“What stage am I, really?”
Had surgery of right lower lobe of lung 1/19/21. Removed lobe, no mets, all nodes and margins clear. However, during surgery, the surgeon found a small, 3 mm, tumor next to, and the same side as, primary cancer. She removed it along with all other cancer and lobe. She also froze my insides and I am now suffering from that. The results of that cryosurgery hurt more than any surgery. Still annoys me, can't sleep at night. My tumor went from 2.5 to 1.5 to larger than 4CM from November, when it was discovered, until Jan when I had surgery. I am elderly, 76, do have a few co-morbidities, diabetes, a fib, RA, COPD, ILD (restrictive lung disease) and other problems that are annoying. Prior to her finding this smaller tumor I was a stage 1. Now she stages me at 11B because of the second tumor which, I believe, she considers mets. My pulmonologist disagrees, my oncologist agrees. I have refused chemo as they told me it would give me a 5% boost of living longer...not great odds for me. I would like second-generation testing, biomarkers, etc. The oncologist doesn't seem to be on the same page with me. So, why am I a 2B when all was well, nothing spread, and my first two scans since 1/19 were clear...no cancer shows? Shall I push for the biomarkers? I would consider therapy, just NOT chemo!! Do you agree with my staging assuming all I stated is correct? Thanks!!! PS Would it help me to get a 2nd opinion? I would like to travel up North (Phila) to an accredited institution which my hospital is not. I would never have stayed here but COVID changed my plans.
Female | 76 years old
Complaint duration: one year
Medications: none/wait and see
Conditions: NSLC adenocarcinoma
1 Answer
PulmonologistPulmonologist
Hello,
You are asking questions that are normal for a patient who has been diagnosed with cancer. Your analysis of the situation is excellent.
Tumor staging is a mechanism to provide about three types of information. The first is to describe the extent of the cancer. This allows doctors to group patients into various categories for which treatment is recommended. Many groups have produced various staging parameters. One area to find more information would be the treatment guidelines produced by the National Comprehensive Cancer Network. (Www.nccn.org). Search on the guidelines for non-small cell lung cancer. Another group with information is the American Cancer Society. (Www.cancer.org). Search on this topic with a google search. Then look for staging of non-small cell lung cancer.
In general the risk of recurrence is generally larger with multiple tumors or larger primaries. The staging is dependent on the pathological findings following the surgery even if all of the tumor nodules are removed.
It is impossible to know if the second very small tumor is another primary or a metastasis. I think that your surgeon was very wise in removing both tumors.
Your largest tumor was greater than 4 cm, making it a T2 tumor. Your smaller tumor was 3 mm a T1 lesion. This is if one prefers to consider these individual primaries. The other alternative is to assume that the smaller one is a tumor nodule in the same lobe of the lung. This would be defined as a T3 lesion. All nodes are negative. For situation number 1, with two primaries, one would be stage 2B and the other stage 1A. For situation number 2 the staging would be 2B.
Now how does this effect the future treatment recommendations? One piece of information that would be helpful is to talk to the pathologist to see if either scenario is more likely.
You are asking questions that are normal for a patient who has been diagnosed with cancer. Your analysis of the situation is excellent.
Tumor staging is a mechanism to provide about three types of information. The first is to describe the extent of the cancer. This allows doctors to group patients into various categories for which treatment is recommended. Many groups have produced various staging parameters. One area to find more information would be the treatment guidelines produced by the National Comprehensive Cancer Network. (Www.nccn.org). Search on the guidelines for non-small cell lung cancer. Another group with information is the American Cancer Society. (Www.cancer.org). Search on this topic with a google search. Then look for staging of non-small cell lung cancer.
In general the risk of recurrence is generally larger with multiple tumors or larger primaries. The staging is dependent on the pathological findings following the surgery even if all of the tumor nodules are removed.
It is impossible to know if the second very small tumor is another primary or a metastasis. I think that your surgeon was very wise in removing both tumors.
Your largest tumor was greater than 4 cm, making it a T2 tumor. Your smaller tumor was 3 mm a T1 lesion. This is if one prefers to consider these individual primaries. The other alternative is to assume that the smaller one is a tumor nodule in the same lobe of the lung. This would be defined as a T3 lesion. All nodes are negative. For situation number 1, with two primaries, one would be stage 2B and the other stage 1A. For situation number 2 the staging would be 2B.
Now how does this effect the future treatment recommendations? One piece of information that would be helpful is to talk to the pathologist to see if either scenario is more likely.
