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Father newly diagnosed
My dad (70+) has just been diagnosed with lung cancer. He had occasional dry cough so we went to see his PCP to make sure it wasn't pneumonia. Xray showed a lung mass, which resulted in a CT scan, a PET scan (that showed metastasis to bone) and two biopsies (bone and lung lymph node). Just received bone biopsy results (posted below) and the pulmonary specialist who just did the lung biopsy also told us that he saw that it is cancer for sure. Still waiting for lung biopsy results, biomarker testing. Still need to go for a brain MRI and have an appointment with oncologist in 10 days (hopefully all of the results will be ready by then). As you all probably know, there is a lot of confusion, fear and denial happening. Can anyone help me understand what we are dealing with here, treatment options or at least help me prepare for the appointment with the oncologist or guide me to what to ask for, any additional testing etc. (reading about liquid biopsy for example) that needs to be done. Thank you very much.
The pathologic findings are consistent with sampling of a pleomorphic, poorly differentiated non-small cell carcinoma. There is patchy/variable TTF-1 expression within the tumor, though Napsin A is negative. All other markers to suggest extrathoracic sites of origin are negative (see microscopic description for full details). Ultimately, in conjunction with the clinical and radiographic findings, this is favored to represent a metastatic poorly differentiated/pleomorphic carcinoma of primary pulmonary origin. These can arise from either squamous cell carcinoma or adenocarcinoma, though in the present case, the TTF-1 expression would favor adenocarcinoma. Based on the clinical and radiographic information, this case likely qualifies for Med Fusion guideline-based molecular panel pathway testing, and it has been marked as such.
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@pofpof, I'm so sorry to hear of your father's diagnosis. Having the diagnosis is definitely the worst, but being the caregiver of someone with the diagnosis is a close second. I see how much my wife struggles with my ongoing journey.
That being said, there is a key piece of information you've left out: does or did your father smoke? Smokers and nonsmokers tend to get different types of lung cancer with different treatments and different prognoses. A tissue sample is the gold standard in biopsies. Liquid biopsies are a new idea primarily aimed at those people where a standard biopsy is very difficult or not possible. Lung biopsies, an MRI, and biomarker testing are the next steps.
It sounds like you're dad's current oncologist is really on the ball. By all means, direct your medical questions to him or her. A good oncologist knows how hard this diagnosis is on the family members as well as the person involved. Once your father has a diagnosis and a treatment plan, members of this site will be able to share their personal experiences.
The good news is that lung cancer is more survivable than ever. As I say in my presentations, "This is not your parents' lung cancer." I was diagnosed seven years ago, became stage 4 five years ago and am still working full-time at a job I love. True, I'm a mere 65 years young, but I don't remember hearing about anybody that lived this well with lung cancer for this long before now. And my friend is still working as a personal trainer eight years after a stage 4 diagnosis. Hope is the byword of all survivors and caregivers, so stay positive. I wish you and your father the best possible outcome.
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2 ReactionsThank you for the thoughtful message. Yes, he smoked in the past I will say for 30 to 40 years but also gave up smoking 25+ years ago. When I was asking "why?" in a state of shock, the pulmonary specialist said odds are it is tied to his smoking in the past.
Lung biopsy was done early this week and sent to pathology. Brain MRI is scheduled by the end of the week. I am being told that the biomaker testing is being done or will be done. They are hoping most if not all of the results will be available by the time we see the oncologist next week.
hi @pofpof - not all families step up when a loved one has a cancer diagnosis, so well done. It takes courage. I think the questions you have should be addressed at the upcoming oncology appointment. You'll want to find out the official diagnosis (with biomarkers) and staging. That should dictate the treatment options your dad has available. I would encourage a second opinion, but only if you can do it in a timely manner. I went to 2 places and got the same treatment recommendation, so I felt confident it was the best course of action. The waiting is hard. Make sure to take care of yourself and manage your own stress during this time. Let us know what you find out in the appointment.
Hi @mamajite thank you for the response. We are located at a midsize city in middle east. I think our options for a second opinion is limited unless we travel to bigger cities several hours away. Do you know if it is possible to have some cancer centers look over your records and provide recommendations or does it always have to be an in-person visit?
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1 ReactionYou're most welcome. As far as I know, they want to see you in person. But that might be different where you live. I think you'll have more information to work with after you meet with the oncologist.