SCLC or not? - 1245364

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stevieb54
SCLC or not? - 1245364

My mother-in-law first presented with a small growth on the inner eye-lid. This was removed, and the biopsy showed "Merkel Cell Cancer". At the same time, she was being treated by a Pulmonary specialist for a persistent cough, and he immediately did a chest X-Ray, found something, and the biopsy showed SCLC.

This was all in Summer 2011.

She was treated at Heidelberg Thoraxklinik (The best in Germany?) and had 4x Chemo and a set of brain radiotherapy, which she completed in February 2012. At a check-up in Heidelberg in April, the SCLC was unchanged, (good news) and she was ordered back for late July for another check. She presented two weeks ago with lumps on the neck and in the groin - these have been removed, and confirmed as metastasis in the lymph nodes.

Couple of strange things - Heidelberg re-did the first biopsy of the eye lid growth, because they didn't believe the co-incidence of Merkel Cell and SCLC at the same time. They were right, the growth was a meta from the SCLC, not Merkel Cell.

Second, the new biopsy of the meta in the lymph nodes is showing reaction to SCLC markers, but the tissue is apparently like NSCLC. The pulmonary specialist, who is co-ordinating treatment, describes the case as "Exquisite" and says she should go back to Heidelberg, probably for more Chemo. He talks about a "mixed" NSCLC / SCLC. As I have found no reference to this anywhere, could you tell me if this is possible. If so, what are the treatment options? The SCLC is not operable.

Also, I assume that if the original eye-lid growth was a meta of SCLC; then she was in Extended Disease before the SCLC diagnosis. Is this correct?

Many thanks
Steve

catdander
Reply To: SCLC or not?

Steve, Welcome to Grace, I think you will be able to find a lot of very informative information here that will help shed light on what's going on.

From this thread, http://cancergrace.org/forums/index.php?topic=11445.0 Dr. Pennell says, " It is not uncommon for SCLC patients to develop NSCLC, and mixed tumors which progress in the NSCLC component are not exactly common but can certainly happen.
"The key is in the tissue biopsy, and as Dr. Hensing said, the treatment is then dictated by the stage of the new cancer. "

If you haven't already you may want to familiarize yourself with the basics of sclc and nsclc.
This blog is an introduction to lung cancer, http://cancergrace.org/lung/2010/04/05/an-introduction-to-lung-cancer/
This blog/post explains sclc, scroll down to extensive cell to read about that, http://cancergrace.org/lung/2010/08/07/treatment-of-small-cell-lung-cancer/

There have been several members describe similar situations where nsclc was treated then apparently the cancer evolved into sclc and vis versa. A search for these threads may shed even more light.

Your last question asked about mets. Yes, having mets at diagnosis is considered extensive (sclc) or metastatic depending on type of lung cancer your talking about. neither is considered operable. However both are very treatable and the 2 treatments have a lot in common so it will be very doable to expect good results from the treatment moving forward.

Please read through the information and let us know more about what you need.
I hope your mother in law does well,

Janine
forum moderator

PS be sure to subscribe ( in the green box above the first post) to the thread as we will move it to suitable location but the address will remain the same.

catdander
Reply To: SCLC or not?

I didn't mention in the earlier post that your thread has been assigned to one of our faculty for comment. You should receive it within 12 hours.

Thanks again,
Janine

Dr Pennell
Reply To: SCLC or not?

Hi Steve, you are correct that small cell carcinoma that spreads to the eyelid would be considered extensive stage, or metastatic. Merkel cell and small cell are very very similar so the mixup is understandable. This unfortunately is incurable but is treatable with chemotherapy, and the link above to SCLC treatment hopefully will explain this in general.

It is actually not uncommon for lung cancer to be a mix of small cell and non-small cell carcinoma, nor is it uncommon for some non-small cell carcinomas to express neuroendocrine markers (like chromogranin and synpatophysin) which is what I think they must mean by "reaction to small cell markers". Without seeing the pathology report I cannot say for certain what is going on, but some NSCLCs are in the same spectrum of diseases as SCLC. One such is large cell neuroendocrine carcinoma, which is often treated much like small cell carcinoma. As Dr. Hensing mentioned, the treatment should be guided by the biopsy results. So if the new biopsy clearly shows non-small cell carcinoma, I would recommend chemotherapy tailored to that type of cancer. It does not mean this is a different cancer.

stevieb54
Reply To: SCLC or not?

Janine, Dr. Pennell,

Thank you for your replies. The answers, and the other information on the site is very useful in understanding (as a lay person) what is going on, and what might happen. I will keep you informed of progress. My mother-in-law has an appointment in Heidelberg next Tuesday, and we should learn what Chemo is recommended now.

Please keep up the good work. I have found no other site like GRACE!

Steve