How did my stage 4 cancer go into remission after a lobectomy?

Question

Hello doctor,

My stage 4 lung cancer at age 32 went into complete remission after a lobectomy without chemotherapy, and even my doctors seem surprised. I was diagnosed almost two years ago with what was initially staged as stage 4 non-small cell lung cancer, based on a suspicious lesion seen on my liver during a PET scan.

My thoracic surgeon recommended a lobectomy to remove the primary tumor in the right lower lobe. After surgery, my pathology report showed clear margins. When we re-evaluated the liver lesion with a contrast MRI, it turned out to be a benign hemangioma, not a metastasis.

My last three CT scans have shown no evidence of disease, and my oncologist is now calling it a complete remission. My CEA levels have dropped from 18.5 to 1.2, which is within the normal range. I never received chemotherapy or immunotherapy because the restaging changed everything.

However, I now worry constantly that the cancer will come back. How often should I be getting surveillance scans? And is it normal for staging to be revised like this after surgery? My pulmonologist has also recommended spirometry every six months.

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

Your case most likely represents initial overstaging due to a false suspicion of liver metastasis on a PET (positron emission tomography) scan. PET scans can sometimes show uptake in benign lesions, and hepatic hemangiomas may mimic metastasis. After the lobectomy with clear margins and MRI (magnetic resonance imaging) confirmation that the liver lesion is benign, the disease was appropriately restaged, which explains why you achieved complete remission without chemotherapy or immunotherapy. Such stage revision after surgery and further imaging is not uncommon when suspected metastatic lesions are later proven to be benign.

Regarding follow-up, a CT (computed tomography) scan of the chest is typically recommended every six months for the first two to three years, and then annually if no recurrence is detected. Clinical evaluation is usually advised every three to six months initially.

CEA (carcinoembryonic antigen) levels may be monitored periodically, especially since they were previously elevated. Pulmonary function testing (spirometry) is generally recommended every six to 12 months after lobectomy to assess lung capacity and recovery.

Since your recent CT scans show no evidence of disease and your CEA has normalized, the prognosis is favorable; however, regular surveillance remains important because the risk of recurrence is highest in the first few years after surgery.

If you develop symptoms such as a persistent cough, unexplained weight loss, chest pain, breathlessness, or hemoptysis, you should seek prompt medical evaluation.

Hope I have addressed all of your queries and concerns. Do follow up whenever needed.

Thank you.