Any members have recurrent after complete resection?

[Minh]

11-25-2021, 

Happy Thanksgiving to all,

I just had a lobectomy 8 days ago (11-17-2021) at MD Anderson in Houston Texas. First time in 20 years I am away from home on Thanksgiving day. Typically every year on this day, I’d put a huge chunky turkey in the oven before we’d get together and go out to see local Thanksgiving parade with our two kids and my brother’s family (he died last year of lung cancer). Then we would come home and stuff ourselves with juicy turkey and smash potatoes. Afterward, we would spend all night looking for Black Fridays deals. This time we’ll watch it on tv in the hotel without our kids and without our only few nephews and nieces which will definitely make me feel isolated and disconnected. 

My recovery is going fine I supposed because my surgeon has gone on vacation immediately after the surgery and I won’t see him until next Monday. The pain is manageable with meds. I am easily tired, have shortness of breath, and chest pain when cough which is expected. I am not sure if I have air leakage or not because every time I take a deep breath I can hear a raspy noise. No pain just raspy noise.

I just got the pathology report yesterday and have not discussed with surgeon yet. Here is the summary of the report:

1. Lymph nodes stations: 11R, 9R, N1, 11R, 7, 4R, 10R are negative for tumor.

2. Tumor size: 1.5x1.6x1.7 cm.

3. Tumor site: right lower lobe of lung.

4. Histologic Type: invasive adenocarcinoma, acinar predominant.

5. Histologic Grade G2: Moderately differentiated

6. Tumor Focality: single focus

7. Visceral pleura invasion: not identified.

8. Direct invasion of adjacent structures: no adjacent structures present

It’s appear to be good news because few experienced members of this forum have believed so and told me so. I am cautiously welcoming and celebrating all the good news I can get. But I do have a question if anyone has recurrent (local, regional, or distant) after complete lobectomy? How long after lobectomy did recurrent occur?
 

Happy Thanksgiving to all!
I used to be thankful every year, now I am thankful everyday!

[Tom Galli]

Minh,

Happy Thanksgiving. As I said, your pathology report is possibly the best report that could be expected. No sampled nodes displayed cancer and a single focus tumor without invasion to adjacent structures.

As for recurrence after surgery, that unfortunately is a topic I'm well familiar with. In my case, my recurrence in the form of 3 tumors to my left (only remaining lung) happened about 7 months after lung resection. First, here is some information and commentary on lung cancer recurrence for background. The referenced study suggests stage IA and IB have about a 33-percent chance of recurrence after resection. Indeed recurrence is what makes lung cancer so dangerous. Second, I suggest you consult with a medical oncologist when you get home and start a program of regular CT screening to catch any recurrence early. 

Happy Thanksgiving and stay the course.

Tom

[LexieCat]

Three years after my lobectomy I had cancer in the other lung--at that point, Stage IV. Nobody can say whether it was a recurrence of the original cancer or a completely new one, though it didn't make any practical difference. 

Tom's right--no matter how good the surgery, there is always some risk of recurrence. That's why they will follow you with CTs for several years. The longer you go without a recurrence, the better the odds, but in my case, even three years wasn't enough to be sure.

[Minh]

Good morning,

After this lobectomy which got rid of the 1.7cm tumor, I still have 3 more nodules in both lungs. These 3 nodules range from 3mm to 6mm size. Two are on the lung pleurals. At this time, the doctors here in MD Anderson told me they don’t worry about these nodules unless they show some growth in the next couple CT scans. They can’t do biopsies because these nodules are too small and the PET/CT scan did not show SUV uptake. At this point they assume these nodules are benign. I have a feeling that these nodules are precancerous, but I can’t do anything about them. I just have to wait and watch. I hope they will not become cancer for another 5 years. I assume the cancer will come back per statistics. The question will be how soon? And what will be my next best scenarios? 
 

cancers suck!!!

[BridgetO]

Your best scenario is not to assume cancer will come back! And do your regular CT scans as scheduled, to assure that it hasn't. It's no use getting too far out in the future, which will only make you much more anxious and depressed in the present. Enjoy each day as it comes and deal with any problems (health or otherwise) if they come and not before.

I had a lobectomy  (adenocarcinoma stage 1a) 5 years ago this month and I have no evidence of disease. I had an unrelated cancer, very aggressive and stage 3, 10 years ago. I completed treatment and have had no evidence of disease since, despite a "dire prognosis" .  Statistics are NOT reliable to predict what will happen with an individual and they're REALLY not reliable now for lung cancer since there are so many new treatments.

Trust your care team! You have one of the best in the country. Live day by day and enjoy your life. Not always easy to do, but it's a good goal.

[Tom Galli]

Minh,

Lexie’s suggestion mirrors mine. Attend to screening scans but live. 

