Path Report reads: poorly differentiated NSCLC w/basaloid squamous LC - 1255043

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mkangas
Path Report reads: poorly differentiated NSCLC w/basaloid squamous LC - 1255043

I had a 4.1 cm tumor in upper rt. lung. VATS lobectomy Feb. 18, 2013. Have recovered from surgery nicely.

Negative nodes, negative on mets.

Path report "summary" is above in title. Since Basaloid Squamous seems to be rare I have requested a 2nd opinion by MSKCC in NYC. Slides, path report & block hopefully sent today via Fed Ex to path dep't out there.

Saw an Onc. Dr. at the Univ. of Iowa, Iowa City on March 18 and he recommends 4 rounds Carbo/Taxol. NO mention of the path info regarding rarity of Basaloid, no comment on what poorly differentiated meant in terms of recurrence, etc.

Any advice or suggestions would be appreciated. Final Staging was listed as 1b. I am a former smoker, no longer smoking. Obviously quite worried as the FNA Biopsy (before the surgery) read out as being Adeno.

Thank you.

JimC
Reply To: Path Report reads: poorly differentiated NSCLC w

Hi mkangas,

I'm sorry to hear about the change in the histology of your tumor, but Dr. Pennell has previously stated:

"I agree that basaloid histology is rare, but before worrying too much about it I would note that only recently are we paying much attention to histology and I would not put much weight in anecdotal reports of aggressiveness. I would treat it just like any other NSCLC..." - http://cancergrace.org/forums/index.php?topic=2846.msg16882#msg16882 (the entire thread may be of interest to you).

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

mkangas
Reply To: Path Report reads: poorly differentiated NSCLC w

I read through the link and the information regarding the patient (described above). I would not characterize my personal histology of my own tumor as a "change" but rather it was the initial reading of what was found after surgery via pathology. Isn't this a correct statement?

I am pleased to report or add that my stage is 1b with no mets or node involvement at time of surgery. I guess I should take that as a big plus.

I notice the original poster is no longer active on the site regarding her husband's complex treatment that had been discussed in the above thread which to me - is sort of a bad sign. It has been almost 3 yrs. since she had done a post here.

I feel I need to have this 100% verified by a 2nd opinion before I proceed with any chemo regime. Would you agree on this thought process?

Thank you JimC for your initial response to my post.
Mkangas

JimC
Reply To: Path Report reads: poorly differentiated NSCLC w

Yes, by citing that thread I did not intend to imply that your situation is exactly the same. Your diagnosis is not a change, and your stage, with no evidence of mets, has a much better prognosis than that of the poster in that thread.

Although I don't think you should assume anything from that poster's lack of continued involvement here, the fact is that if you read enough posts here you will find sad stories as well as tales of success. It is the disadvantage of being active on a lung cancer forum, but I have been here for four years and I am certain that the advantages have far outweighed the negatives. Of course, if you read my signature below including the linked thread, you can see that I owe more to this site than anyone.

I agree that since the histology of your cancer is so rare it makes sense to wait for the second opinion before proceeding with further treatment. You are not symptomatic and you have had your tumor removed with no evidence of residual cancer, so there is not the same urgency for chemo as there would be if you had verifiable active cancer. Your surgery may already have cured you.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: Path Report reads: poorly differentiated NSCLC w

I would underscore Dr. Pennell's main argument, which is that there's a danger of putting too fine a point on this. There isn't enough data to make specific recommendation for basaloid squamous NSCLC, but adjuvant (post-operative) chemotherapy would be a very appropriate recommendation for a fit patient with a resected cancer of that size whether it's called poorly differentiated NSCLC, not otherwise specified, or squamous NSCLC or basaloid squamous NSCLC. The specifics become a semantic argument but shouldn't be a practical one, since there are no data on the planet to favor changing the treatment recommendation on the basis of that assessment.

The only other thing I'd mention is that the current standard of care, what we'd really define as "best treatment", is up to 4 cycles of a cisplatin-based doublet after surgery with curative intent. Here's a link that describes the state of the field:

http://cancergrace.org/lung/2010/05/17/systemic-therapy-for-resected-nsc...

Carboplatin/Taxol (paclitaxel) is commonly recommended and given here, and it may be as effective as a cisplatin-based doublet in this curative setting, but the best evidence is that carboplatin may be a shade less effective in advanced NSCLC, where there are more studies to compare cisplatin and carboplatin. We commonly favor carboplatin in advanced disease, where a very small difference in efficacy may be more than offset by the greater side effect challenges of cisplatin (a very realistic consideration, including for earlier stage disease), but if the goal is cure, there may be good reason to favor the treatment with the best evidence and may be a little more effective if that little difference might be the difference between cure and not being cured. Just about every expert in lung cancer favors starting with cisplatin paired with another drug as adjuvant therapy, then switching to carboplatin if side effects become prohibitive.

Good luck.

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education