I recently had a lobectomy RLL with wedge resection in URL for BAC, with the histpathology report showing "nearly whole lobe diffusely pale yellow with jelly like consistency ( ? mucinous tumour)." The tumour was reported as clear of the pleura, the bronchial and vascular resection margins were also clear. lymph nodes were normal and upper wedge resection showed no evidence of tumour, but mild emphysema.(TNM stage pT3 pNO pMx) The CT scans before the procedure did not show any evidence of tumour in the upper lobes or left lung.
The question we now face is whether to have chemotherapy treatment in case any disease is still present, or wait and see with regular checkups.
I would be most grateful for input you could offer on the above,
Reply # - August 20, 2013, 08:21 AM
rjiliffe, Welcome to Grace. I hope you are recovering well from the surgery.
People with stage III nsclc have improved odds of being cured when they add chemotherapy after surgery than surgery alone if the person is physically fit enough to have this treatment. Doctors usually suggest this path to those who are willing and able.
We have a lot written on the subject here. This is the most consise to the point answer to your question, http://cancergrace.org/lung/2010/05/17/systemic-therapy-for-resected-ns…
Don't hesitate to ask follow up questions for our doctors
Reply # - August 20, 2013, 12:51 PM
Congratulations on making it this far in your treatment, making it through this type of surgery is a big milestone. In cases like yours, "adjuvant" chemotherapy is known to reduce the risk of the cancer returning. There is high level evidence that shows it increases the number of 'cures' from surgery by ~10% or so. For most patients, four doses (12 weeks) of a combination chemotherapy (eg Alimta with platinium) goes fairly smoothly. Good luck.
Reply # - August 24, 2013, 12:55 AM
Many thanks for that. Have met with Oncologists who seems to agree to monitoring with the RGCC laboratory in Greece Oncogene tests ( had one test previous to surgery ) which measures circulating cancer cells in the blood is a possibility. he also mentioned the possibility of monitoring with DNA tests, but as we covered so much ground it wasn't possible to go into more details. I wondered if there was any precedent in America for this kind of monitoring. ( i'm in the UK)
He seemed to initially suggest 'mopping up' with combination chemo ( carboplatin/ vinorelbine) a possibility.
As the pain levels dictate a usage of paracetamol/ tramadol/naproxen with cyclizine to control nausea, i wondered if chemotherapy would be possible whilst taking this medication.
Reply # - August 24, 2013, 05:46 PM
The tests you mentioned are not well studied enough to be considered standard in the US. They remain the subject of some clinical trials.
As Dr. Creelan noted, the leading consideration would be adjuvant or "mopping up" chemotherapy in hopes of improving the chance for cure in patients with a significant risk of recurrence. This is likely to be feasible on the medications you mentioned.