Primary adenocarcinoma lung cancer - 1254180

Mon, 02/25/2013 - 09:52

Primary adenocarcinoma lung cancer.

Hi doc I was wondering if you could tell me what is the complete work up protocol after having a right lower lobe removed via open surgery for adenocarcinoma lung cancer. My Surgery was December 13th – 2012. My Surgeon and Pulmonary doctors said I did not need to see an oncologist and that I just need to do follow ups every 6 months.

51 year old male 1.5 pack a day smoker 30 years.
Single nodule 2.5 cm was found by accident after cute sinus infection, nose polyps that need to be removed yet.

This is pre surgery biopsy pathology:
• Stage 1
• Single nodule 2.5 cm
• Adenocarcinoma of the lung, compatible with lung primary
• Moderately-to-poorly-differentiated Adenocarcinoma

Testing already preformed pre surgery:

• Cat scan came back good (only showed single nodule)
• Pet scan came back good (nothing else lit up)
• Biopsy pathology (Moderately-to-poorly-differentiated Adenocarcinoma)
• Lung function test came back (Normal ranges)
• Lymph nodes do not appear to be infected (pre surgery, CAT & PET)

This is Post surgery:

Pathologic:
Stage pT1b, pNO, pMX
Tumor size greatest dimension: 3.0 cm
Moderately to poorly differentiated Adenocarcinoma
No Evidence of ALK gene rearrangement detected by fish
No K-ras Mutation was identified
Bronchial margin, uninvolved
Vascular margin, uninvolved
21 lymph nodes negative

Lobe sectioning demonstrated a 3.0 cm mass located at least 2 cm from the nearest vascular and bronchial margins, and 0.8 cm from the pleural surface.
No additional lesions or suspicious areas identified.

I want to see a oncologist just to make sure I did everything possible, however since its been almost 3 months post surgery maybe its to late. Also is it too late for someone to do further mutation testing on my lung and lymph nodes that were removed on 12/13/12.

The other reason I want to see a oncologist is to make sure all of these weird post symptoms I am having are not a recurrence already are somethi

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road3000

Opps here is rest of it was cut off - Thanks

I want to see a oncologist just to make sure I did everything possible, however since its been almost 3 months post surgery maybe its to late. Also is it too late for someone to do further mutation testing on my lung and lymph nodes that were removed on 12/13/12.

The other reason I want to see a oncologist is to make sure all of these weird post symptoms I am having are not a recurrence already are something was missed. For instance when I yawn it just smells bad, my ears have this constant haze in them (no pain), my urine seems a odd color, I have brown tar stools, frequent night urination (already there) and I just seem older mentally. I did just have a right low lobectomy.

I do seem to be recovering from my right low lobectomy pretty good, hiking (short winded to be expected) weight lifting, good appetite. Grumpy and moody from worry cancer stress, working on that.

Also what kind of blood work, x-rays, cat scans, pet scans do you recommend and how often.

Thank you for your time.

laya d.

Hi road3000:

Welcome to GRACE...and I'm so happy to read that your lung cancer was found incidentally at a very low stage, and that you generally are recovering well from surgery. In terms of your question, and while wating for the Doctors and Moderators to come online, here is what Dr. Wakelee has said in the past regarding further treatment post-surgery for a Stage 1 patient:

"Patients with stage I NSCLC (lung cancer that has not spread to any lymph nodes or anywhere else in the body) have about a 60-80% chance of being cured with surgery alone. The size of the tumor is important in determining whether or not the cancer may come back, and other factors matter as well. The clinical trials that included patients with stage I lung cancer have not given us a definite answer about whether or not chemotherapy helps this group of patients. The studies have been clear that chemotherapy for patients with small tumors (< 3 centimeters) does not help reduce the risk of the cancer coming back. However, for patients with larger tumors, there does seem to be benefit. In two of the larger trials, patients who had tumors that were at least 4 centimeters in size did seem to have improved survival after receiving 3 months of chemotherapy. The improved survival rate was about 5% at the 5-year mark. That means that if 200 people had surgery for stage I lung cancer that was at least 4 centimeters in size, and they were divided into 2 groups of 100 and 1 group had chemotherapy, in 5 years there would be about 5 more people alive in the group that got the chemotherapy."

