My wife is 49 and has an adenocarcinoma in her right lung apex of about 6 cm in each dimension. This has been confirmed with needle biopsy. This was followed by a PET scan and a brain MRI. Both of these showed clean (except for the right lung on the PET with a SUV of ~14). The issue is that the left lung CT showed a speculated mass about 1 cm. x 1.7 cm. in the left lung apex. Even though the PET was negative, a needle biopsy was done and confirmed an adenocarcinoma. We meet with the onco next week but was wondering if you could help in the meantime with the following questions:
1. Statistically, is this likely a primary or secondary tumor?
2. If it is secondary, does that automatically make it a Stage 4?
3. If everything other than the lungs are truly clean, is surgery still an option?
4. How did this likely spread from one lung to the other (lymph nodes showing clear, no other signs of mets).
5. Is it common to spread to the other lung and not other areas of the body?
6. What is the likely prognosis for this situation?
I really appreciate any information. I am sure we will learn more next week, but the waiting has been so difficult as I am sure many of you can relate to.
Thank you and bless you.
Thu, 08/20/2015 - 07:55
Welcome to GRACE. I'm sorry to hear of your wife's diagnosis, and all the uncertainty that comes with it. We're here to help you through this process.
In answer to your specific questions -
1. Although the discovery of a nodule in left lung at the same time as the right lung tumor raises a strong possibility that it is a metastasis, metastases are more often rounded in shape rather than spiculated. It is possible that a comparison of the pathology may yield an answer, and you may want to inquire about that in your meeting with the oncologist.
2. Unfortunately a metastasis to the other lung does make it Stage IV.
3-4. If the left lung nodule is a metastasis, those cancer cells got there via the bloodstream (which is why it would be stage IV). Usually local treatment such as surgery or radiation is not preferred, because the cancer cells are extremely likely to show up again somewhere in the body. The treatment of choice would be systemic therapy such as chemotherapy or targeted drugs such as Tarceva. In that regard, you would want to get the biopsied tissue tested for genetic mutations, especially EGFR and ALK, which have drugs which are designed to target cancer with those mutations.
5. It is not an uncommon occurrence for lung cancer to spread first to the other lung before other areas of the body.
6. Stage IV cancer is not curable, but it is treatable, and new treatments are being developed and becoming available more rapidly than ever before. The goal of such treatments is to prolong life and increase the quality of that life.
If you haven't seen it already, you may want to read Dr. Weiss' An Introduction to Lung Cancer. If you have further questions, please don't hesitate to post them.
I hope you have a good meeting with your oncologist.
Tue, 08/25/2015 - 07:45
Thanks for the information. We have been to the oncologist and the left lung has confirmed to be an adenocarcinoma same as the right lung. The oncologist said that since there are no signs of cancer anywhere else in her body (both PET and MRI of brain were clean other than tumor in right lung), they felt that the left lung was a primary tumor not a secondary tumor. They are moving forward with radiation and chemo to shrink the tumor in the right lung to an operable size. Once surgery is complete on the right lung, they will assess the best way to deal with the left lung (radiation, surgery, or both). I am worried that the left lung may still be a secondary tumor but am hopeful that the docs are right. Based on this, the doctor has said that the right lung is a stage IIB and the left lung is stage 1. Are there other factors that would help to indicate whether the left lung is primary or secondary? I am happy that the docs are moving forward towards surgery because I think that is our best hope here.
Is a primary tumor in both lungs very common? Is there anywhere I can get more information on this?
Tue, 08/25/2015 - 09:48
It's not common but can and does happen and it's almost impossible to tell. But with the shapes spiculated like a primary and no other tumors than just the two it's possible. It is known that people with one cancer are more likely to have another cancer in life than people who haven't had cancer at all. Your doctors want to gamble on the possibility of cure and I hope it is.
If she or you (if your concerns can be put to action) are worried about taking invasive procedures or for which should be taken a second opinion is perfectly appropriate, 2 heads are better than one. This is an excellent post on the subject, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
You can search our website, there have been conversations on this topic two primaries. It's just impossible to give much more info than to say it can happen but since it doesn't happen often there aren't specialists on the subject. This is where the individual case comes together with an oncologist with lots of experience seeing nsclc and individualized as well as personalized decisions are made.
On a personal note, my husband was diagnosed with stage IV nsclc with a primary that was a bear. 6 years ago today (I just looked at the date and saw!) he was diagnosed unresectable stage III nsclc. Today he's been without anti cancer treatment for 3 years (almost to the day) and his last scan was NED. Sometimes there's no telling what is or will happen and with cancer it seems to be a daily struggle to read what may or may not happen. We have great medicine behind our loved ones and I'm constantly amazed at how they have to make an art out of the medicine on oncology. Cancer can a does anything. Too often it's bad but sometimes it's breathtakingly wonderful. For you and your wife my hopes are for her to be cured. Only time will tell.
I hope this helps.