Recurrence?

[Julie in SoCal]

Hi Friends,

Here's my story. in 2017 I was dx'd with NSCLC 3a Adenocarcinoma , I had left upper lobectomy via VATS, 4 rounds Carbo/Pemetrexed, 39 rounds of radiation.  I also have stage 3c melanoma, so we found it in the process of scanning for Mel. 

Last week I had a PET scan and it has shown hot spots : 1) in my left 2nd rib bone, 2) cervical neck lymph nodes (iv) , 3) in my right shoulder infraspinatus muscle, and 4 ) some  noncalcified lung nodules.

Here are the deets:

New left level IV (lower jugular) hypermetabolic lymphadenopathy. For example there is a new left level IV node now measuring 16 x 8 mm maximum dimensions with a max SUV of 7.8 (3-475). Another level IV node measures 14 x 11 mm in maximum dimensions with a max SUV of 4.2.  I've also been coughing up a lung for the past 3 months.

Chest: Enlarged hypermetabolic right infraspinatus muscle with a max SUV of 9.0.

Interval enlargement in some of the previously visualized noncalcified pulmonary nodules. For example a right upper lobe pulmonary nodule now measures 7 x 7 mm in maximum dimensions compared to 6 x 5 mm previously with background level FDG avidity.

There are multiple new noncalcified pulmonary nodules. For example a right middle lobe pulmonary nodule now measures 5 mm maximum dimensions (3-439), right upper lobe pulmonary nodule measures 5 mm (3-448), and a right upper lobe pulmonary nodule measures 6 mm in maximum dimensions (3-451).

Bones: New 6 mm lytic destructive lesion within the left anterior second rib with a max SUV of 6.6.

I've talked with my pulmonologist about the lung nodules.  He says they are too small to worry about and that my cough is (probably) the remnants of walking pneumonia. Antibiotics are working wonders!

I have a brain and a shoulder MRI on Fri to take a better look at everything there.  I'll also have a fine needle bx of my lymph nodes to figure out why they were lighting up.

So my questions are:

1) Does this sound like lung cancer recurrence? (Rather than melanoma?)

2) Can NSCLC travel up lymph paths?  Or is it more likely to travel south with gravity?

3) NSCLC in a muscle?  Does this make sense.

Ideas what is next if it is NSCLC? Surgery? An EGFR drug (I'm a mutant).

Thank you friends, I won't get any results for another week and I'm sitting on pins and needles.

Julie

[Tom Galli]

Julie,

The PET report strongly suggests a recurrence. I wouldn't know if is melanoma or lung cancer.  The scheduled needle biopsy ought to clarify the nature of the recurrence. In my reading, lung cancer and melanoma rarely presents in skeletal muscle but rare is not impossible.

I'm pretty sure any form of cancer can travel anywhere in the lymphatic system.  From the number of SUV returns, next would likely be EGFR countering targeted therapy.

Recurrence is such a pain.  It is common in both lung cancer and melanoma. The only thing worse that a recurrence is scanziety waiting for biopsy results. I wish I could make both disappear.

Stay the course.

Tom

[Curt]

Hi Julie.  That’s a lot of info to absorb.  I’ll answer from what I know but please understand I am not a doctor.  I’ve responded in bold below   

1) Does this sound like lung cancer recurrence? (Rather than melanoma?) - It sounds like it could be either.  Both can spread in the lungs and lymph nodes   

2) Can NSCLC travel up lymph paths?  Or is it more likely to travel south with gravity?  - NSCLC can spread to the lymph nodes and often does.  Grab it does not work the same way inside your body as it does on the outside   

 3) NSCLC in a muscle?  Does this make sense. -  NSCLC is not a muscle but can spread to the muscles   The part they say “Enlarged hypermetabolic right infraspinatus muscle with a max SUV of 9.0.” implies that they are seeing that muscle light up in the PET scan.

 Ideas what is next if it is NSCLC? Surgery? An EGFR drug (I'm a mutant). - Not sure what the next step will be.  It will depends on what treatments you’ve had and could depend on the specific EGFR mutation you have.  

Recurrence is is what makes this disease do difficult.  Hopefully it’s not.  If it is you’ve best it back once.  There are lots of new treatments that can do that again.  Hang in there.