best time to begin treatment of cancerous tumor - 1295162


I can't seem to find an answer to my question concerning is it is better to start treatment sooner for a cancerous tumor when it is small and less complex or is there no difference in waiting until it is larger and more complex. I.E. Is treatment better when the tumor is 20mm in size or 60mm in size? IS the blood supply much more developed in a tumor that grew for a year making it more difficult to treat? Both examples of this tumor are stage four metastatic NSCLC adenocarcinoma. Thanks!



Hi djorner3,

There are many factors to consider when deciding on treatments for metastatic cancer. Are you talking focal or systemic treatment?

Focal/local treatment is used when the tumor is or could invade structures like the vertebra or an airway or esophagus. Or is this is a reurrance where there is only one tumor that could be the only cancer cells left and focal treatment could cure. There are times when acquired resistance to a TKI happens to just one or 2 spots and focal treatment there could let the person continue on the TKI.

The usual way cancer progresses is through the blood or lymph system and cancer cells will circulate finding places to grab onto and multiply. So there are cancer cells circulating in the system that will most likely (90 something % of the time) find its way to create tumors throughout the system. In this case local treatment doesn't give the person longer or better life. It's systemic treatment that targets all the cancer cells in the body that works best in this case. There are exceptions and should always to discussed with your medical team about the best course of action that's right for you. Or see a second opinion specialist if you need to make sure your onc is on the right track.

To your question on when to treat. This depends on how aggressive the cancer is. There are occasions when a nsclc is very indolent and is treated only when it's causing problems letting the person live close to a normal lifestyle. For most adeno nsclc systemic treatment is used continuously with breaks from time to time. At 6 cm tumors tend to start causing issues and oncologists will want to treat if possible.

I hope this helped. You can be more specific if you'd like.

All best,

Posts: 2753

Hi David,

Welcome to GRACE. I will just add a few thoughts to complement the good information Janine provided.

When lung cancer is first discovered at a small size with no evidence of spread, it's typical to remove it with surgery or radiation before it spreads, although as Janine stated there are exceptions for some types of indolent cancer. Allowing a growing cancer to continue to increase in size at a fast rate increases the possibility that the cancer may spread to other areas.

When the cancer is stage IV at diagnosis, it's typical to initiate systemic therapy to prevent further spread and eradicate or reduce the existing cancer. If after initial therapy a new tumor appears, the question of when to start therapy would be based on the size of the tumor, its growth rate and other relevant factors such as its location and effect on vital body structures.

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