My husband just had another scan. I haven't seen the actual report yet but Louisville doctor called and said there was more density in the lung and he has some fluid on the lung. He is contacting Dr. Fossella at MD Anderson since we sent a copy of the disc to him as well. Louisville doctor said he showed it to several radiologists but none said they could confirm that it was the cancer. I am assuming it is. He wants to do a needle biopsy and drain the fluid tomorrow or Friday. What all can we learn by testing the fluid on the lung? I'm curious to see what the MDA people see on this scan. My husband feels pretty good and continues to work 50 hour weeks at 5 different hospitals and even finds time to announce the football games on Sunday's from 11 am - 7 pm. He has adenocarcinoma with BAC features according to the very first bronch he did - which they didn't get enough tissue to test for mutations. Lots of scar tissue from radiation 19 years ago. Tarceva was first, carbo/alimta 2nd and alimta alone after. I'm sure he feels good right now because he hasn't had a treatment since Labor Day weekend. Will we possibly finally learn more about his cancer if they test the fluid?
mutation testing from plural effusion and needle biopsy - 1249132
kate0228
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Reply # - October 17, 2012, 12:18 PM
Reply To: mutation testing from plural effusion and needle
It is sometimes, though certainly not always, possible to do mutation testing from cells collected after draining a pleural effusion. That would be a benefit, and seeing cancer cells in the fluid would conclusively demonstrate that these new imaging findings represent cancer, though we might safely infer that this is the case without a biopsy if there isn't a readily available competing explanation.
Good luck.
-Dr. West
Reply # - October 17, 2012, 12:22 PM
Reply To: mutation testing from plural effusion and needle
Dr West's comments of course out weigh mine but I'll leave it.
Hi Kate,
I'm very glad your husband is managing such an active lifestyle. It sounds like he's doing very well.
In testing fluid from a plural effusion you can't expect to capture enough cancer cells to test for mutations. In fact even if it is malignant you may not find cancer cells at all. Also if the plural effusion isn't causing problems it doesn't necessarily need to be drained.
However a core needle biopsy may capture enough cancer cells to do mutation testing, but there is no guarantee. There is just a much better chance with a core needle biopsy.
With BAC there really isn't a need to move forward with treatment if it is slow growing and there are no symptoms.
I'd be interested in what the doctors at MDA have to add before moving forward.
Janine
BTW, I split your thread from Mark's. When you want to start a new thread click "start new topic".
Reply # - October 18, 2012, 07:52 PM
Reply To: mutation testing from plural effusion and needle
Hi Kate,
Just to add some personal experience, my wife's NSCLC was diagnosed from cancer cells detected in the fluid drained from her pleural effusion. On the other hand when she had a large pericardial effusion which had no other apparent cause other than her cancer, no cancer cells were found in a liter of fluid.
JimC
Forum moderator
Reply # - October 18, 2012, 09:22 PM
Reply To: mutation testing from plural effusion and needle
He's having the fluid drained tomorrow afternoon. Curious to see what they come up with. While I am chomping at the bit to get a new treatment plan in place, it's been a really nice chemo break. Tony hasn't had a treatment since the Friday before Labor Day. He feels pretty good and his stamina is amazing.
Jim, I noticed on your wife's treatments, she visited and revisited Tarceva. I didn't think they would do that once you have progression? Or, do they treat Tarceva differently than traditional chemo?
Reply # - October 18, 2012, 09:25 PM
Reply To: mutation testing from plural effusion and needle
One last question - how long does it take to get results from the fluid? Is this something that the lab can see immediately or will this take days?
Reply # - October 19, 2012, 02:19 AM
Reply To: mutation testing from plural effusion and needle
Good morning Kate.
The principle is that if someone with an EGFR mutation, who's had a good response to Tarceva, is taken off the drug and treated with something else (chemo usually), the cancer may become "re-sensitised" and can be "re-challenged" with more Tarceva. Dr West wrote a post about it:
http://cancergrace.org/lung/2012/06/30/re-treatment-with-targeted-rx/#m…
I'm not in the US, but here in the UK it would take a couple of days to get the results of a mutation test.
Just wanted to mention that your signature isn't showing up, although I can see there is one on your Profile page. It needs to go into the "Forum Signature" box as well as the "Biographical Information" box, otherwise it doesn't show up on the forums. Irritating, but true:
http://cancergrace.org/topic/grace-site-tips-profile-bio-forum-signature
Good luck with the testing!
Reply # - October 19, 2012, 06:00 AM
Reply To: mutation testing from plural effusion and needle
Hi Kate,
We had results in a couple of days.
JimC
Forum moderator
Reply # - October 19, 2012, 07:41 AM
Reply To: mutation testing from plural effusion and needle
A result within a few days is great, but that's on the fast side of a range that can easily go out to 7-10 business days. One big determinant is how long it really takes for the testing lab to get the material from the local pathology lab that currently has the tissue. That can be quick, but sometimes there are delays and it takes a few days just to get to the lab where the testing actually happens.
-Dr. West