My mom was diagnosed with Stage IV adenocarincoma with malignant pleural effusion, cancer in the lung lymp node, no tumor no spread outside of the lung. About 2 and 1/2 years ago she had a wedge surgery to remove a tumor and was staged at 1a. She has been getting CT scan every six months with clear results, pushed the last one to 9 months. In the meantime developed a cough, I asked her to go the doctor, she move her CT scan up instead. This is when they found the MPE and spread to the lymph node.
She is schedule for chemo in a couple weeks. And waiting test results to see if she can take Travcin (spelling?).
Her oncologist is out of the country for two weeks. I have questions about her prognosis.
Does going from no evidence of cancer to Stage 4 indicate a fast growing cancer? Does the fact that she does have a tumor increase her life expectancy?
I don't know if I have a short amount of time with her and should take leave from work or if this is a long process and should plan accordingly.
She is a non smoker, 74, somewhat active (hiking, rafting) and has good nutrition.
Thanks for any information you can provide.
Reply # - July 12, 2014, 10:43 AM
Reply To: Stage 1 to Stage IV NSCLC
Hi bookend and welcome to Grace. I'm very sorry your mom had this recurrence after doing so well for 2 1/2 years. There's just no way to say at this point what her cancer might be like so there's no way to say how long she'll live. Prognosis at any point except the most dire is simply conjecture and no one can say.
It's becoming more normal for people do well for 2 and 3 even 5 years and some cancers are quite aggressive. Longevity with stage IV nsclc is just getting longer with each passing year. You'll get a better understanding for what's happening as time passes for the next few months. Just finding stage IV nsclc can be one to the most disorienting times of the disease. There are so many unknowns even for the doctors. For the person with and the loved ones it's a time of complete reorientation. She may need to control what she can and stay as normal in daily life as possible or she may need to have you around for a readjustment period. But she's not likely to die any time in the very near future. It's likely you'll have a difficult conversation with her to shed light on how to move forward.
In the meantime read up on the many topics we have available and ask questions when you have them.
All the best moving forward,
Janine
One of my favorite statements in all of our blog posts is the first pp but keep reading, http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-thera…
Reply # - July 12, 2014, 10:52 AM
Reply To: Stage 1 to Stage IV NSCLC
The testing that is being done is molecular marker testing, at least for an EGFR mutation, which is associated with a high probability of responding well to an EGFR tyrosine kinase inhibitor like Tarceva (erlotinib) or Gilotrif (afatinib) or Iressa (gefitinib). Another relevant marker is an ALK rearrangement, which is associated with a high probability of response to an ALK inhibitor like XALKORI (crizotinib).
In the absence of a "driver mutation" associated with a high probability of a response to a specific targeted therapy, the main treatment is standard chemotherapy. You can read more about selection of first line treatment here:
http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-thera…
It's unfortunate that the lung cancer apparently recurred 2.5 years after initial presentation, but we know this will happen about 30% of the time. These cancers are clearly more "aggressive" than other stage I lung cancers that don't recur, but they actually tend to be slower growing and have a more favorable prognosis than lung cancers that were initially detected as stage IV lung cancers. You can think of it as being a slower process if it took 2.5 years to go from being detected as stage I and going to stage IV than in the many other cases when the cancer first presented as stage IV, presumably with less time to be detected as a stage I cancer before appearing as stage IV. For this reason, patients who experience a relapse/recurrence of cancer after earlier disease tend to have a more favorable survival than people who were diagnosed initially as stage IV, and the longer the interval between initial treatment and relapse, the more favorable outcomes are likely to be (the slower the engine behind the cancer).
Good luck.
-Dr. West
Reply # - July 12, 2014, 11:41 AM
Reply To: Stage 1 to Stage IV NSCLC
Thank you for your thoughtful responses, it is helpful.
Reply # - August 24, 2014, 07:06 PM
Reply To: Stage 1 to Stage IV NSCLC
Hi, it' has been over a month since I learned about my mothers diagnoses. We have gotten a second opinion and went for two assessments for clinical trails for pd1 and pdl1. She has had two thoracentesis since the original that determine there were malignant cell in the fluid. She does not have EGFR or ALK mutations. She has not started any traditional treatments yet. She has been doing a variety of Chinese herbs, acupuncture and other things. She is very resistant to doing chemo or pleurodesis -hence the attempts for an immunotherapy trail.
She has a persistent cough and some shortness of breath but otherwise is symptom free. She had her first scan since early July as part of the applicant to one of the trails. As of her scan in July her cancer wasn't measurable enough for the trail. Her recent results are she has had little to no growth in the lymph nodes and the cancer has not spread beyond the nodes and fluid. However the fluid is close to the same level as July even after a drain the week before. And as I understand it she isn't eligible for the trail she was looking into for the time being.
I am really confused by the malignant pleural effusion and what it means that it seems to be growing but the tumors don't show growth. Any easy way to explain this to me?
Reply # - August 24, 2014, 07:34 PM
Reply To: Stage 1 to Stage IV NSCLC
Hi bookend,
Pleural effusions are caused by an irritation in the pleural space, caused by inflammation, infection or in this case by the presence of cancer cells. Regardless of whether those cancer cells are increasing in number, that irritation is still present and even after draining, more fluid can develop. Especially in the absence of treatment, a recurring effusion is not strong evidence of progressing cancer; more likely it just means that the presence of untreated cancer cells continues to produce excess pleural fluid.
If you haven't already seen it, Dr. West's post on pleural effusions may be helpful: http://cancergrace.org/lung/2007/03/17/intro-to-pleural-effusions/
Hopefully, when treatment is started the effusions will no longer appear.
JimC
Forum moderator