Posted: June 6, 2020

For a long time there was a nihilism about following patients who had undergone surgery for lung cancer.  What good would it do to get lots of subsequent x-rays and scans, since recurrence was a death sentence anyway and there was not much that could be done?  All that has changed and has been summarized in a scholarly review article published in the Journal of Clinical Oncology in late 2019.  Click here for the entire article, which is currently provided free of charge by the journal.  In it the authors, from a number of distinguished cancer centers in the US and Canada, lay out upbeat recommendations designed to optimize chances for cure even in patients who are not cured with initial surgery.  They address two major issues.  First, can you do anything for patients by diagnosing metastasis early rather than later?  Second, should these patients be under heightened surveillance for a second lung cancer, and does doing this accomplish anything?  As to the first, occasional patients can have their first metastasis surgically removed and can still be cured.  Typically that would involve a second lung operation, or a removal of a part of the liver or an adrenal gland.  There is evidence that doing so before further metastasis has been allowed to occur actually improves survival and does cure a few more people.  Early identification of metastasis also allows for the time to do genetic testing looking for mutations that would allow for more effective therapy if surgery is not an option.  As to the second, there is now abundant evidence that screening for lung cancer with low-dose CT scanning improves outome among patients at highest risk for getting lung cancer — typically heavy smokers.  The highest risk of all is in patients already cured of their first lung cancer.  So boiled down, get CT’s every six months for two years looking for the first metastasis; and get CT’s annually after that forever looking for the second lung cancer.

There is reason for cautious optimism and reason to follow these patients closesly, essentially forever.