BAC Lung Cancer - 1286743

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ljscott26
BAC Lung Cancer - 1286743

Due to my participation in a lung cancer screening program, they found my lung cancer early. I had a lobectomy of RL lobe in May 2015 for 1.2 CM adenocarcinoma, mucinous with no lymph node involvement. I have had no chemo or radiation.

At my first 6 month check up, there is evidence of 2 new .2 CM suspicious nodules in my RU lobe and BAC in LU lobe. The radiologist and thoracic surgeon disagree on the size, growth rate, and if should there be a biopsy. It may or may not be 2.4 CM. This growth was first noted on the April 2013 CT scan. What I have read indicates that BAC should be surgically removed early for a 100% cure. I am ready for surgery but the thoracic surgeon wants to continue watching the growth.

Are there cancer centers in the US that specialize in BAC? I am ready for a second opinion

JimC
Hi ljscott26,

Hi ljscott26,

Welcome to GRACE. I'm sorry to hear of your diagnosis and scan findings. I'm not entirely clear on what the latest scan shows. In particular, the reference to two 0.2 cm nodules, then what may or may not be 2.4 cm. Are we talking about a third nodule? Also, you state that this was seen back in April, 2013. Has it grown in size since then?

The answers to these questions may have a significant impact on any treatment decisions. Although there are some instances of BAC in which growth is fast, it can often be one of the slowest-growing cancers. GRACE founder Dr. West, one of the leading experts on BAC, cautions that it should not be over-treated, and he has designed an algorithm to assist in treatment decisions for BAC. You can see that algorithm here.It is likely that this is the type of thinking that has led your thoracic surgeon to recommend watching a bit longer to judge the pace of growth of the cancer.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

ljscott26
I will ty to clarify. My 06

I will ty to clarify. My 06/2016 scan says:

Linear nodular opacity in the subpleural left upper lobe is unchanged measuring up to 2.4 cm in length on series 5, image 25. However, this has shown significant increase in size and density since the first available study of April 23, 2013.

Significant increase in size and density of a linear subpleural nodular opacity in the left upper lobe. While the linear configuration would be atypical for neoplasm, the increase in size and density is concerning for low-grade primary lung neoplasm such as bronchoalveolar cell carcinoma. Biopsy is recommended.

Right lower lobectomy changes are again noted with associated pleural parenchymal scarring and trace right pleural effusion. Faint semisolid nodular opacity is seen in the posterior right lung measuring 0.5 cm on series 5, image 24. Additional faint linear and nodular opacity is seen in the anterolateral right lung on series 5, image 26. Mild biapical scarring is stable. No left pleural effusion.

So the 2 new nodules in the upper right are 1- 0.5 M and 2- a faint nodular opacity.

The suspected BAC is what I want removed.

ljscott26
So the 2 new nodules in the

So the 2 new nodules in the upper right are 1- 0.5 CM and 2- a faint nodular opacity.

correction 0.5 CM not M

JimC
If the suspected BAC nodule

If the suspected BAC nodule was seen in 2013, then the pace of growth should be discernible. It's a three-year plus interval, so a comparison to its size and appearance on the 2013 scan should help. As the report notes, the present appearance is atypical, which further justifies the doctor's recommendation to watch and wait, as described in Dr. West's algorithm.

The problem with surgery for each BAC nodule that appears is that not only does each procedure entail risk, but may reduce lung function and may delay necessary systemic treatment such as chemotherapy. For instance, if all the nodules described in the report represent cancer, and they show signs of progression, the systemic therapy is the treatment of choice. Dr. West's algorithm suggest waiting until the pace of growth and extent of the disease are known.

It's a common sentiment for patients to want every known bit of cancer surgically removed or radiated, but this FAQ helps explain why that is usually not the best course of action in the metastatic setting (which has not been established in your situation, and hopefully will not). Watching and waiting will provide an opportunity to see if not only the left lung nodule grows but also whether there is growth in the nodules in the right lung.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

ljscott26
Sorry I left out that info:

Sorry I left out that info:

On CT Chest w/ Contrast dated 12/17/15:

Airway, Lungs and Pleura: There has been an interval right lower lobectomy. A small right pleural effusion is present. Mild emphysema is present. In a long dated area of mixed solid and ground glass opacity is present within the left upper lobe (image 26 series 5) which measures approximately 2.5 cm in length and has been slowly increasing in size and density since the earliest available CT of 4/23/2013, when it measured 1.8 cm in length. Subpleural nodularity within the right apex is slightly more conspicuous,, though is likely scarring. A 0.4 cm nodule is seen within the right upper lobe (image 14 series 5) which was not definitely seen on prior exams. No focal consolidation is identified.

I know the 6/2016 measured the suspected BAC at 2.4 CM. Different physicians/radiologist wrote the reports

Linda.

JimC
In terms of the growth of the

In terms of the growth of the suspected BAC nodule, this looks like a pretty indolent process, especially since it does not seem to have grown at all since the scan in December, 2015. The additional information you have provided seems to lend additional support to the "watch and wait" recommendation of the thoracic surgeon.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>