At to what is next, immunotherapy or perhaps a new form of radiation called PULSAR. (I can’t make a link but search for PULSAR using the search function in this Forum for additional details). 

Stay the course. 

Tom

[LexieCat]

2 hours ago, Tom Galli said:

At to what is next, immunotherapy or perhaps a new form of radiation called PULSAR. (I can’t make a link but search for PULSAR using the search function in this Forum for additional details). 

https://forums.lungevity.org/topic/48886-the-next-big-thing-in-lung-cancer-radiation/

 

[Minh]

11-30-2021

I had a followup meeting with the surgeon yesterday. After reviewing the pathology report,  he staged me at pT1bN0 as many members in this forum have predicted. He said I don’t need any additional adjuvant therapy. He said the chance for cancer to return in the next 5 years is 20% and there isn’t anything adjuvant therapy out there that can help. The only things can help is controlling diet and stress. As for biomarker testing, he said it won’t necessary since there is no more cancer to treat after the lobectomy and typically insurance won’t allow biomarker testing after the treatment of stage 1 cancer. He said if the cancer comes back, it may not has the same biomarker. I agreed with him with his logic, but my argument to him was if the cancer comes back it would be advantageous to know if the cancer is new or metastasis. We had little fun (friendly discussion) debating if biomarker should be done for stage 1 patients. He finally agreed to order biomarker testing, but he does not guarantee insurance will approve. So I may not find out what my biomarker will be.

Anyway he approved me for flying home so I am packing today and ready to fly home tomorrow. Hopefully I won’t have any major complication when I get home. As of now, I am only taking tylenol and gabapentin for pain and have dry cough and shortness of breath. I am kind spoil with Houston nice weather. Now I have to come to Indiana weather - COLD!!! 

[Tom Galli]

Minh,

While I can't fault your surgeon's knowledge, if it were me, I'd pay out-of-pocket for biomarker testing. Your surgeon may at this juncture be correct. He can see no evidence of disease and what he saw and removed was at Stage 1. He sights a recurrence rate at 20% in 5 years. He may be right, but you are carrying the 20% risk.

Go home and recover but do consult with a medical oncologist to arrange for screening. Also solicit a recurrence projection from the medical oncologist to see if there is divergence in the projection and to question how frequently type changes on recurrence. Get well!

Stay the course.

Tom

 

[Scruboak]

Dear Minh, hope you made it home alright and are recovering well. I, too, had a Stage I tumor (pt1b) no lymph involvement, no pleural invasion. Left lower lobectomy. Invasive mucinous adenocarcinoma. I was also told that biomarker testing is “not done” for this stage of lung cancer but would be done if I had a recurrence. I have my 18 month scan next week. Ive often wondered what mutations, if any, were present as this does give more information about likelihood of recurrence (invasive mucinous adenocarcinoma have a high probability of KRAS mutation which is different from invasive non mucinous adenocarcinomas). And, Tom? Is it possible to get this information even though a fresh specimen is no longer available?

[Judy M2]

If tissue isn't available, a blood or liquid biopsy may reveal biomarker(s) if there is circulating tumor DNA (ctDNA). 

I agree with Tom's comment. For EGFR mutations, osimertinib was approved last year for Stages 1B-3A as adjuvant therapy after surgery. 

Of course, with any progression, there may be new or different mutations--or none, so biomarker testing would be essential if and when that happens. Hopefully it won't. 

[Deb W]

Hi Minh,

Regarding recurrence - I had stage 1B in 3/19.  The surgeon "got it all."  He said there was no need for adjuvant treatment.  One year later I had asked to see an Oncologist because I was short of breath on the tennis court.  I was told I didn't need an oncologist and that my symptoms were typical after having a lobectomy.  I persisted and finally got the referral.  I told him I was experiencing fatigue and had the same back pain that I had before the surgery.  He finally did a CT and the cancer team decided that although inflammation was seen it was on the surgical line which was expected after a lobectomy.  Two months later I went back to the same oncologist because I was still having symptoms and asked to have a PET.  I was shocked to learn that I now had Stage IV and it was a recurrence.  So it was confirmed 13 months after the Stage IB diagnosis. 

Since that time I've had the triplet and then Keytruda for about 7 months and it was stopped because I developed a pretty severe case of colitis.   Then in 3/21 there were nodules that appeared in the mediastinum. I was given targeted therapy (I have the MET mutation - which was missed by the 1st oncologist) in 4/21 for 10 days and ended up in the hospital with anaphylaxis.   However, it appears that Tabrecta worked because I had a scan 9/21 and the cancer cells were small enough to have radiation. I completed IMRT radiation in early October and I was told that I am in remission.  I say that with caution because cancer is sneaky. 

 

[LouT]

Deb,

You're a warrior and let's see this damned cancer stay in remission this time.  

Lou