GRACE,
What a great name for what you have to offer. I found your website a few days ago while trying to research BAC. I am a medical professional in the field of Radiation Oncology and we see very few cases of BAC. As you might know you can only treat a very small portion of lung tissue at a time and if the lesion is very small. From what I have been reading surgical removal of a single primary lesion is the preferred treatment. My situation is a little different, I am a 41 yr old female with a history of congenital lobar emphysema and I had 2/3 of my right lung removed when I was 10 days old. I have never smoked a day in my life, but my father owned an auto shop in which my siblings and I helped out in the shop regularly and spent the summers there.
I was recently admitted to the hospital with left side chest pain, thought to be a possible PE but turns out to be more like pleurisy. They did a CT scan and found a 1.6cm GGO in the right upper lobe and when they looked at prior scan in 2006 it was .5cm.
I have yet to see my pulmonologist and would like to see if you can help me come up with some valid questions for him when the time comes. I guess one of my concerns is since the BAC is only ~4% of lung cancers that the physicians in my area are not that well versed in BAC.
I have not formally been diagnosed with BAC, but I have seen that in a lot of cases a PET/CT, biopsy, as well as bronchial washings are a lot of times inconclusive. Do you tend to follow a guide line for diagnosis?? I’m trying to get as much information as possible so I can be well informed and make an informed decision in my care.
Thank you for all you provide at Grace!!!
Latonja
Reply # - August 7, 2012, 09:03 AM
Reply To: Possible BAC
Latonja, I'm very sorry you're in this position. But Welcome to Grace (right, great name) I'm sure we can help you learn enough to figure out what you need to ask; however there is no set list of questions.
There is a very recent thread with a discussion about seeing a BAC specialist. If you're in the Seattle area that would be our Dr. West. I will ask him to respond to your post (even if we are trying to bring different lung specialist into the forum).
For a diagnosis there must be a positive biopsy, with cancer cells in hand. You're right that it can be difficult to capture cancer cells during biopsy but it rarely has to go as far as surgery. Unfortunately my husband had to have surgery to get a diagnosis. To add to that it is becoming just as important to capture enough cells to do several gene mutation tests such as EGFR and ALK both have fda approved drugs for advanced nsclc. Dr. Silvestri has written an excellent blog on work up and diagnosis. http://cancergrace.org/lung/2010/05/12/general-work-up-and-staging-of-l…
You very well may have read these but for others, this is a link to Dr. West's blog on the basics of BAC. There are several links at the end of the blog and a good conversation after that.
http://cancergrace.org/lung/2010/07/09/basics-of-bac/
I certainly hope that spot is benign.
Janine
Reply # - August 7, 2012, 09:08 PM
Reply To: Possible BAC
That sounds like very slow progression, but if there's an area that is not going away but growing over time, especially if it's over a centimeter, that would lead most people to biopsy it, especially in a 41 year old. It's true that a PET/CT or other imaging could be ambiguous, but a biopsy should provide a definitive answer if it samples the lesion properly.
If additional workup indicates that it's an isolated lesion, the standard approach would be surgery. I think the biggest question is, if it proves to be BAC, would the surgeon favor a wedge resection or a lobectomy. Though the textbook answer is to do a lobectomy, if there's anyone you might consider a more limited surgery for, it's someone who has already lost a lot of lung tissue and has a cancer that hasn't spread beyond that area over many years (which you can tell from the scans going back to 2006). Still, that's a judgment call.
-Dr. West
Reply # - August 8, 2012, 06:27 AM
Reply To: Possible BAC
Thank you both for your reply. I appreciate all that you are doing. I'll keep you posted.
lpiland