Best of luck to you, and please keep us posted on how you are doing...
Laya

catdander

Here is the post from which Laya quoted,
http://cancergrace.org/lung/2010/05/17/systemic-therapy-for-resected-ns…

About your symptoms, your surgeon should be contacted about any symptoms you're having.

For follow up in early stage lung cancer, http://cancergrace.org/lung/2008/08/10/fu-after-resection/

I hope this helps answer your questions. Please let us know if you have any follow up questions.

Janine
forum moderator

road3000

Hi Laya

Thanks for your reply – what you quoted is basically what my surgeon and pulmonary doctors have said. However everything you read and others say since I came back Moderately-to-poorly-differentiated adenocarcinoma that I am in a high recurrence bracket and that I should see an onc doc.

Ugh it’s the unknown that is nerve racking for sure.

Thanks

road3000

Hi Catdander – Jaime

Thanks for your reply

My symptoms yes my surgeon shrugs and tells me to see my family doc, my family doc says I need to see an oncologist for his opinions.

Thanks

catdander

It would seem that your family doc should be in charge of getting you an audience with an oncologist. One of the most trying times for me has been when my husband was between knowing he had cancer and seeing an oncologist, about 10 weeks and when I found Grace.

Dr. West has explained many times with such elegance, the woos of reading and listening to what others have to say about your situation, it's why he started Grace, so people will have a place to get current and accurate answers. People with little knowledge about lung cancer often have much bad information about a very intricate, individual, ever changing, and complicated subject.
The data about how differentiated your cancer cells are is speaking about a very large population of people and the variance is huge. I'm sure it is a factor but very small.

Every case is individual but keep in mind chemo after surgery is not without the possibility of difficult complications. Remember the real data shows more harm can be done than good from chemo after surgery in cases where the tumor is less than 3cm.

Under the heading, chemotherapy specifics in the post linked to above Dr. Wakelee states, " There is some data to support chemotherapy as far as 12 weeks after surgery, but if a patient has still not recovered enough for chemotherapy by 12 weeks after surgery, it is unclear that chemotherapy given later than this will be of any benefit."

And lastly, I'll make sure either Dr. West or Dr. Weiss comments on your concerns.

It's your life and worth pushing to get the answers you need to be satisfied you've gotten the care you need.

road3000

Thank Catdander,

That does make sense, and pretty much in line what my surgeon said to me.

I do have a apointment with a oncologist for this coming Thursday, so I will keep it, meet him pick his brain and then I will have a onc on my team.

I do understand that I am blessed being stage 1b <3cm - trust me I do not want chemo if I do not need it, I have a 3 year old and a 15 year old left to rasie.

Do you think I should get a MRI brain scan to make sure nothing spread up there are would it have been in one of my lymph nodes tested after surgery?

Thanks Jerry

catdander

Hi Jerry, I think it's great that it was caught early and I'm under no impression that you would want chemo for any other reason than to up your chances of a cure. You have every reason to personally make sure you're getting every chance you can. Hopefully your oncologist will agree in your case less is more.

We can't say what you "should" do. However it's usually standard to get an MRI of the brain as part of initial work up. However it doesn't always happen. Someone last week or so was in the same position as you, they didn't get a brain MRI as part of initial work up and the doctor responding agreed if he were his patient he would go ahead and get the brain scan now. It's definitely something to ask during your appointment.

Janine

Dr West

The general rule is that we don't recommend post-operative chemotherapy for patients with a node-negative cancer smaller than 4 cm. However, there can be exceptions, as I describe in this post I just did about a patient in a similar situation:

http://cancergrace.org/lung/2013/02/11/cip-adjuvant-chemo-for-smaller-h…

That said, it's not "standard" to recommend chemotherapy for a smaller tumor, even if it's understandable and a reasonable thing to do for individual patients.

With regard to molecular testing, that can be done at any time, but the majority of experts don't favor using that information to guide clinical decisions in the post-operative setting, since there is no good evidence supporting a role for targeted therapies in earlier stage patients. Dr. Wakelee, who has a particular expertise in post-operative therapy, describes her views here:

http://cancergrace.org/lung/2013/02/24/wakelee-markers-in-early-stage-n…

Good luck.

-Dr. West