Stage IA1 Lung Adenocarcinoma and Tumor Marker Abnormalities

Q: Stage IA1 Lung Adenocarcinoma and Tumor Marker Abnormalities

Huang, 27 years old, male, has been diagnosed with stage I lung cancer. <br>The Cyfra 21-1 level is 4.11, which is greater than the standard of 3.3 (first test). <br>It is advisable to conduct follow-up testing for Cyfra 21-1 earlier, which is out-of-pocket, so you can have it ch

Stage I lung adenocarcinoma with abnormal tumor markers?

Hello Doctor, this is my mother's pathology report from that time.

NOMED: 28000-B-M81403, 29000-B-M09450
DX: Lung, right middle lobe, wedge resection - Invasive acinar adenocarcinoma, moderately differentiated (G2)
AJCC 8TH Pathological stage: IA1 (pT1a Nx) (also referring to S2022=92488)
Pleura, right middle lobe, wedge resection - Negative for malignancy
GROSS DESCRIPTION: The specimen consists of a wedge resection of the right middle lung, measuring 3.0 x 2.2 x 1.5 cm and weighing 2.7 gm.
The surface shows focal retraction and fibrosis.
It had been opened, and a tumor measuring 0.6 x 0.3 x 0.3 cm was located 0.6 cm beneath the pleura and 0.6 cm from the resection margins.
The tumor is ill-defined and appears whitish and solid.
All sections are labeled as: 1: tumor; 2-3: non-tumor lung tissue.

MICROSCOPIC DESCRIPTION:
Procedure: Wedge resection
Synchronous Tumors: Not applicable
Tumor Site: Right middle lobe
Tumor Size (also referring to S2022=92488):
Total tumor size: 1.0 x 0.8 x 0.6 cm
Invasive tumor size: 0.8 x 0.6 x 0.6 cm
Tumor Focality: Single focus
Histologic Type: Invasive acinar adenocarcinoma
Percentage of each component: Lepidic (40%), Acinar (60%)
Histologic Grade: Moderately differentiated (G2)
Margin: All margins negative for invasive carcinoma
Distance of invasive carcinoma from closest margin: 0.6 cm (Specify closest margin: parenchymal resection margin)
Direct invasion of adjacent structures: Not applicable (No adjacent structures present)
Visceral pleural invasion: The tumor does not invade the visceral pleura (PL0).

Lymphovascular invasion: Not identified
Perineural invasion: Not identified
Spread through air spaces (STAS): Not identified
MICROSCOPIC DESCRIPTION (Cont):
Treatment Effect: No known presurgical treatment
Lymph node: No lymph node submitted
Non-tumor Parenchyma: The non-tumorous parenchyma does not show significant pathological change.

Pathologic Staging (pTNM):
Primary tumor (pT) pT1a: Tumor ≤ 1 cm or less in greatest dimension
Regional lymph node (pN) pN not assigned (no nodes submitted or found)
Distant metastasis (pM) Not applicable - pM cannot be determined from the submitted specimen(s)
Pathological stage: IA1 (pT1a Nx) (AJCC 8th)
Additional pathological findings: Lymphocytic infiltration
Typed by: Pathologist: Li Peihang
Report No.: 0610
This year's CT
Indication: Lung cancer s/p lobectomy for follow-up study
This imaging study has been compared with previous CT on 2023/06/12.

Chest CT without and with IV contrast enhancement study shows:
Techniques: From lower neck to diaphragmatic level in 3-mm contiguous sections for pre-enhanced and enhanced CT
Coronal (3mm) and sagittal (5mm) reconstruction performed
Imaging findings: s/p RML wedge resection.

Stable tiny RUL, RML, RLL nodules (<3mm)
Blebs up to 14mm in both lungs
No definite pneumothorax.

No definite pleural effusion.

No definite pericardial effusion.

No definite enlargement of mediastinal lymph nodes.

No definite adrenal mass.

