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  • Q&A with Australian Health Practitioners

    This is a question about Adenocarcinoma Lung Cancer non-small cells

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    Cancer Lung Cancer
    My 47-year-old sister in law has been diagnosed with lung cancer adenocarcinoma right lower lobe 5 cms and lymph nodes in the centre of the chest. We are very depressed and confused about the decision of treatment whether in Australia, in New Zealand or in the USA. Her life is at risk now so we want to prolong her life. Please advise.
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    Dr Samantha Herath

    Respiratory & Sleep Medicine Physician

    Dr Samantha Herath completed her Respiratory and Sleep Medicine training in New Zealand, Australia and Canada. She has extensive post-fellowship, sub-speciality training in Sleep Medicine … View Profile

    Lung cancer prevalence is on the rise. There are several types of lung cancer and adenocarcinoma is currently the commonest type of lung cancer.

    The most important part of the history that I would have liked to know is whether your sister in law was a current or recent ex-smoker. As adenocarcinomas have a mutation called EGFR that commonly occurs in non-smoking  Asian women that significantly improves their survival when immunotherapy is given.

    However, in treating lung cancer surgery still remains the best means of cure and every effort should be made to see if the patient can have surgery.

    When I decide on treatment for lung cancer there are two processes I carry out.

    1. Stage the disease 

    2. Stage the patient.

    1.Stage the disease: According to the information I have, firstly I will look at the size of her tumour. This is 5cm in the right lower lobe. This is a moderately large lung cancer. 

    You mention that the centre of the chest has lymph nodes. Lymph nodes can be enlarged due to cancer. infection or inflammation. Therefore as her treatment decisions depend on it, the lymph nodes need to be biopsied via EBUS or Endobronchial USS guided Biopsy, which is a safe bronchoscopic method used to get cells and confirm/exclude the involvement of the lymph nodes.

    It is important to know what lymph nodes are involved as well. If the lymph nodes in the right hilum is involved (proven via EBUS biopsy) she can still have surgery. However if the paratracheal, sub carinal or left sided lymph nodes are proven to be involved, then she will not be suitable for surgery.

    She should also have a PET scan for work up. This is done to see if any other organs outside the chest are involved with cancer cells. A PET scan showing high uptake in the lymph nodes in the chest alone is not adequate to say that the lymph nodes are invaded by cancer cells.

    It is very important that the biopsy sample is sent for mutation analysis even if she was a smoker.

    2. Staging the patient: Whilst above investigations are carried out the patient requires blood tests and full lung function tests to decide how fit she is to tolerate surgery if offered.  

    In summary: It is a devastating news when someone is diagnosed with lung cancer. The patient and the cancer requires aggressive and rapid staging to see if the patient can have surgery. 

    After proper staging, if surgery is not possible, then treatment is combined chemo radiotherapy.

    Immunotherapy status must be evaluated to see if she has EGFR or Alk mutations.

    Although lung cancer is commonly dealt by Respiratory Physicians, the expertise and interests vary.

    I would highly recommend finding a Respiratory Physician (either in New Zealand or Australia) who has an interest and advance training in lung cancer and also takes part in a multidisciplinary lung cancer meeting on regular basis in a tertiary care hospital, to give an opinion, after assessing the patient.

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    Surinder Raghav

    HealthShare Member

    Thanks for your detailed valuable guidance. The patient has gone through genetic mutution and PET scan. BRAF gene found and have 7.5 cms size on right lower lobe. Tubercolusis found in lymph nodes so the doctors started B12 and folic acid but still no treatment started for lung cancer i.e. chemotherapy etc. 1.5 Ltrs fluid has been drained out from lungs. Stage IIIb found. Extremely upset about uncertainty going on. We are happy to bring her over to Australia even if this uncertaintly can finish.

    Thanks a lot for your valuable advice again.

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