I was diagnosed with Adenocarcinoma for the second time just a few weeks ago. I had VATS surgery 5 years ago to remove very small tumors (2cm) in my right lower lobe. Since that date, I have had CT scans every 6 months. In September the radiologist noticed some growth in what had been a suspicious spot in my left upper lobe. Biopsy confirmed it was the same multifocal, indolent kind of cancer that I had in my right lung. I am schedule for an upper lobe lobectomy in 2 weeks via VATS to remove two ~ 1.3 cm tumors. This cancer from the beginning was found very early because I requested a scan due to my mother's and sister's lung cancer. They have both since died. My doctor says my case is unusual because, 1.) they found it so early 2.) and because I had a reoccurrence. He is really unable to give me an idea of my future with this cancer. Evidently, most people don't have reoccurrences. Both my oncologist is optimistic that the surgery will be successful and they will get all the cancer by taking the whole lobe. Because my pulmonary function test was good, they think my recovery will be good too. I am 61 years old. I am fairly healthy but have experienced a major loss in the last 3 months, my son's suicide. I feel ok about the upcoming surgery, and because I know what the recovery is like I know I can get through it, but I worry about my future quality of life, and if the cancer will come back again. I have two beautiful grandchildren and a daughter that need me right now. I do qualify for targeted therapy if we get to that point in the future. Any insights from this community would be appreciated.
Thu, 01/23/2020 - 17:23
Hi Sue, I'm so sorry you have this recurrence. It could be worth getting a second opinion from a lung cancer specialist who sees a lot of BAC nsclc. I'm going to leave you with a quote from an article Dr. West wrote in 2006. There have been a lot of changes in lung cancer care since then but the way in which BAC is treated and not treated has not changed. Interesting enough this quote uses an example that sounds a lot like what you've shared with us.
From The Risk of Overtreating Indolent Bronchioloalveolar Carcinoma Dr. West writes, "So treating BAC like every other kind of lung cancer, which would involve removing a lobe of the lung or perhaps the entire lung, has a real risk of making the treatment worse than the disease. BAC tumors have a tendency to grow slowly over time, and if they’re surgically removed, you can have another BAC come up many years later, unlike other types of lung cancer where you either develop a recurrence within the first 2-3 years or you probably never will. With BAC, you can develop another, likely related BAC lesion 5 or more years later. But it may grow so slowly that it causes no symptoms and is no threat to a person’s life for another 5, 10, 15 years, or perhaps until that person is over 90. But you can make that person symptomatic if you remove enough good lung tissue every time they develop a 5-10 mm BAC lesion. That patient may find themself really missing that good lung tissue that was surgically removed as a lobectomy 5 years ago (perhaps their 2nd lobectomy for BAC) if they develop new BAC in the remaining lung."
The rest of the article is worth reading and the comments that follow provide an excellent discussion. Keep in mind the specific drugs may be different and radiation options.
Let us know what you think.
All the best,
Sat, 01/25/2020 - 09:29
Sue, I wanted to add that I'm not suggesting surgery is the wrong way to go. I just wanted to make sure you best understand your specific situation. Also radiation may be an option, SBRT, or stereotactic body radiation therapy is a technique that has been recently adopted in lung cancer care instead of surgery in some cases. EGFR TKIs and immunotherapies (depending on testing results) can be used to control more effectively than chemo.
And if you don't have an activating mutation this is a very new change in treatment.
Mon, 01/27/2020 - 17:50
I would just add, as a way of "connecting the dots" from the good information that Janine has provided, including the quote from Dr. West, that although BAC can grow quite slowly, we don't know the pace of growth until two scans separated by a sufficient interval are conducted. If the two tumors have grown significantly since they were discovered in September, that might be a relevant factor in favor of surgery, whereas if they've grown only minimally since then, "watching and waiting" (conducting another scan after perhaps a couple of months) might be preferred.
Jim C Forum Moderator
Tue, 01/28/2020 - 13:00
Thank you everyone for your feedback. I am going to seek a second opinion with a good cancer center at the Univeristy of Colorado, which is close to me. Are you familiar with this place? https://www.uchealth.org/locations/uchealth-university-of-colorado-cancer-center-anschutz/I am grateful that my insurance will pay. Finally feeling more optimistic about this. I will keep you posted.
Wed, 01/29/2020 - 18:16
That's a great lung cancer center...one of the staff doctors, Dr. Ross Camidge, is a leading expert and has in fact contributed quite a bit of information to the GRACE site over the years. And a cancer center affiliated with a teaching institution is just what we would recommend. I hope that you have a good meeting and gain a great deal of insight into the advantages and disadvantages of surgery and other options.
Jim C Forum Moderator
Sun, 02/02/2020 - 18:12
Good luck Sue. The University of Colorado is as good an option as it gets.