What's "Normal"? - 1267424

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phillydaughter
What's "Normal"? - 1267424

My mom (Stage 4 cancer in lymph nodes and hip/spine) has had 3 treatments carbo/alimta. Only a brain scan since treatment started and that was stable.

The doc is rescanning next week before fourth treatment. Is that normal? Would they typically scan just lung or from "neck to knees" to check for all spots? What test? A CT?

Also, it is typical to be seen by a pulminologist? As far as we know one has never be consulted by the medical onco.

cards7up
From my own LC experience, I

From my own LC experience, I only saw a pulmonary doctor once to have the lung function test. I'm a little confused, did your Mom have brain mets and if she did, were they treated? It's normal to do a CT scan part way through chemo to check progress. If they see progression, they may switch chemo. Otherwise, she'd finish whatever treatment she's on. Then after her last infusion, they'll wait approximately 6-8 weeks to rescan. Hope this helps. Take care, Judy

JimC
Hi phillydaughter,

Hi phillydaughter,

It's typical to scan after two or three cycles of a new regimen, and most oncologists favor a chest CT rather than multiple CTs or a PET scan. The chest CT images not only the lungs but also the spine most of the liver, and the adrenal glands. In addition to the brain, these are the typical places for lung cancer to metastasize.

Once lung cancer is diagnosed, a patient's care tends to be handled by an oncologist, who might bring in a pulmonologist if that expertise is required.

Good luck with the scan!

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Agree on both points. It's

Agree on both points. It's most common and appropriate to scan after 2-3 cycles. A pulmonologist is not routinely involved after initial diagnosis of a lung cancer if they don't have active issues with problems commonly managed by a pulmonologist, such as a pleural effusion, emphysema/need for oxygen, and/or obstruction of an airway that may potentially be treated by stenting.

That said, now that we're doing repeat biopsies more often to check for changes in molecular markers for more patients, some patients are being referred back to their pulmonologist to get tissue again months or years after their initial workup and diagnosis.

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

phillydaughter
Dr. West mentioned about

Dr. West mentioned about "doing repeat biopsies more often to check for changes in molecular markers".
Are the repeat biopsies only for those with targetable mutation(EGFR / ALK)?
My mom's only path report is KRAS (65%)and TP53(55%).
Would it be reasonable to retest her? And if so when?
Also what do those percentages mean?

catdander
Hi phillydaughter, I won't

Hi phillydaughter, I won't guess about the repeat biopsies but will ask a doctor to comment.

I hope your mom is feeling alright.

Best of luck,
Janine

Dr West
Repeat biopsies are

Repeat biopsies are definitely not standard for most patients, and there is no established role or value for doing it if there isn't an expected change in management because of it. Right now, the only setting in which that's compelling is for patients who have an EGFR mutation and acquired resistance and who may benefit from a treatment like AZD9291 or rociletinib (CO-1686) if they have an acquired T790M mutation (these agents have demonstrated very promising activity almost exclusively in the ~60% of EGFR mutation-positive patients who develop a T790M mutation as the mechanism of their acquired resistance). Otherwise, there's no reason to expect that a repeat biopsy would lead to any new options.

And the percentages listed refer to the % of cancer cells with the mutation in question.

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

phillydaughter
Thank you for the detailed

Thank you for the detailed explanation. That was my basic understanding from what I've learned from being on this amazingly informative and caring site.

catdander
phillydaughter, I asked Dr.

phillydaughter, I asked Dr. Ramchandran ( http://cancergrace.org/faculty/kavitha-ramchandran-md ) to comment but she was unable to log in so she emailed this reply,

"Hi phillydaughter

"It appears your mom has received appropriate care. A scan after 2 to 3 cycles is normal. And yes a pulmonologist is not usually needed.
Repeat biopsy is indicated if you're thinking about a clinical trial. It is always worth asking about. I hope your mom is doing well.

"Kavitha Ramchandran", MD

b-1 83
Teacher Wife had the enhanced

Teacher Wife had the enhanced CT on her chest every 2 months for nearly 3 years. I'm no doctor, but it would seem that when that primary tumor is getting thumped on by the chemo, the others are likely feeling it too. She also had the bone scans to go along with it. On another note, she initially tested negative for the EGFR mutation, but later was found to have it after all. There was a reason Tarceva worked so well, and later she was a candidate for the Battle II test for drugs to fight Tarceva resistance.

Keep up the fight!!!!