Dr. Kristin Manning: Introduction to Imaging for Lung Cancer

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A radiologist, the person who specializes in reviewing imaging studies in medicine, is often someone you notice if they're unusually bad or unusually good. They perform a service and you presume that they're good at it, but a few are so sharp that the other doctors they work with notice it at every tumor board discussion or one on one exchange.

Debate Over the Value of Progression-Free Survival Affects Clinical Decisions Now

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Continuing on the introduction to the concept from a recent prior post, the issue of whether it’s important to see an improvement in progression-free survival (PFS) if there is no improvement in overall survival (OS) after additional therapy is going to be a central issue in lung cancer management, relevant in several key issues in coming years.

Do Patient Symptoms Correlate with Response and Survival?

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Intuitively, you'd think that people who are doing worse while getting treated for lung cancer are not going to do as well as people who have improvement in their symptoms after treatment starts. But how much do patient symptoms count in our current medical system for deciding whether a treatment is working or not, and when to move to a new therapy? The answer is that patient reported symptoms don't have a clear role yet.

Lung Nodule Growth Rate: An Important Factor in Assessing Risk of Cancer

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A cancer has to grow faster than the tissue around it to become a tumor. Progressive growth is therefore a central feature of a cancer and a critical factor in distinguishing cancerous nodules from benign ones. There is a characteristic "volume doubling time" (VDT), the interval it takes for a nodule to double in volume. It's worth keeping in mind that because a nodule is generally spherical, an increase in the diameter by just 28% (such as a 2 mm increase from 7 to 9 mm) actually represents a doubling of the volume of a nodule.

Imaging Features of Nodules: What Makes a Lung Nodule High Risk for Cancer?

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As you might suspect, there are features of different spolitary pulmonary nodules (SPNs) that makes us more or less suspicious for cancer. The first is the size of the nodule. Looking at multiple series of SPNs, the likelihood of cancer among nodules that measured under 5 mm is generally in the 0-1% range. Nodules in the 5-10 mm range have been found to be cancer in up to about about 28% of cases, with most studies showing the risk of cancer in this range to be one in four or five.

PET Scans for Follow-up of Patients After Surgery or Chemo/Radiation

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We know PET scans can provide additional metabolic information that can be more sensitive and specific for cancer than chest x-rays and even CT scans in the initial staging of lung cancer (see prior post on introduction to PET scans). PET scans are now nearly universally employed in the initial workup, at least of patients who have NSCLC and aren’t already known to have stage IV disease.