Dear Dr. West,
My wife recently had her second CT scan since starting “combination treatment” for limited progression. Her oncologist reported that he was pleased with the result and all was going well. However, when I asked to see the CT report he said he would have to "qualify" the comments of the radiologist. The reason being that the Liver met and Kidney met had grown considerably in size - although the expressions "atrophy" and "cystic degeneration" were used in the report when referring to these two tumours. He said he had been to "see the slides" and that the tumours were dead inside (or words to that effect) also her “LDH” and other tumor markers were considerably improved and liver function up.
Question: Is it common for a tumor to have grown in size yet be dead on the inside?
A quick summary of my wife’s circumstances is provided below:
Diagnosed Stage 4 NSCLC Squamous in Oct. 2011.
Initial biopsy testing found no mutations hence traditional treatment began using:
Cisplatin/GEM followed by Carboplatin/ GEM (Reasonable response initially followed by progression).
A second biopsy confirmed EGFR positive (Exon21). Targeted treatment began with:
Tarceva 100mg (single agent) (Excellent response for 13 months, then limited progression in Liver and Kidney).
Combination Navelbine / Tarceva 100mg (Really good response - approx. 50% shrinkage to this point).
Reply # - August 14, 2013, 08:08 AM
Reply To: Common for a tumor to have grown in size yet be dead
Hi Betty85, So glad you got good news from your wife's doctor. I know your need to understand, it really does make all the difference for some of us, and for some even means making treatment changes. I will ask a doctor to comment on your questions. I hope all is well and she stays that way for a long time.
Janine
Reply # - August 14, 2013, 10:24 AM
Reply To: Common for a tumor to have grown in size yet be dead
The idea of necrosis, which is dead tissue, in the center of a tumor is common. We definitely prefer to see that in tumors that are shrinking or stable in size rather than growing. I couldn't really say what it means when the lesions are growing but the center of them is necrotic (dead), but one concern would be that the death of those cells is because the cancer is growing quickly and outgrowing its blood supply. We can see this pattern even when a patient is on no treatment and the cancer is just growing unchecked.
The declining LDH level is encouraging, and overall I'd say that it's not possible for someone who isn't directly involved to offer insight that would over-ride what is being offered from the doctor(s) directly involved here.
Good luck.
-Dr. West