IMA (BAC) recurrence 21 years and 24 years out

Hi Blaze,

As much as I hate to say it, Welcome back Blaze.  It sounds like you're otherwise feeling good and enjoying life which is a wonderful place to be.  It makes sense that you want to balance the side effects of new treatments with living the rest of your life well.  You have a complex situation in which only a doctor with all your medical info and your input can help you form a plan.  It could be that no treatment is necessary unless symptoms arise or get worse.  Treatment could be a short round of something just to knock it back.  2 mm in 6 months could literally be nothing (even the same person reading the same scans can be off that much) but it is certainly not much.  An in-person or virtual consultation with a lung cancer specialist at an NCI-Designated Cancer Center is a good place to start.  Dr. West was named Vice President of Clinical Development at Summit Therapeutics last fall.  I'm afraid he wouldn't be able to help from here since your case is complicated and I'm not sure if he still takes consultations but you can contact him through his website and ask. 

It's good to hear from you and that you're still balancing cancer and life.  So many find that too difficult and move much too quickly through the vast treatment options. BTW, KRAS g12d treatments are still in the early stages of cliinical trials. EGFR exon 20 insertions have a couple of treatments though they can be harsh. 

I hope you keep us posted and more than that I hope you do well and continue to enjoy your retirement on the coast.

All the best,

Janine

It sounds like you’re thinking of this in a very appropriate way. Specifically, it sounds like the growth of the nodule is rather modest, though keep in mind that the change in diameter that sounds small is actually in 3 dimensions, so the change in volume is more: if a nodule grows from 1.4 to 1.6 cm, that’s a nearly 50% increase in volume (presuming it’s a perfect sphere, which it isn’t — this is just a rough concept). I don’t mean to suggest that this is an imminent threat, but growing from 4 mm to 1.4 cm to 1.6 cm shows it’s growing at what is probably a clinically significant rate by my estimation, in the context of not having a clearly greater threat over the next 3-5 years. The most important other factor is how limiting the CHF is — if it’s causing your shortness of breath and is a significant threat to how long you’re likely to live over the coming years, the growing lung nodule is probably secondary and easier to ignore. But if it’s just percolating in the background, also just slowly advancing without a clear timetable, the lung nodule rises to the level of being a more realistic threat. Being 70 is different from being 40, but that in itself isn’t a real limitation, given how many people are doing well even beyond 80.

As for a biopsy, the group I worked with for a long time, which had a lot of experience with these situations, had an approach that there was a higher compulsion to biopsy a growing nodule if there was no prior diagnosis of lung cancer. However, in a situation like yours, where there is a history of a lung cancer not just once but on a couple of occasions, previously documented by pathology, it is not a real leap to diagnose a consistently growing lesion that shows the exact same characteristics as the same cancer process. After all, this has now been growing steadily for years, which is not what you would expect for a benign process. We would always prefer to get tissue, both to confirm the diagnosis and to test the current molecular profile (and Janine is exactly right that KRAS G12D, very typical for a mucinous BAC, doesn’t have a clearly promising targeted therapy in early 2024), but there is some degree of risk involved with the procedure, and it is always a balance of anticipated benefit vs. risk, the benefit being not that great when you are at least 99% certain this is the same process you’ve already documented.

I would just say that while radiating the lesion would be associated with some damage to surrounding lung tissue that will make the scan look abnormal there and may contribute to shortness of breath, the lesion growing over time may prove to be the greater threat — and if it’s necessary to radiate it at some point, there will be less damage radiating a smaller lesion than a bigger one.

Good luck.

Hi Blaze,

I'm glad you've got a plan of action, I hope it goes well, and then can take a long break from scans and anxiety.  I'll let Dr. West know you've posted a follow-up and a thank you. 

Best of luck,

Janine

Hi again, Dr. West isn't able to log in at the moment but he did say, "24 years -- wow!"

I'm sure you know Dr. West has spent a good part of his oncology career spreading the word (to oncs and patients)about BAC and the importance of using a light touch when treating this slow-growing cancer.  Unfortunately, many oncologists and even more patients don't want to treat this way.  I know he is legitimately proud to see the level heads that got you here.  

Take care and keep us posted,

Janine 

Glad it's done and I know it's a relief.  I understand that cells' life cycle is important in radiation planning but don't know about the slow growth of BAC being the reason it took a year to resolve.  Radiation does continue to kill cancer cells for some time after.  Also, radiation causes inflammation that can take a year to resolve and often causes scar that looks like nodules on CT.

(At least for the carnivores) Indeed, the best part of healing is eating hearty pot roasts and things with butter, and dare I add bacon and bacon grease all in the name of healing.  <3