Hello,
Thankfully, it's been a while since I've posted, as my Mom has been off chemo for one year. Unfortunately, her latest CT scan shows small changes and she will be starting chemo again. Her situation has been quite unique and a bit puzzling to her doctors (in a good way) as her oncologist puts it - her disease has not behaved as SCLC-ext normally does.
A background on my mom:
Diagnosed with SCLC-ext in October, 2010, never smoked and hardly had an symptoms at diagnosis other than some weight loss. Was found by accident, but lived around second hand smoke as her parents smoked.
Had 6 rounds of cisplatin + etoposide -- developed blood clots, PE, and subsequently was diagnosed with HIT (heparin induced thrombocytopenia) -- had slight response with this, nothing to write home about. Went through 6 rounds of carboplatin + irinotecan and had some response. Everything has pretty much been status quo since the beginning. Truthfully, the only reason she ever felt sick of had problems were all side effects of the chemo. Chemo was finished in July,2011. She went through PCI in October. Has overall been doing GREAT and doctor is just amazed that her case is so rare with having SCLC, no symptoms and a great quality of life. She's having scans every 2 to 2 1/2 months.
Which brings us to now and my question --- With the latest CT scan showing some small changes/growth and chemo is on the horizon, her oncologist wants to repeat the lung biopsy before starting chemo again. She does have liver mets and my question is if there is some "concern" or "doubt" on the initial biopsy results would a liver biopsy AND a lung biopsy be beneficial or would the lung biopsy be sufficient?
As always - your responses are life savers!
Reply # - July 17, 2012, 11:09 AM
Reply To: Is liver biopsy necessary along with lung biopsy
Hi Binkygirl,
Your Mom's results do seem quite unique and very encouraging. I don't blame her doctor for wanting a new biopsy, since her cancer is not at all acting like typical SCLC-ext.
I am forwarding your question to the GRACE faculty for response. You should expect a response within 12 hours.
JimC
Forum Moderator
Reply # - July 17, 2012, 03:48 PM
Reply To: Is liver biopsy necessary along with lung biopsy
i have had 2 biopsy's (FNA and core biopsy) and both times they went straight to the liver rather than the lung, because it is easier to access physically.I think the theory is that the cancer is the same whereever it is located, so I suspct they just do one biopsy - either/all.
I'm also a never smoker with SCLC, and seem to have managed better than most people who have been smokers previously. i suspect that our lungs are more robust than a smokers, and that helps with managing the disease. Apart from the symptoms I had initially, it was nearly 18 months before I had any regular symptoms, and that was from the bone mets... I still dont have any lung symptoms 2 years on
Reply # - July 17, 2012, 09:07 PM
Reply To: Is liver biopsy necessary along with lung biopsy
In general, we presume the process is the same in both locations. Perhaps the textbook answer is to biopsy a more distant metastatic site preferentially to both confirm the diagnosis and confirm that it's metastatic at the same time, but in practice, often a cancer is very obviously metastatic (the pattern on imaging isn't feasibly just cysts in the liver or benign skeletal degenerative changes), and in that setting, we are usually very satisfied getting the biopsy from a location that is most accessible and safe. A biopsy from the lung tumor is extremely likely to demonstrate the same process/diagnosis as a biopsy from a liver lesion in the same patient. I think very few people giving a second opinion on someone who had undergone a biopsy of the lung primary tumor for diagnosis would quibble that there's a need for a liver biopsy. The issue is just that a second biopsy, from any area viable cancer, would make it possible to confirm the findings from the first time or cast that conclusion into doubt.
-Dr. West
Reply # - July 18, 2012, 09:05 AM
Reply To: Is liver biopsy necessary along with lung biopsy
I would agree with Dr. West. A repeat biospy from either location may be helpful in this setting to confirm the original diagnosis. In situations where the stage is not in doubt, we would typically try to biospy the site with the highest yield (highest likelihood to get enough tissue to answer the question) and with the least risk.
I hope this is helpful.
Best of luck,
Dr. Hensing
Reply # - July 20, 2012, 10:10 PM
Reply To: Is liver biopsy necessary along with lung biopsy
As always, thank you all so much for your replies. They always seem to be a source of comfort and reassurance for me.
The biopsy is scheduled for next week and I will update when we get the results. I am not sure what i am hoping for. Isn't it strange, crazy and nuts that I am almost hoping that the results show that all this time, it's actually been nsclc!? I feel my Mom would have more options available (e.g. genetic testing) -- then again, I would just be beside myself with anger that the initial biopsy was wrong. Just a bunch of what ifs. In the meantime I will continue to do my research and gathering of facts so I can hit the oncologist with my usual tons of questions!
Reply # - July 21, 2012, 10:07 AM
Reply To: Is liver biopsy necessary along with lung biopsy
One thing to bear in mind is that the result could be different this time without either being wrong. Up to 5% of lung cancers can be "mixed" histology with SCLC and NSCLC, depending on what part of the cancer is sampled; in such cases, the recommendation is to treat it as SCLC. So I wouldn't presume that a different result implies that an error was made the first time.
-Dr. West