Hi, Dr. West,
We heard so much about your expertise in BAC lung cancer. We would like to ask you some questions. Please help! To save your time, I make her story short.
In July 2011, my wife had stage IB lung cancer. She was 46 years old then. She is eastern Asian, non smoker. She had her right upper lobe removed. The single tumor was 3.2 cm. Pathology report stated that her cancer was adenocarcinoma mixed subtype (papillary, bronchioloalveolar, and acinar), well differentiated, visceral pleural invasion present. All lymph nodes are negative. Nowhere else had cancer. She finished 4 rounds of cisplatin/alimta chemotherapy in November 2011.
She had follow up CT or PET Scans every year since 2012. In February 2015, CT discovered that she had a new 7mm nodule at right lower lobe. Then the nodule was measured at 6mm in April 2015 PET Scan and July 2015 CT, 9mm in January 2016 PET Scan, 6mm in February 2016 CT and 10mm in June 2016 CT. Two new smaller nodules (both 3mm) at right lower lobe were discovered in June 2016 CT, too. We had a biopsy in July and pathology confirmed that the big nodule is the same cancer as in year 2011.
Her doctor recommends Tarceva as next therapy.
Given the history above, I have the following questions:
Does my wife’s adenocarcinoma have BAC features?
Is her lung cancer considered slow growing?
Is Tarceva the best therapy she should have now?
Do you think you can help her and she needs to schedule appointment to see you?
Reply # - August 7, 2016, 06:46 AM
Welcome to GRACE. I'm sorry to hear of your wife's diagnosis, but it is encouraging that since that time and her surgery, her cancer has indeed remained slow-growing. The pathology seems to confirm that BAC is present, and the pace of growth is consistent with that. Dr. West has written an algorithm to help guide treatment decisions for such indolent cancers, and as you can see when there is slow growth, watchful waiting is recommended. If the pace of growth quickens to the extent treatment is considered necessary, then Tarceva would be appropriate if there is an activating EGFR mutation (or Xalkori would be the choice if ALK+), otherwise standard chemotherapy would be given.
I hope that the pace of her disease remains slow for a very long time.
Reply # - August 11, 2016, 04:53 AM
Our history is similar. I have been following slow growing nodules for 8 years and had two removed but another came back. My doctor recommends annual scans and careful watching, which I believe is consistent with Dr. West approach. Based on my conversations with several doctors at several hospitals, the suggested treatment varies. I opted for no further treatment and challenged those doctors who suggested treatment to provide me with studies of how such treatment in my slow growing indolent case improved my chances.
Never-smoker tracked two nodules since 11/2008 with regular scans. Estimated 15 % growth over 2 1/2 years. VATS surgery 3/21/2011 removed lower right lobe. Diagnosed IIB Adeno with BAC features. Opted against chemo due to indolent nature. Scans 6/29/2011.. Scans 9/2012, 3/2012 and 9/2012 shows 2 very small nodules, one 2 mm and other 4 mm. Scan on 4/9/2013 shows no growth. Scan 11/8/2013 shows 2 mm growth compared with 10/1/2011. New nodules were thought to be either indolent BAC or nothing. Scan 8/4/2016 shows a 10 mm well-defined groundglass nodule in right lower lung , scan on 6/2015, shows a 9 mm well-defined groundglass nodule in the right lower lung , previously was 7 mm in the CT from June 2014 and was 6 mm in the CT from November 2013, and 4 mm in the CT from April 2013. There are no new lung nodules. Scans every year.
Reply # - August 11, 2016, 05:29 PM
Thanks for sharing your experience, messagejim. It's a great example of Dr. West's philosophy of not over-treating an indolent cancer, and for you personally, it's a great success story.
I hope you continue to have uneventful scans for a very long time!
Reply # - September 19, 2017, 09:03 AM
My scan showed more of same. Still on annual scans. Had discussion regarding another potential surgery. 1.3 CM. Problem is the nodule is not easily removed and would likely involve removing an entire lower lobe. With no symptoms and approaching a full decade of watching the indolent behavior seems to me indefinite waiting and watching is a reasonable approach so long as behavior is consistent and indolent. However, At what point does the nodule become so big that it should come out (under your get the lead runner analysis) even if you lose vital lung tissue?
Reply # - September 19, 2017, 06:56 PM
It's good to get your update and hear that you're cancer is remaining indolent. As far as the question of how big is too big, I think it's a combination of factors. In your case I think the main considerations argue against removal. Those include the size of the nodule as compared to the cost of removing it (not money, but loss of lung function and the risks of surgery), lack of symptoms and the slow growth as demonstrated over a long period of time.
There may be a time when circumstances change and treatment might be favored, but I don't think it could be described strictly in terms of size.
Keep those good updates coming!