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Brian

50 y/o nonsmoker = NSCLC, favor SCC

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I got my results back from my biopsy today, it shows NSCLC favoring squamous cell carcinoma. Nonsmoker, 50 y/o in good health, so why wouldn't I get something more identified with smokers...

It doesn't look like anything is in the left lung or lymph nodes, so that's good.

Question; does this type of cancer generally spread to the opposite lung and lymph nodes before it would metastasize elsewhere, or is it completely random?

I'm curious as to some of the other information in the report, I see the radiation oncologist on the 3rd, and I will ask him a ton of questions, but if anyone can share any insight to these areas underlined below, it would be much appreciated!

Specimens:

A - Lymph Node, Other, 4R.   Lesion Size and Description: 1.99cm
B - Lymph Node, Other, 11R  Lesion Size and Description: 1.91cm
C - Other Source, Lung, right mass.    Lesion Size and Description: 10.0cm

Diagnosis:

A. Lymph node, 4R, EBUS-guided transbronchial needle
aspiration, cytology with cell block:
-Non-small cell carcinoma, favor squamous cell carcinoma (see
comment)
B. Lymph node, 11R, EBUS-guided transbronchial needle
aspiration, cytology with cell block:
-Non-small cell carcinoma, favor squamous cell carcinoma (see
comment)
C. Right lung mass, EBUS-guided transbronchial needle
aspiration, cell block only:
-Non-small cell carcinoma, favor squamous cell carcinoma (see comment)

Interpretation/Comment:


The aspirate smears show relatively abundant fragments of nonsmall
cell carcinoma. Morphologic features are compatible with
squamous cell carcinoma, and probable intercellular bridges are
seen, although no keratin pearls or cytoplasmic keratinization
(as evidenced by cytoplasmic orangeophilia) is seen.
No small
cell component is seen.
Immunohistochemical stains performed
on C1 show the following results in the tumor cells:
p40: Positive
TTF-1: Negative
This immunohistochemical staining profile supports the
morphologic impression of squamous cell carcinoma.
Cell blocks A1 and C1 contain very scant tumor. Cell block B1
contains almost no tumor.
(this seems like good news, but since they reference tumor and not cancer, I am not sure)

 

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Hi Brian,

I think your radiation oncologist would be best positioned to answer your question about metastesis. May I suggest the following if you haven't already done so:

  1. Consult with a medical oncologist. 
  2. Consult with a surgeon (in concert with your oncologists) to listen to surgical options.
  3. Have NGS (Next Generation Sequencing) done to determine available treatment options.

All the best!

 

God bless,
Martin

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Brian,

I’m not sure if one can predict a metastatic site for any flavor of lung cancer. There are general patterns, for example, small cell often moves to the brain but nothing I’ve encountered that cites a specific pattern of movement. I do believe lymph nodes in proximity to the lung are often first effected, but I’ve known many who had organ and bone mets without lymph node involvement. 

I don’t know what the underlined and bold text in the pathology report means. 

Stay the course. 

Tom

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Been awhile, I came back about two weeks ago after a notification about a new post in my introduction post, but it seems to have gone missing. I wonder what happened? I will say that the content in said notification seemed like it had nothing to do with my post...


Anyway, I've now met my radiation and medical oncologists, had a brain scan that was negative, and had the PET scan today, I should get the results tomorrow at my appointment  with the pulmonologist.

Right after that appointment, I meet with the radiation onc for the simulation test. I asked at the last appointment what the goal of his treatment plan is. Cure? Control? Relieve symptoms? Without missing a beat, he says “cure.” He goes on to say that this could also mean treating it as a chronic condition depending on a whole host of factors that we don't yet know, but he seemed optimistic.

The next day, back with the medical onc. She ordered genetic testing to see if there are any, that will take about three weeks to get back, but no rush obviously, I have more than enough to do right now.

So far, the original diagnosis of Stage IIIa has held, and both oncologists feel good about that remaining the diagnosis, but the PET will shine a light on that. If all remains the same, then I will likely begin treatment the following week:

Radiation - 5x a week for 6 weeks

Chemo - 1x a week for 6 weeks

(radiation and chemo are concurrent)

Immunotherapy - Every three weeks or so when chemo/radiation is complete

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Hi Brian-

This process is going very quickly and smoothly, that’s not the normal experience,  great news! 

 Let’s hope there’s nothing unexpected in the PET scan today.  Your team sounds amazing and supportive, that’s important!  
As you’re gearing up for treatment, it’s time to begin the transition to the new normal. Your only priority is to manage your wellness. This means getting really good at setting limits to give your body time to heal.   It can take a little while to settle into a new pace especially as your appointments start to get spaced out post diagnostic frenzy.  
The proposed plan sounds spot on to me.  
Michelle 

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Hi Brian, 

Sounds like you have a good plan and things are moving forward. I wish you all the best with your treatment.  I had concurrent chemo and radiation for an unrelated cancer prior to my lung cancer. The worst of it was having to go there every day. I hope you don't have far to drive. A lot of people have fatigue with radiation but I didn't. I'm NED on that cancer, which was stage 3, almost 9 years ago now. 

About that deleted post-- we moderators sometimes hide or delete posts. Most often they're commercials or spam.

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Brian,

Glad to hear that your treatment plan is in place.  My mom has had all of the proposed treatments included in your plan.  Chemo and radiation for 6 weeks then for a recurrence, she had chemo + immunotherapy for 6 doses and then immunotherapy alone.  The treatment came with lots of bumps, but she survived and is LIVING her life.  You can too!  It sounds like you are in good hands with your team and wish you the best.

Take Care,

Steff

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PET and MRI results showed no other cancer, so Stage III. I start radiation next Wednesday, and then I'll get my schedule for the rest of the radiation and the chemo after that.

 

 

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2 hours ago, BridgetO said:

About that deleted post-- we moderators sometimes hide or delete posts. Most often they're commercials or spam.

The whole thread is gone, not just the post, just FYI.

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My wife and I started a blog to document out experiences as patient and partner, which we hope will give people who follow us into this minefield some insight into the early days, the treatment cycle, and hopefully how to live with the long-term impact of cancer. Obviously I have many days of treatment ahead of me, and we will be writing along the way, so if you're so inclined, feel free to take a look!

https://risingredlung.com/

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