I have been diagnosed with multifocal lung cancer by my surgeon; and with metastatic lung cancer by my oncologist. My pulmonologist says it's hard to diagnose which. A summary pathology report from the second lobectomy states that "The main tumor and two additional tumor nodules are morphologically similar to each other and are suggestive of intrapulmonary metastases." It also states that "two additional nodules are morphologically different from the main tumor and from each other and may represent separate primaries." The tumor in the first lobectomy, some but not all growths in the second lobectomy, and the three nodules removed in the bronchoscopy were all EGFR-positive. Not all EGFR-positive growths have the same (or the same number of) co-mutations. Two growths from the second lobectomy were varieties of KRAS.

My oncologist's treatment strategy is Tagrisso (osimertinib) as monotherapy; I want to at least have considered other options (including other drugs and drugs in combination with chemo, as well as radiation and even surgery) because of worse response with EGFR TKIs (not only Tagrisso) when there is a TP53 co-mutation. (For example, progression-free survival and overall survival can be shorter with some co-mutations.) Radiation interests me because all of the nodules are still slow-growing but one cluster is of concern because of its position. I wouldn’t expect radiation to be a treatment strategy for all nodules. I have 20 to 30 nodules (Swiss cheese indeed).

I have an appointment scheduled with my surgeon and with a pulmonologist and I expect to talk to a radiation oncologist also.