Visceral Pleural Invasion T3 N1 M0 - 1268897

Fri, 03/13/2015 - 09:59

I have searched visceral pleural invasion and Stage III but I can't find answers. I am sorry if I have missed something. My husband who is 71 and a never smoker (but exposed to asbestos) had a left pneumonectomy in October for adenocarcenoma 7.2cm (pT3N1M0). Only yesterday did we think to ask for a copy of the pathology report. It mentions 'completely excised', but also says there was visceral pleural invasion. Neither the surgeon nor the oncologist has ever mentioned this. As he has just finished adjuvant chemotherapy and next sees the oncologist in June, I am trying to google to find out the prognostic implications of the visceral pleural invasion. So far I have mostly found information about Stage I or II and VPI, not Stage III. If you can help, we would be most appreciative.

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Hi Judy, I certainly hope all cancer is now gone.

I'll let a faculty comment on the implications of you husbands dx. But I want you to note my husband's good fortune with his cancer. You can read my signature below but what it doesn't say is, his primary tumor made his dx stage III and was by most standards (including every person at the cancer center where he was being seen) his tumor was unresectable so was given curable doses of chemo and radiation. With that tx the prognosis was very dire. So later in his story nodules thought to be mets were or weren't mets I guess we'll never know. Today he has no evidence of disease and hasn't had tx in almost 3 years. He's a bit worse for wear and we don't know if the cancer will return but he has bet any prognostic guesses by 1000.

All that to say prognostics are good when looking at the big picture but not so much the individual. A number given as a median means half the people do better. Sometimes it's better to not put too much on those numbers, especially when you're in the waiting and watching mode. Waiting and watching is bad enough, there are things I wish I hadn't made so clear to my husband.

I hope you and he do well and grow and heal together.


Thank you Janine. We are adjusting now to watch and wait and in a bit of a transition period as my husband's adjuvant chemo has recently finished. Since last July when he first went to the GP with a slight crackle in his breathing we seem to have had no other focus than 'the next appointment'. As for many, the dx came as a complete thunderbolt and we both started thinking too far ahead. He has 8 weeks pulmonary rehabilitation coming up so there will still be a hospital connection but we are planning short holidays etc. The visceral invasion on the pathology report was entirely new to us and we can't find too much information and it is June before he can ask the oncologist. But we are not going to dwell on it!

Many thanks again for your lovely words and your encouragement. Very much appreciated


Well it's great to hear your plan Judy. It is absolutely fine and I'd think preferable to seek out his oncologist's thinking of this. No one can say what he or she may have thought. It's perfectly fine and reasonable to call with questions. Get it out of the way to move on with those small trips. :)

Pleural invasion does make a prognosis less favorable but again that's just a stat of many not the individual. My husband's type tumor has a very bad prognosis. As far as the difference between staging and the type of tumor is either the tumor itself or involved nodules. Anything you've read about pleural invasion is probably applicable to your husband with the addition of whatever made the dx stage III. The following link has a good discussion on stagging.

I hope this helps,


Congratulations on your husband's completing his surgery and adjuvant chemotherapy!
So visceral pleural invasion is a negative prognostic factor, and when seen in a tumor that would otherwise be a T1 tumor (meaning a tumor less than 3 cm), visceral pleural invasion, when present, will "upstage" that tumor to a T2 designation. This is because it demonstrates that while the tumor is quite small, it still has the ability to be invasive and is more likely to spread relative to if it had NOT done so. However, for a lung cancer that is T2N0 (stage IB) with pleural invasion as the only negative prognostic factor, cure rates are quite good. There are several prognostic factors for lung cancer, two of which are size of tumor, and degree of nodal involvement. In the setting of a tumor that is already T3 (likely by virtue of its size being greater than 7cm) and N1 (meaning nodal involvement), it is unlikely that the visceral pleural invasion adds much at all in terms of determining prognosis. The important thing to remember is that this is still a potentially curable cancer that was managed appropriately with aggressive surgery and chemotherapy. Hope this helps.