Hello,
some time ago I have posted here for the first time asking for Drs' opinion on my mom's therapy (IIIB, NSCLC NOS but with components of SCLC, concurrent radiochemo therapy with 64gy and cisplatin/vinorelbine - back then, we were told she had a mixed type: http://cancergrace.org/lung/topic/nsclc-nos-not-otherwise-specified/).
They managed to provide me with a more detailed explanation - apparently, at the first "glance" under the microscope it looked like the tumor had components of SCLC in it (the doctor said they look like tiny blue cells). That was the first "differential diagnosis" and briefly thereafter I talked to the doctor. However, the later immuno-histo-chemical testings showed that all indicators of a SCLC were absent in the biopsed tissues and that these "blue cells" are actually smashed lymph cells due to a chronical bronchitis. So, the diagnosis was/is NSCLC NOS. The pathology report also stated that the tumor has a proliferation rate of 25-35%.
After the completed radiation and two chemo cycles, my mom went to the re-staging and we were very happy to hear that the tumor has shrunk by 50% and all lymph nodes have cleared/are not visible in the CT anymore. The doctor said at the same time that they still see a mass of approx. 2.7cm, but that he cannot tell if this is a rest tumor or just a scar from the radiation. And this was quite a surprise to hear.
My mom will receive two more chemo cycles (the first two she tolerated really good, same as the radiation).
My questions now are:
1) Is this a good response to the therapy for a "NOS" type?
2) Is the proliferation rate indicative for smth? What does it actually say? That 25% of the tumor cell multiply? If so, in what time?! Within 24h?
3) Are there really no possibilities to see if the mass in the CT is a tumor or a scar?
4) Is there any chance to still have a rest-tumor tissue, but that the tumor itself is "dead"?
Many thanks in advance to you!
Kind regards,
Meli
Reply # - August 28, 2012, 09:43 AM
Reply To: Lung Tumor (NSCLC NOS) Shrinkage by 50% or Maybe Even
Hello Meli,
Congratulations on your mom's great response! Yes, it's very good news but unfortunately only time can tell if the rest of the tumor is active cancer or scar. But let's see what the professionals have to say.
I will ask a doctor to reply to questions. You should hear back within 12 hours.
I couldn't find any info that relates rest-tumor to nsclc.
I'm curious too to see what they have to say about the proliferation rate. I know it exists but it hasn't been discussed in those terms on Grace to any extent.
Doctor,
What does smth stand for?
Would there be reason to use a PET to give anymore info in a situation like this?
I hope for cure for your mom,
Janine
Reply # - August 28, 2012, 05:49 PM
Reply To: Lung Tumor (NSCLC NOS) Shrinkage by 50% or Maybe Even
Yes, I don't know what smth means.
I don't commonly get a proliferation rate -- it isn't standard thing to look for, but it refers to the % of cells that are dividing in the tumor sample. It's not something that is part of a standard workup.
It is very, very common to have a residual nodule after chemo/radiation, and it's essentially impossible to know whether it's cancer or post-treatment scar tissue except for looking for change over time, as frustrating as that seems. In fact, here's a podcast largely about this very predicament:
http://cancergrace.org/lung/2010/05/26/imaging-after-chemor/
I hope that's helpful.
-Dr. West