What to do when Pathologist can't be 100% sure it's SCLC - 1261378

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bird
What to do when Pathologist can't be 100% sure it's SCLC - 1261378

My father has a tumor in his right lung which led to post-obstructive pneumonia. This led to a tumor ablation and hospitalization. He is much improved, but we waited nearly two weeks to receive a pathology report that indicates high grade carcinoma with neuroendocrine differentiation that they believe to be highly aggressive. The surgeon has told us the pathologist can't be certain it's SCLC, but they believe they should proceed as if it were. My question is how can we proceed with confidence without certainty? Is this common in pathology of lung cancer?

Robin

Dr West
Reply To: What to do when Pathologist can't be 100% sure it's

It sounds like the main question is whether it's small cell lung cancer or perhaps non-small cell lung cancer with neuroendocrine features, or possibly a neuroendocrine carcinoma other than lung cancer. All of these are essentially treated the same way, with a chemotherapy backbone of a platinum and most commonly etoposide, typically with radiation added if the cancer is limited to a relatively small area that can be covered in a radiation field safely.

You may be able to get a little more information from a medical oncologist, but it sounds like there's enough evidence to proceed with this general plan.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

bird
Reply To: What to do when Pathologist can't be 100% sure it's

Thank you, Dr. West. We meet with a medical oncologist tomorrow. Can you please tell me how I can search clinical trials when my dad doesn't have a definitive pathology and clear diagnosis? I've looked through the NCI clinical trials and found a few at NIH, but without knowing for sure if it's small cell or non-small cell, I can't decide which ones to contact.

Dr West
Reply To: What to do when Pathologist can't be 100% sure it's

I think you'll need to ask the medical oncologist what the diagnosis would fall under, or you can look to see if there are trials for "neuroendocrine carcinoma".

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

carrigallen
Reply To: What to do when Pathologist can't be 100% sure it's

If you are interested in clinical trials, I suggest it may be wise to come to a consensus and pick the closest assessment of type of cancer. For example, perhaps it could arguably be defined as 'poorly differentiated non-small cell lung cancer with neuroendocrine features'. That may potentially permit eligibility for non-small cell lung cancer (NSCLC) trials. It all depends on the clinical context.