According to a recent article published in the Archives of Surgery, close follow-up screening may detect early second cancers in patients already considered cured following the surgical removal of stage IA non-small cell lung cancer.

Lung cancer is the leading cause of cancer deaths in the United States. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and refers to the type of cell within the lung in which the cancer starts. Stage IA NSCLC refers to cancer that is comprised of only one tumor that is 3 centimeters or less. Standard therapy for stage IA NSCLC often consists of the surgical removal of the cancer, which may be accomplished by removing the entire lung (pneumonectomy), a lobe of the lung (lobectomy), or even a small segment of the lung (segmentectomy). Chemotherapy and/or radiation therapy may or may not be a part of the treatment regimen for patients with this stage of disease.

Although patients with stage IA NSCLC have a relatively high rate of long-term survival following therapy and some may be considered to be cured following therapy, these patients are still at risk for developing a cancer recurrence, as some undetectable cancer cells may have remained following treatment, or developing a second separate lung cancer. Researchers have been evaluating different screening modalities and schedules for these patients in order to detect second cancers early, when they are most treatable.

Researchers from the City of Hope National Medical Center recently conducted a clinical study to evaluate the effectiveness of close follow-up in 124 patients with stage IA NSCLC previously treated with surgery alone. Follow-up included an annual computed tomographic (CT) scan of the chest with interval chest x-rays every 4 months for 2 years and every 6 months for 3 additional years. During this time, 14 patients were found to have developed a second NSCLC and received further surgery. The average diameter of cancers detected by CT was approximately 14 millimeters, compared to 26.5 millimeters for those detected by x-ray. Nine of the 14 patients with second cancers were alive and free of cancer at the time this data was published, with an average time of 20 months from surgery. Two patients were still alive but had cancer, two patients died from causes not related to cancer and one patient died from surgical complications.

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These researchers concluded that annual CT scans and chest x-rays three times per year may detect early second NSCLC in patients with previously treated stage IA NSCLC who appeared to be cured. Detecting second cancers early offers chance of effective treatment and a cure for these patients. Patients who have been treated for stage IA NSCLC may wish to speak with their physician about follow-up screening procedures or the participation in a clinical trial further evaluating screening regimens. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

Reference: Lamong J, Kakuda J, Smith D, et al. Systematic postoperative radiologic follow-up in patients with non-small cell lung cancer for detecting second primary lung cancer in stage IA.

Archives of Surgery. 2002;137:935-939.

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