Linda661 Posted May 15, 2006 Share Posted May 15, 2006 Hi again. Have been so busy, haven't been able to participate much lately. Today's onc. visit generated another question: mom was originally staged IIIb before treatment got going. Today, I was asking some questions about when we are gonna' do another followup CT scan to see if we have any more tumour shrinkage happening --we haven't done any more followup like that since just after chemo #6 on Mar 1st (we are now at chemo #13, with 9 radiation complete and none of us, docs included, have any clue how we are doing these days; plus, first CT report was not what I would call great treatment success under current chemo.....really want to push for another chemo option if things are continuing the way they have been in the past...before mom hits the floor with exhaustion from all of this). The PA (physician's assistant) referred to another followup CT scan as a "restaging" -- I haven't heard that used around here or I misunderstood it......are you restaged during or after a treatment course? In other words, can mom become a IIa or something better? Will be interesting to see what responses come as it certainly will clarify to me that a "restaging" ought to open the doors to other options (like surgery, etc.) that were closed to mom initially, in my mind. Need help understanding this better.....I see some are at least in a remission at a current "staging".....and NED is everything gone or is it also nothing continuing to advance (i.e. the tumour appears still there, but totally inactive)? Thanks in advance for your clarification -- this is probably a really simple question that I just missed in my learning here.... As of today, looks like we are doing 3 more 1/2 dose chemos (taxol/carbo) while this course of 22 total radiation treatments is going.....next chest CT somewhere around June 8; followup head CT on June 1. Linda P.S. Everyone cross what you can.....mom is coming off of C-diff meds today (again) with another test for that scheduled at the end of this week.....hoping that mess is cleared up by now at least -- hard to tell, she still has symptoms for that but it could be the radiation or some other side effect too (sorting this stuff out just s**ks, and the patient suffers with every day that goes by while the rest of us scratch our heads with this....ugh!!!!). Quote Link to comment Share on other sites More sharing options...
Kasey Posted May 15, 2006 Share Posted May 15, 2006 Good to see you, Linda!!!! This is some info I got from my very GREAT surgeon at NIH! First of all, NED means No Evidence of Disease. It does NOT mean ther is NO disease. It means it can't be SEEN at a particular time. Now MAYBE it is GONE, but maybe it is just hiding somewhere to present itself at some later point in time. I then asked if I could be a Stage 0 since I had a WONDERFUL surgery......................dead tumor and all nodes and margins negative. He told me I was a RECOVERING Stage 3 patient. I was led to understand there's no going backwaards. Now I will also be interested to see what others say. I would LOVE to be Stage 0, ya know! But that is what my understanding is as of right now. Hope you are hanging in there, Linda. Think of you and Mom quite often. Glad you asked this. I could be WAY off base. Kasey Quote Link to comment Share on other sites More sharing options...
mamasbabygirl Posted May 15, 2006 Share Posted May 15, 2006 Linda, You spoke the truth about our families suffering while we fight for them. It is tempting to throw in the towel many days but I somehow always manage to sleep and refocus and get back on the horse to move forward. I am not sure about restaging. I thought they could do that if treatment was successful and then a patient is eligible for surgery or something. I am sure many others will know the answer to this. Hang in there sista... Quote Link to comment Share on other sites More sharing options...
Snowflake Posted May 15, 2006 Share Posted May 15, 2006 http://www.cancer.org/docroot/eto/conte ... taging.asp A Cancer's Stage Does Not Change An important point some people have trouble understanding is that the formal "stage" of a cancer does not change over time, even if the cancer progresses. A cancer that comes back or spreads is still referred to by the stage it was given when it was first diagnosed. For example, if a woman was first diagnosed with "stage II breast cance," but the cancer now has spread to the bones, the cancer is called "stage II breast cancer with recurrent disease in the bones" (if the cancer went away with treatment) or "stage II breast cancer with metastasis in the bones" (if the cancer never went away completely). This is not "stage IV breast cancer". A stage IV breast cancer refers to a cancer that has already spread to a distant part of the body when it is first diagnosed. A person keeps the same diagnosis stage, but more information is added to the diagnosis to explain the current disease status. (The treatment of a stage II cancer with metastasis and a stage IV cancer may be the same, however.) This is important to understand because survival statistics and treatment by stage information on specific cancer types refer to the stage when the cancer was first diagnosed. The survival statistics related to stage II breast cancer that has recurred in the bones may not be the same as the survival statistics for stage IV breast cancer. Sometimes, after a period of remission (cancer being undetectable) for certain cancers, if more treatment is planned, a doctor might restage the cancer. This will mean going through the same process that was done when the cancer was first diagnosed: exams, imaging tests, biopsies, and possibly surgery to restage the cancer. If the cancer is restaged, the new stage will be recorded with a lower case "r" before the restaged designation. This is not often done. Quote Link to comment Share on other sites More sharing options...