No definite enlarged lymph nodes noted in the upper retroperitoneum
Impression:
* s/p RML wedge resection
* Stable tiny RUL, RML, RLL nodules (<3mm)
However, the company health check showed CEA 1.56.
Each follow-up visit has been normal: CA-125 25.7, CA 15-3 12.3, CA 19-9 12.3, Cyfra 21-1 4.11 (greater than the standard 3.3, first test).
The doctor originally planned for a follow-up in October.
Should I take my mother back to the outpatient clinic first? Is there a possibility of recurrence? I'm very worried; please help me clarify this.
Thank you.

Huang Kejia, 20~29 year old female. Ask Date: 2024/04/25

Dr. Chen Sirong reply Oncology

Huang, 27 years old, male, has been diagnosed with stage I lung cancer.
The Cyfra 21-1 level is 4.11, which is greater than the standard of 3.3 (first test).
It is advisable to conduct follow-up testing for Cyfra 21-1 earlier, which is out-of-pocket, so you can have it checked every month or every 2-3 months.
If the levels increase, you can schedule an earlier outpatient visit.
Of course, the National Health Insurance card does not prevent you from seeking consultation now.
Wishing you peace and joy.
Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2024/04/25

More Info

Understanding the pathology report and the implications of tumor markers in the context of Stage IA1 lung adenocarcinoma is crucial for managing your mother's health. Based on the provided information, your mother was diagnosed with invasive acinar adenocarcinoma, which is a subtype of lung cancer. The AJCC 8th edition staging indicates that her cancer is classified as Stage IA1 (pT1a Nx), meaning the tumor is 1 cm or less in size and there is no evidence of lymph node involvement (Nx).

Key Points from the Pathology Report:
1. Tumor Characteristics:
- The tumor was moderately differentiated (G2) and measured 0.6 cm at its largest dimension.
- It was located in the right middle lobe and did not invade the visceral pleura or show lymphovascular invasion, which are positive indicators for a better prognosis.

2. Margins and Invasion:
- All surgical margins were negative for invasive carcinoma, indicating that the tumor was completely resected, which is a favorable outcome.

- There was no evidence of direct invasion into adjacent structures, which further supports a less aggressive disease course.

3. Lymph Node Status:
- No lymph nodes were submitted for examination, and thus, the regional lymph node status is classified as not assigned (Nx). This is common in early-stage lung cancers where lymphatic spread is not yet evident.

4. Additional Findings:
- The report noted lymphocytic infiltration, which can indicate an immune response to the tumor.

Tumor Markers and Their Implications:
- CEA (Carcinoembryonic Antigen): A level of 1.56 is considered within the normal range for most labs, suggesting no significant tumor activity at this time.

- CA-125, CA 15-3, CA 19-9: These markers are often used for monitoring various cancers, but they are not specific for lung cancer. The values you provided are also within a range that does not typically indicate active disease.

- Cyfra 21-1: This marker is more specific to lung cancer, and a level of 4.11, which is above the standard cutoff of 3.3, may warrant further investigation. Elevated levels can sometimes indicate the presence of cancer, but they can also be influenced by other factors, including inflammation or benign lung conditions.

Recommendations:
Given the current findings and your concerns about potential recurrence, it is advisable to follow up with your mother's oncologist sooner rather than later, especially considering the elevated Cyfra 21-1 level. While the other tumor markers are stable or within normal limits, any increase in tumor markers, particularly in the context of a previous cancer diagnosis, should be evaluated.

1. Follow-Up Appointment: It would be prudent to schedule an earlier follow-up appointment to discuss the elevated Cyfra 21-1 and any other concerns you may have. This will allow the oncologist to assess whether further imaging or tests are necessary.

2. Monitoring: Regular monitoring through imaging (like CT scans) and blood tests is essential in the post-operative period to catch any potential recurrence early.

3. Emotional Support: It’s understandable to feel anxious about your mother’s health. Engaging with support groups or counseling can be beneficial for both you and your mother during this time.

In summary, while the pathology report indicates a favorable outcome for Stage IA1 lung adenocarcinoma, the elevated Cyfra 21-1 level should be addressed promptly. Regular follow-ups and open communication with her healthcare team will be key in managing her health moving forward.

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