Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist, and Executive Director of Employer Services at the City of Hope Comprehensive Cancer Center in Duarte, CA.

Recurrence and New Cancers after Curative Treatment of Lung Cancer
Tue, 10/30/2007 - 22:20
Author
Howard (Jack) West, MD, Associate Clinical Professor, Medical Oncology, Executive Director, Employer Services, Founder, President and CEO of GRACE

Among the key issues in following patients with a history of treated lung cancer is the pattern of recurrence. We need to have a sense of when the risk is highest and where people are more likely to demonstrate new evidence of disease. Fortunately, there are several studies that can help us with these questions.

Looking at patients who have undergone potentially curative surgery for stage I NSCLC, we know that recurrence rates in the range of 20-35%. Most of these recurrences are distant metastatic disease, not failure of local treatment that leads to disease recurrence close to the site of the original primary. This is why we feel that chemotherapy, which goes throughout the body, is the more effective way to reduce the risk of cancer recurrence after surgery. In addition, most recurrences are in the first 3-4 years after surgery, but there are also reported recurrences beyond 5 years out. We know that people who have nodal involvement have a higher risk of recurrence than those with stage I disease (and no lymph node disease), and they also tend to develop recurrences earlier than those without nodal involvement.

In addition to the risk of recurrence of a prior cancer, there is also a risk of a new cancer developing. We know that patients with a history of lung cancer, not only have a risk of their prior cancer returning, but they also generally have a greater predisposition to develop another, independent lung cancer. In many cases, the cells of the lung have a field defect (a problem that affects not just the cancer, but an area around the cancer as well), often from prolonged exposure to carcinogenic tobacco smoke, which means a large population of cells is also part way along a path toward cancer. The estimate of risk for developing a new lung cancer is in the range of 1-2% per year, and this remains constant with more time after potentially curative surgery for a first cancer.

Of course, when we talk about risk of cancer recurrence after surgery, we’re generally talking about NSCLC, but studies have also been done looking at SCLC patients, who are at risk for developing NSCLC as well. Within just two years after treatment for SCLC, the risk of developing a metachronous (new cancer at a later time than the original, vs. synchronous, which is two different cancers in a person at the same time) NSCLC tumor is as high as 12-15%.

These results underscore the need to follow patients closely after treatment for cancer. While it may or may not be feasible to treat a cancer recurrence with curative intent, it’s certainly appropriate to be vigilant about jumping on a new cancer early, and we know that people with a history of a treated lung cancer are at unacceptably high risk for a new cancer.

Next we’ll review how we do in treating recurrences and new cancers.

Next Previous link

Previous PostNext Post

Related Content

Forum Discussions

Hi JW and welcome to Grace. I'm sorry you're going through this but hopefully and probably this isn't cancer. There is so much going on anatomically in that area that the...

Hi and welcome to Grace. I'm so sorry about your mom's situation, it's very complicated and not at all reasonable for us to comment on all that is being taken into...

Hi Scruboak, I will ask Dr. West to comment, it may be tomorrow. He's an expert in the field and will have thoughtful input. The fact that it was caught and...

I asked Dr. West and he said that this is a question he can't answer, we don't have studies that give details that specific. He said to his knowledge, that this...

Thank you so much, Janine. It helps me to just chill overall.

It's surprising how a little piece of intel can make everything else in life easier.

Hi Scrappy,


 


Below I've pasted my comment from facebook. Google is a double-edged sword, you can find anything but without some context, it can be tough to digest. We get...

Recent Comments

JOIN THE CONVERSATION
Hi JW and welcome to Grace. …
By JanineT Forum … on Mon, 05/16/2022 - 10:52
All's good
By JanineT Forum … on Sat, 05/14/2022 - 15:10
Can Pancoast affect both sides of the body?
By JanineT Forum … on Wed, 05/11/2022 - 19:49
Hi and welcome to Grace. I…
By JanineT Forum … on Sun, 04/24/2022 - 08:41