only 7% shrinkage after chemo and radiation - 1293645

Hi jkkwok1,

Welcome to GRACE. I'm sorry to hear that so far you've only seen 7% shrinkage, and I hope that you do continue to get further reductions in the size of your nodules. The full effect of radiation treatments can take quite a while to become fully evident, so there is that possibility.

Since crizotinib has been suggested as the next treatment if there is disease progression, I assume that your cancer cells have been tested for certain genetic abnormalities, which has revealed an ALK rearrangement. Crizotinib is specifically designed to target cancer cells bearing the ALK rearrangement, and such targeted therapies can be extremely effective.

Although that means that NED (no evidence of disease) is still a possible outcome, you should be aware that many patients manage to keep their cancer stable for long periods of time before switching to another therapy. In the case of ALK inhibitors such as crizotinib, there are next-generation inhibitors that can be effective should crizotinib cease working. In addition, there are other standard chemotherapy options, plus immunotherapies to which you might turn. Finally, the pace of research and introduction of new treatments is moving faster than ever, so by the time you might need a new treatment, there may be something new available.

Good luck with your follow-up scans, which I hope will show continued shrinkage or stable disease.

JimC
Forum moderator

Hi jkkwok1,

Although it's great to hear that the previous evidence of cancer appears to have diminished, I'm sorry that this latest finding of an enlarged lymph node has caused such concern for you. In the context of an existing lung cancer diagnosis, this finding does raise the suspicion that the cancer has spread to this lymph node, but such nodes can become enlarged for a variety of reasons not related to cancer. Your doctor may want to biopsy the node to check for cancer cells, order blood work to look for an infection or may suggest a period of watchful waiting to see if the node returns to normal over time.

From this lymph node alone, you're not likely to notice any new symptoms, and at this point there's no way to know whether your cancer has progressed. Even if it has, there are a number of possible treatments, some of which may significantly prolong your life. If your oncologist feels that this is the only active area of cancer, he or she may even recommend radiation.

I hope that your next meeting with your doctor is productive and helps ease your concerns.

JimC
Forum moderator

Hi jkkwok1,

With regard to the first of your two new posts, when there is the possibility of new growth or a newly enlarged node, but not clear progression, the options suggested by your doctor are common. You can have a biopsy which, as is the case with any invasive procedure (even one which may be minimally invasive), carries some risks of complications and may not provide a definitive answer. Or you can watch the suspicious areas over a relatively short interval to see if there is further growth. Although many patients worry about the risk involved in watchful waiting, in a situation in which the growth so far has not been rapid that risk is relatively minor, and if progression becomes clear it will be treatable.

Either option is appropriate. Unfortunately we can't tell you which option you should choose, and the recommendation of your oncologist would be much better informed and of greater value to you.

In the context of an existing cancer diagnosis, any new growth or node enlargement is suspicious for cancer, which is why the radiologist described the new node as likely corresponding to the clinical findings (of cancer). On the other hand, it is only an assumption, as cancer patients develop infections just as anyone else does, and those infections can cause enlargement of a node. In the case of an infection, the node shrinks as the infection resolves, so continued enlargement or further growth can be a sign that it represents cancer. That's why it can be good to wait a bit to see what happens with the node.

JimC
Forum moderator