Ground Glass Opacities/NSLC - 1259620

patty
Posts:8

I was diagnosed with Stage 1b NSLC in 1999 with upper left lobectomy. In 2006 CT scan showed GGO areas in upper right lobe and lower right lobe. Upper stayed stable, but lower GGO grew from 7mm to 15mm in six years with almost certain probability that it was BAC. Finally had VATS resection to both areas in 2012 which revealed multifocal NSLC. Pathology report was pT4NO-Stage 3A. Surgeon and oncologist have recommended no further treatment unless it reoccurs. Confused as to why no genetic testing was done on tumors for biomarkers because of my previous history. Can testing still be done from 2012 pathology slides? I'm feeling desparate because both physicians have stated the cancer will return and yet I feel like there is something preventative that could be done. Any input would be greatly appreciated.

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Reply # - October 2, 2013, 07:18 PM

Dr West
Posts: 4735

I would strongly suggest you read this post:

http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

Anything that takes six years to grow is a significant risk for being over-treated. In my mind, the reason to not focus on molecular marker testing is that if there is not a good reason to treat right now, it doesn't matter what you don't treat with. In this situation, I also strongly urge patients to not rush into a treatment they don't need because it will take years to grow. And if there's multifocal disease, it's probably not realistic to expect that treatment will be curative, and if it isn't going to be curative, the treatment should be administered judiciously, not reflexively for the sake of being on treatment.

-Dr. West

Reply # - October 2, 2013, 08:11 PM

catdander
Posts:

Patty, I merged your 2 threads since Dr. West addressed the title of the blank one with a couple of excellent posts.

I hope you are able to be treatment free for a very long time, say forever...?

All best,
Janine
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Reply # - October 3, 2013, 08:23 AM

patty
Posts: 8

Dr. West,
Thank you so much for your professional response. The web site does such a wonderful service for all that suffer from this dreaded disease.

Patty

Reply # - October 3, 2013, 09:39 AM

Dr West
Posts: 4735

Patty,

Thanks very much for your kind words. Please remember that the key point I mean to convey is that the reason I favor a minimalist approach is not that in such cases, patients tend to have a [i]very favorable prognosis[/i] regardless of what they do, so it makes sense to accept no increased adverse effects from treatments unless/until interventions are convincingly proven as needed.

-Dr. West

Reply # - October 3, 2013, 01:04 PM

patty
Posts: 8

Dr. West,

If you wouldn't mind answering one more question I forgot to ask, I would be so grateful. Since the path report came back as multifocal invasive NSCLC instead of BAC, what would your recommendation be with future follow ups, a chest x-ray or CT scan? How often? My oncologist and pulmonologist don't agree with each other.

Patty

Reply # - October 3, 2013, 05:29 PM

Dr West
Posts: 4735

I don't base it on the pathology definition. I base it on the rate of change in the scans. In someone with resected NSCLC that history has shown to be indolent, I typically pursue a schedule of 6 month scans initially. If those have shown little or no change in a year, I sometimes consider moving to annual scans, especially if I have a good sense that we're going to be doing a lot of follow-up scans over a long time.

-Dr. West

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