Published on August 25, 2015
Where do lung cancers frequently arise from? Dr. David Carbone and Dr. Scott Antonia explain the complex origin of lung cancers. They contend the lungs aren’t just an area where lung cancer starts but are also organs where other cancers turn up. Tune in to learn more.
Transcript | Where Do Lung Cancers Frequently Arise From?
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Hi, I’m Sharon. This is my boyfriend Bill. And he was diagnosed with adenocarcinoma. They determined it to be from the lung. How certain can you be that adenocarcinoma is from the lung and not somewhere else in the body?
And also, a second pathology report showed he had mucinous adenocarcinoma. Is it the same thing? Is it treated the same? I have a second question being if you have no ill side effects from the chemotherapy that you’re on, could that mean that it’s too weak? Is there any reason to think that it might be stepped up a little bit?
Don’t wish for side effects for sure.
No hair loss, no weight loss, no nausea—well, a little nausea, no vomiting.
As long as the cancer is shrinking, it’s a good thing.
A little bit, but maybe we’d like it if it shrunk a little more. So is there any reason to step it up a little bit?
First question, adenocarcinoma. Adenocarcinoma is sort of a general term of what these cells look like. They form glands. Pancreas cancer can be adenocarcinoma. Colon cancer can be adenocarcinoma.
So the question is, is it lung adenocarcinoma? Sometimes, it’s very obvious. You’ve got a big tumor in the lung, and you’ve got nothing else. Well, it’s lung cancer. Sometimes, there are some specific markers that they stain them for and look at. TTF1 or pseudo-carotene 7 and pseudo-carotene 20 differential. So these are clues. It doesn’t help me all of the time. And this is also where the art of it comes in as well, because the lung not only is a place where lung cancers frequently arise from.
The lung is also an organ where other cancers frequently go to. So it’s not uncommon that we have someone that comes to us with a large lung tumor and some other distribution. And you’ve got to figure out, is this primary lung or not? And a lot of art comes into that. So then we look at it and say well, are the lymph nodes in the center of the chest involved? You look at the CK7 and CK20. And you put a whole bunch of things together, radiographs, history and pathology to come to that final decision.
Most of the time, it doesn’t take all that. Most of the time, it’s kind of easy. But it’s not uncommon that it takes that extra effort. I’ll let David talk about the potency as it relates to the side effects.
Well, I’ve had patients that have virtually no side effects and do quite well on therapies. But the fact is that, in many of our treatments, we use guidelines for dosing that may yield variable blood levels for these things in different people.
For example, erlotinib (Tarceva) is giving it the same dose if you’re a 60-pound woman or a 600-pound guy, the dose is the same. So obviously, the blood levels are different. So people have talked about adjusting doses to toxicity.
But really, that’s not been proven to improve outcomes. And I think I would be guided by how the tumor is doing. If the tumor is shrinking, and you’re feeling great, be thankful.