Lung Cancer: Surgery, Recurrence, and Screening Guidelines

Lung cancer that is inoperable and the recurrence of lung cancer along with regular check-ups?

1.
My mother was diagnosed with three lesions last year through LDCT.
The doctor recommended a thoracoscopic resection of the largest one.
Later, it was determined to be stage 0 lung cancer, or carcinoma in situ.
However, there is still a possibility of recurrence, right? If the lesion is located in a position that is not operable, I read online about using cryoablation with a fine needle.
Is this considered immunotherapy? If fine needle ablation is also ineffective, would targeted therapy be necessary?
2.
My mother does not smoke, but I have a 23-year history of smoking.
How often should I undergo LDCT?

Lin, 40~49 year old female. Ask Date: 2022/05/20

Dr. Hu Ziren reply Oncology

1.
The surgical resection cure rate for stage 0 lung cancer is very high (indicating a very low likelihood of recurrence).

2.
Cryoablation is not an immunotherapy; it is somewhat similar to electrosurgery.
A thin needle is first placed at the tumor site, and then a heat source is used to destroy the tumor.
In contrast, cryoablation uses cold air to "freeze" the tumor, achieving a localized tumor treatment effect.

3.
Currently, targeted therapies are only applicable to locally advanced (stage II to III) and metastatic (stage IV) lung cancer patients with genetic mutations, and not all patients are suitable for these treatments.

Reply Date: 2022/05/20

More Info

Understanding lung cancer, particularly in the context of surgery, recurrence, and screening guidelines, is crucial for both patients and their families. Your mother's case, where she was diagnosed with stage 0 lung cancer (also known as carcinoma in situ), raises important questions about recurrence and treatment options.

1. Recurrence of Lung Cancer: Even with a diagnosis of stage 0 lung cancer, there is still a possibility of recurrence. Stage 0 indicates that the cancer is localized and has not invaded deeper tissues or spread to lymph nodes or distant sites. However, the risk of recurrence can depend on various factors, including the type of cancer, the completeness of the surgical resection, and the presence of any residual atypical cells. Regular follow-ups with imaging studies, such as low-dose computed tomography (LDCT), are essential for early detection of any recurrence.

If the cancer is located in a position that is not amenable to surgical resection, alternative treatments may be considered. Cryoablation, which you mentioned, is a minimally invasive procedure that uses extreme cold to destroy cancer cells. While it is not classified as immunotherapy, it can be part of a broader treatment strategy. Immunotherapy typically involves drugs that help the immune system recognize and attack cancer cells, such as checkpoint inhibitors or monoclonal antibodies. If cryoablation is not effective, targeted therapy may be an option, especially if genetic testing reveals specific mutations that can be targeted by available drugs.

2. Screening Guidelines for Smokers: As for your smoking history, the guidelines for lung cancer screening with LDCT recommend that individuals aged 50 to 80 years who have a significant smoking history (defined as a 20 pack-year smoking history) should undergo annual screening. Since you have a 23-year smoking history, you would fall into this category. It is advisable to discuss your specific situation with your healthcare provider, who can help determine the appropriate screening schedule based on your overall health, smoking history, and any other risk factors.

In summary, while your mother's diagnosis of stage 0 lung cancer is a positive indicator, vigilance is necessary to monitor for recurrence. Treatment options like cryoablation and targeted therapies can be explored if surgery is not feasible. For yourself, adhering to the LDCT screening guidelines is essential for early detection, especially given your smoking history. Regular consultations with your healthcare provider will ensure that both you and your mother receive the best possible care tailored to your individual circumstances.

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