answered your question before I could even try but I'll leave my info as is.

Dr. West often reminds us that cancer can do anything so it's not surprising that a paper published last year states,
"Only seventeen cases of pulmonary adenocarcinoma with massive lymphocytic infiltration (AMLI) have been reported in literature so far." http://www.biomedcentral.com/1471-2466/13/44

As someone who reads most that's written here, 17 reported cases ever is as close to 0 as nsclc is going to get. The American Cancer Society estimates 224,210 new cases of lung cancer in the US this year alone.

One answer to any cancer question is never say never. So it makes the questions as endless.

I'm curious why you ask. I don't mean to suggest any question is inappropriate. However our oncologist faculty have limited time on any given day so we want to make their time here count for as many people as possible. So go ahead and ask the questions you have and will try to get you where you need to be.

All best,
Janine