Multifocal adenocarcinoma treatment - 1253626

Sun, 02/10/2013 - 10:10

I'm a 64 year old female that was diagnosed with NSCL stage 1b with left upper lobectomy followed with chemotherapy in 1999. In 2006 several GGO's appeared in upper, mid and lower right lung which I was advised to do the "wait and watch" theory because I was probably dealing with BAC which is slow growing. Middle right GGO continued to grow from 7mm in 2206 to 15mm in 2012. Finally made decision to have VATS wedge resection on upper and mid right lung November 2012. Pathology report revealed stage 1A multifocal invasive NSCL adenocarcinoma with no lymph node involvement and no BAC features. Oncologist does not advise any further treatment at this time, but follow up visits every 3 to 4 months. I have been told recent diagnosis is a secondary cancer possibly related to first, but no one can say for sure. Are there any recommendations you could give me to be proactive with this diagnosis?

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Hello Patty, I'm very sorry you are going through this again. I hope you are cured and nothing else will need to be done but keep a close watch. Sometimes keeping an eye on the lungs and an ear out for odd symptoms is the best treatment. Our faculty can't make recommendations to anyone who isn't a patient. What we do on Grace is give information about certain situations so you can work more closely with your treatment team and make the best decisions for your individual case.

I will ask a doctor to comment on your post. You should hear back within the day.

I hope you do well moving forward,
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Dr West

The situation of multifocal disease is tough, with no clear answer, but there is no evidence that giving chemo or some other systemic therapy at this point will change the course of the disease in any way.

I do agree that it makes sense to follow you clinically and radiographically (i.e., repeating scans) regularly, and intervening with consideration of local therapy (surgery or radiation) if there's evidence of a single area of disease, or with consideration of systemic therapy for a multifocal process that is progressing at a clinically significant rate. The issue that the recent cancer may be related to a process going back >10 years suggests to me that this may be an extremely indolent process, even if it were to recur.

Good luck.

-Dr. West