RandyW Posted May 15, 2006 Share Posted May 15, 2006 Restaging Patients with N2 (Stage IIIa) Non-Small Cell Lung Cancer after Neoadjuvant Chemoradiotherapy: A Prospective Study Back to 86th Annual Meeting Back to Program Outline -------------------------------------------------------------------------------- OBJECTIVE:To assess the accuracy of re-staging patients with stage IIIa non-small cell lung cancer after neoadjuvant chemoradiotherapy. METHODS:A prospective trial of patients with biopsy proven N2 disease who underwent initial clinical staging with mediastinoscopy and integrated PET/CT and CT scans. Patients were then clinically re-staged by the same imaging techniques 4-12 weeks following their induction chemo-radiation therapy and then underwent definitive pathologic staging. RESULTS:Ninety-three patients had their lymph nodes pathologically restaged. Repeat PET/CT after neoadjuvant therapy missed residual N2 disease in 13/65 patients (20%) and falsely suggested it in 7/28 (25%). It was more accurate than repeat CT for restaging at all pathologic stages (stage 0, 92% versus 39%, p=0.03 and stage I 89% versus 36%, p=0.04). When the maxSUV of the primary tumor decreased by > 75% it is highly likely (likelihood ratio, +LR, 6.1) the patient is a complete responder, when it decreased by > 55% it is highly likely (+LR 9.1) the patient is a partial responder. When the maxSUV of the N2 node initially involved with metastatic cancer decreased by greater than 50%, it is highly likely (+LR 7.9) the node is now benign. CONCLUSIONS: Repeat integrated PET/CT is superior to repeat CT scan for the re-staging of patients with stage IIIa non-small cell lung cancer. The percent decrease in the maxSUV of the primary and of the involved lymph node is predictive of pathology, however nodal biopsies are required since a persistently high maxSUV does not equate to residual cancer. -------------------------------------------------------------------------------- Back to 86th Annual Meeting Back to Program Outline DOES THIS HELP CLARIFY ANYTHING??? Quote Link to comment Share on other sites More sharing options...
john Posted May 15, 2006 Share Posted May 15, 2006 Sometimes induction or neoadjuvant chemo therapy is used for Stage IIIa, IIIB with the hopes that it will be "downstaged" The lymph nodes no longer have cancer in them or at least are not detectable via mediascoscopy or other means. If a patient is downstaged then a resection is sometimes done google on : downstaged "lung cancer" google on : induction chemotherapy downstaging or Neoadjuvant downstaging Quote Link to comment Share on other sites More sharing options...
Bill Posted May 15, 2006 Share Posted May 15, 2006 Based on my experience, consensus medical opinion is that the original dx holds despite the popularity of PET scans and other imaging used to " restage " a patient's cancer. May be more meaningful to the patient to hear it than for the practitioners to revamp tx based on it. If you suffer through witnessing the periods of improvement, even dramatic improvement, only to see some or all of it reverse, it's easy to see why restaging is a tricky subject. Based on PET / CT scans, this past year my wife went from stage 4 NSCLC to essentially NED then back to stage 4. Stage 4 NSCLC was her original dx back in May '04. B Quote Link to comment Share on other sites More sharing options...
Linda661 Posted May 16, 2006 Author Share Posted May 16, 2006 This is making sense so far from what I understood initially: we move forward based on improvements (or not) from initial dx staging, rather than changing any sort of "official" staging dx..... what can I say, today was rather confusing to me with this restaging thing. Don't need that sort of confusion on top of all the other messes happening in this process (and you really don't want another novel on those....trust me)! Linda Quote Link to comment Share on other sites More sharing options...
Don M Posted May 16, 2006 Share Posted May 16, 2006 sometimes they use the term restaging on a ct report for a routine scan just to justify to the insurance comapany the reason for the scan. Quote Link to comment Share on other sites More sharing options...
cindi o'h Posted May 16, 2006 Share Posted May 16, 2006 that is also my understanding, Don M., Insurance submission for reimbursement lingo. Cindi o'h Quote Link to comment Share on other sites More sharing options...
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