My mom was recently diagnosed with lung cancer. It was discovered in a routine blood test. Upon CT scan, the doctor found a mass in her right lung. After a biopsy and PET scan, they confirmed in was cancer. We immediately scheduled her for a surgery to remove the cancerous lung mass. She underwent a lobectomy operation. The oncology doctor recommended 3 options for adjuvant treatment post-surgery:
- Chemo - 4 rounds of chemotherapy
- Oral treatment - requires taking Tagrisso medication for up to 3 years, if EGFR DNA mutation test is positive
- Immunotherapy - with PDL1 test
Options #2 and #3 were too expensive without medical insurance, so that leaves us with only chemo as the only option for adjuvant treatment in order to lower chances of recurrence.
It's been 3 months after her lobectomy surgery, she still did not start the chemo yet. Does anyone else have experience in any of the adjuvant treatments?
On the 5th month since surgery, her blood test showed elevated CEA from 16 to 24.6. Her doctor suggested PET scan in order to identify where the new cancer is. 😓
What they found were growing lymph nodes on axillary (armpit) and iliac (pelvis) and another biopsy was recommended in order to determine the type of cancer cells. One treatment option after biopsy was chemotherapy. She would undergo 4 sessions given at the private hospital.
From the public hospital, unfortunately she's not qualified for any clinical trials. They also don't provide oral treatments but chemotherapy as the only available treatment option. However, they warned that chemo will have side effects on her liver. For now, the hospital referred my mom to several specialists and scheduled more tests and scans that are 3 or 4 months away. Even going to a Gynecology specialist, they only did an ultrasound on her lower abdomen and a pap smear, which takes 6-12weeks for the result. Research shows each month that is delay in cancer treatment increases by around 10% risk of death.
On September 4th, my mom went to have additional blood test, which include tumor markers CEA, CA125 (specific to ovarian cancer), CA15-3 (specific to breast cancer), CA19-9 (specific to pancreatic cancer), and AFP (specific to liver disease). Her CEA level continues to rise (from 24.6 to 57.2) even though all other markers are in normal ranges. Rising CEA level is concerning but there's no detectable tumor other than metabolically active lymph nodes in the armpit and pelvis areas. Possible explanations could be:
- Residual microscopic disease
- Micrometastases (hence, lymph nodes size increase)
- New tumor growing
- Other medical conditions (i.e.: liver disease)
Continue monitoring is required to further diagnose her condition. Mammogram in November, blood test in November, CT scan in December. Pap smear result tbd in September - October. If tumor is felt or suspected in the armpit, a biopsy will be needed to remove and test the axillary lymph node.
Recent blood test and ultrasound, on December 15th, 2023:
Liver - fatty liver. No focal lesion.
Gallbladder - a polyp 0.6x0.7cm.
Spleen - normal. No focal lesion.
Pancreatic cyst - calcification 2.3x1.8x1.1cm. (known case)
Kidneys - normal.
Blood count normal. Lipid - high cholesterol.
Liver function test normal. AFP normal.
CA19-9 < 2.06.
Everything in this examination including abdominal ultrasound is normal.
Except, only CEA continues rising, 133.5 (previously 57.2), which is alarming.
Appointment with oncology at public hospital is scheduled for December 29th, 2023. They have her mammogram, CT scan, blood test, pap smear results, we'll find out what they discover and say.
CECT Thorax, Abdomen and Pelvis (Dec 14th, 2023)
- Hyperdensities noted within the right lung, likely surgical material. No enhancing mass seen.
- Scattered plate atelectatic changes in both lungs.
- No suspicious lung nodules. No consolidation. No pleural effusion.
- No significant mediastinal or hilar lymph nodes.
- Aberrant right subclavian artery.
- Heart is not enlarged. No pericardial effusion.
- Subcentimeter bilateral axillary lymph node with preserved fatty hilum.
- Focus of right breast calcification noted.
- Bolateral hypodense thyroid nodules.
- Small hypodensity at segment VI of the liver measuring 0.5cm suggestive of liver cyst, portal and hepatic veins are patent. No biliary duct dilatation.
- Spleen, gallbladder, both adrenal glands and kidneys are unremarkable.
- Well defined multi-cystic lesion with septation and calcifications seen at the pancreatic body, measuring approximately 1.5 x 1.9cm. No enhancing solid component within. No pancreatic duct dilatation.
- No significant abdominal or pelvic lymph node. No ascites.
- Diverticulosis noted at the ascending colon. No abnormal bowel dilatation.
- Urinary bladder is unremarkable.
- Uterus is retroverted. No adnexal mass bilaterally. Small well-defined fat density lesion noted within of the visualized left thing muscle at the anterior compartment, suggestive of intramuscular lipoma.
- Degenerative changes of the spine. No destructive bony lesion.
Impression
Known case of right lung adenocarcinoma post resection and neoadjuvant chemotherapy, current study shows:
- No local recurrence of distant metastasis.
- Multi-cystic complex pancreatic lesion. Suggest comparison with previous images for further evaluation.
As of Mar 18, 2024, Xray report @ LWE:
The heart size is normal.
Both lungs are clear.
No pleural effusion.
Blood test was mostly normal. Uric acid increased to 356 (from 340). CEA improved to 101 from 133.5. CA 125 elevated to 36 from 21.8 in May 2023. In order to continue monitor CEA, which is still considered high, doctor recommended another PET scan given the last scan was done 8 months ago (July 6th, 2023 + Feb 1st, 2023 @ Adventist).
Also, doctor suggested Gefitinib as an alternative to Osimertinib (Tagrisso) being an affordable option. But, he did not clearly explain what brands he offer and there are multiple generic versions of the brand name Iressa.
Mom did an Xray in June and met oncologist, however I do not have a record of what the result was. Further blood test is scheduled for September following with CT scan in October.
CECT Thorax, Abdomen, Pelvis (Oct 7th, 2024):
Known case of right lung NSCLC post lobectomy, current study shows:
1. Minimal right pleural effusion with nodular thickening of right pleural fissue. In view of raised tumor markers, pleural metastases needs to be considered.
2. Complex cystic pancreatic lesion - unchanged.
Unfortunately, Sep 23rd blood test did not include tumor markers.
Ultrasound Abdomen
Known case of pancreatic cyst and calcification.
1. Fatty liver infiltration and right liver cysts.
2. Two pancreatic cysts at the body and tail. Pancreatic calcification is also noted at the tail of pancreas.
3. Gallbladder polyps.
4. Left renal cyst
CA 19.9: < 2.06
CA 125: 72.1
CA 15.3: 21.5
CEA: 155.8 ng/mL (previously 133 and 101)
Elevated CA125 and CEA is concerning as of late. Dr thinks the cysts do not contribute to tumor markers rise. We do not know what is causing the rise of tumor markers.
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