Second diagnosis of adenocarcinoma lung cancer

Dear Malmusher,

This past Spring I received my 2nd diagnosis of NSC lung cancer, adenocarcinoma; the new nodules appeared on my 2nd follow-up CT after having received stereotactic radiation therapy to shrink the original tumor. I had the same questions regarding the 3 months wait between scans, so I asked my pulmonologist. He explained that any new growth or progression of the cancer would take that long to be discernable on the scan since a single cell can take between 18- 24 mos to grow large enough to show up, and what doesn't show on a scan today typically won't reach the point where it's identifiable as cancerous until 3 months from today.

Another factor is the radiation exposure & the potential complications &/or damage that's being done it can cause. I don't fully understand what the radiation limits are or how much we're exposed to per each test/scan, but if you haven't done so already, I'd suggest requesting an opportunity to speak with either your oncologist, pulmonologist, or both; the intention, of course, being to ask this and any other questions you may have pertaining to the cancer & treatment plan.

I can't answer your question about chemo because after hearing my options, I decided not to pursue that route. Like yourself, I have stage 3 COPD as well as having Aplha 1 Antitrypsin Deficiency. I've been battling this since my first bout of respiratory failure 11 years ago, and the prognosis I was given was based on my oncologist's belief that my pre-existing lung disease is likely to do me in before the cancer even becomes symptomatic. My lung function is in the low teens, I require 2 non invasive ventilators to allow me to remain at home, I've been straddling the threshold of hospice since 2017, and I've had a DNR posted on my fridge since last year, when I received my 2nd home ventilator. When asked what I thought abouts chemo/immunotherapy, I asked 2 questions: "for what purpose & to what end?". He said depending on the strain of my cancer, immunotherapy could slow it down. I may have considered it if I would've been eligible for immunotherapy, but since it wasn't, I'd need the standard, old fashioned chemo cocktail. At the time, I was recovering from having had covid twice in 3 mos, amongst other flaring comorbidities & the development of new complications. They offered me a trial run of reduced dosage chemo to minimize the chance of side effects, but in the next breath, said that I'm so fragile & was so broken down that even reduced dosing wasn't likely to make a big difference & I'd probably need to be hospitalized to treat the effects. To me, that sounded like the fast-track to the exit ramp. The "trial run" looked more like a "crash & burn"; I could see myself as a twisted pile of wreckage heaped in the middle of my hospital bed. Rather than going out in a blaze of glory, I chose what sounded to me like the gentler way, liking the odds of having more & better quality time to be here with & for the family.

All that being said? If my PDL1 had been eligible for immunotherapy, I was told other people with scans like mine were actively engaged in living their lives as treatment holds the growth in check & comparison of scans taken 2-3 years apart showed no difference. That sounded great, but unfortunately, it became a moot point when my PDL1 results showed that immunotherapy isn't effective against my cancer; something about the specific DNA signature of the mutation. My docs told me that cancer treatments have changed drastically, and based on what I learned about chemo & immunotherapy as they explained my options & possibilities, I could see they were telling me the truth. I understand your fear of it, though, so perhaps if you arrange a discussion about the wait time & radiation, you could add in the topic of potential treatment options & what the pros & cons are of each.

I know it's a long comment, but my hope was to give you enough of what I've learned so that you'd come out of such a meeting with your treating docs with more information, a greater understanding and maybe, hopefully, you'll feel like you're on a more level field.

Peace & Breathe Easy.