Husband has been on Tarceva for almost 11 months.
Recent CAT scan showed a precarinal lymph node mearsuring 1.9 x 1.4 cm. This was subcentimeter in size on the prior study. No new nodes. What does this all mean and what does subcentimeter in size mean?
Also, an irregular lesion in the posterior right upper lobe measuring currently 1.2 x 3.0 cm. The lesion has become more confluent compared to the prior study although it is difficult to precisely measure similarly. The overall measurements appear about the same but the lesion appears morphologically fuller. Slight progression is suspected. No new findings are noted. What does this mean and what does morphologically fuller mean.
The impression reads: although no significantly changes in size, the primary lesion in the right lung appears 4 from a morphologic stem point suggesting slight progression. New precarinal lymph node.
Is this reason to change Tarceva at this point? Also I do not remember the radiologist mentioning a lesion in the right upper lobe in a previous CAT scan.
Thanks for your help!
K
Reply # - October 28, 2014, 04:56 PM
Hi K,
Hi K,
When the radiologist who wrote the previous scan report said that the lymph node was "subcentimeter", he or she meant that its diameter (if round, otherwise its longest dimension) measured less than a centimeter. As far as the lesion in the right upper lobe, the report suggests that the cells that form the lesion have grown closer together, that there is less empty space within the outer boundaries of the lesion. The report seems to indicate a comparison of that lesion to the prior scan, so it might be good to review the previous report; the radiologist certainly thinks it was mentioned.
The doctors here have often expressed the opinion that a patient should not rush to switch from a targeted therapy which has been effective for a significant period of time (as yours has). Dr. West uses the analogy of “bad brakes vs. no brakes” – if the targeted therapy continues to keep progression at a slow rate, that may be a better result than the unknown effect of a different drug. Furthermore, although new drugs are always being tested and approved, there are a limited number of them available, and you want to get the maximum benefit from each one you use. As Dr. West recently stated: "We don’t like to discard effective therapies too early."
It would be good to discuss with your oncologist whether this represents significant enough progression to warrant a change of treatment.
JimC
Forum moderator
Reply # - October 28, 2014, 07:37 PM
Jim provided a very good
Jim provided a very good summary. Because we can't provide a detailed interpretation of people's scans and can't make treatment recommendations for people who aren't our patients, we can really only say that the findings suggest rather mild progression of the cancer based on imaging, but it is really a judgment whether that progression is significant enough to warrant making a switch from prior therapy. That's a decision to make in discussion with his oncologist, but don't presume that it's necessary to make a change.
Good luck.
-Dr. West
Reply # - October 29, 2014, 07:45 AM
Thank your replies.
Thank your replies.
JimC: we went back to look at the previous CT and there is no mention of a right upper lobe lesion (at all). His primary was located in the right lower lobe. So I don't quite understand this, but we are meeting with the oncologist today so we'll get some clarification.
Thank you!
Reply # - October 29, 2014, 07:59 AM
Perhaps just the most obvious
Perhaps just the most obvious, simplest explanation: the current report might contain an erroneous reference to "upper" when the radiologist meant "lower".
JimC
Forum moderator
Reply # - October 30, 2014, 07:02 AM
Updating from previous
Updating from previous conversations... regarding the report from a local facility, in my opinion it was not a very good report in terms of how he interpreted the scan (IMOO). The radiologist at the cancer center did do his own readings from the CD's. His impression was:
1. Mixed response with a stable to overall slightly smaller solid component of cavitary lesion in the superior segment of the right lower lobe; however, interval enlargement of an 18 mm precarinal lymph node.
2. Stable osseous metastases.
We met with the oncologist who went over the reports. We discussed the precarinal lymph node, that it could be an infection or an inflammation and that the plan is to stay on Tarceva. Oncologist feels it's too early to say if Tarceva is losing it's effectiveness. She did say if it's not infection that it could be the tip of the iceberg than would have to do another biopsy.
He has had lymph node enlargement before... when you have lung cancer isn't this pretty much expected? I know that the precarinal lymph node is near his windpipe, would he have symptoms to suggest that it's getting larger?
Thank you!
K
Reply # - October 30, 2014, 08:07 AM
Hi K,
Hi K,
It sounds as though the controversy about a lesion in the right upper lobe has been resolved, and that you're only dealing with the existing lesion in the lower part of the lobe. So that's a very good development. As your husband's doctor has determined, enlargement of a single lymph node, though it bears watching, is not strong evidence of progression. Remaining on Tarceva and following up with scans is a very reasonable course of action.
Whether there are symptoms from an enlarged lymph node near the windpipe would depend on how close it is and how large it gets. If it he develops symptoms, he would want to report them to his doctor in a timely fashion.
JimC
Forum moderator
Reply # - October 30, 2014, 05:37 PM
I agree that it sounds like
I agree that it sounds like the precarinal node is potentially progression but not necessarily compelling as clinically significant progression necessitating a change in treatment. Disease progression is the more likely cause but certainly not the only explanation. However, it's profoundly reasonable to stay the course even if a little progression may be occurring.
A cough or shortness of breath could occur with lymph node progression, but I suspect that's not likely if the cancer is growing in a mild, subtle way.
Good luck.
-Dr. West
Reply # - February 10, 2015, 09:46 AM
Hi:
Hi:
This is a follow-up from October 2014. My husband had his 3 month CAT scan in January 2015; unfortunately, there is some progression in the primary and the precarinal lymph node. However, his spine is stable.
He is Stage IV EGFR Exon 21 and has been on Tarceva for 14 months.
The oncologist mentioned radiation, but wants to wait until the next CAT scan at the end of April.
My questions is:
1) Why radiation as oppose to chemotherapy?
2) Can he still stay on Tarceva while getting the radiation?
3) Is there much success with doing radiation and Tarceva?
Also, my husband got radiation enteritis from radiation to the spine. Is there a risk to getting this again if he were to get radiation?
Thank you!
K
Reply # - February 10, 2015, 10:47 AM
Hi K,
Hi K,
Normally, local treatment such as radiation is not recommended for patients with metastatic lung cancer, but there are exceptions. It's possible that your husband's doctor is concerned about the lymph node causing problems as it grows, and when a cancerous growth causes significant pain or presses on a vital structure, radiation may be used to prevent that or relieve symptoms.
If the radiation is confined to the chest and does not pass through the digestive tract, it is unlikely to cause enteritis.
JimC
Forum moderator
Reply # - February 15, 2015, 02:14 PM
JimC: thank you for your
JimC: thank you for your reply. What kind of radiation is usually done on a precarinal lymph node... cyberknife?
K
Reply # - February 16, 2015, 08:04 AM
Hi K,
Hi K,
If the target is something small such as a lymph node, I would expect that a form of stereotactic body radiation therapy (SBRT) such as Cyberknife would be used. You can read about SBRT in Dr. Mehta's podcast and post.
JimC
Forum moderator
Reply # - February 16, 2015, 08:17 AM
K,
K,
Cyberknife is another term for stereotactic radiation and is radiation given in high doses to an even more well defined area. It's become common practice to give this type of radiation for brain metastases when there are only a couple or very few mets to treat. More recently it's been given to some lung tumors thought to be specifically suited to its attributes. Safety to normal tissue is one of the biggest hurdles to overcome when deciding if SBRT (stereotactic body radiation therapy) is a wise choice. Another question is whether or not the entire tumor can be ablated.
Following is a podcast on the subject, http://cancergrace.org/radiation/2012/11/10/defining-role-for-sbrt-in-l…
All best,
Janine