Tag Archive for: scans

How Do You Break Down Lung Cancer Diagnosis to New Patients?

How Do You Break Down Lung Cancer Diagnosis to New Patients? from Patient Empowerment Network on Vimeo.

How might a lung cancer diagnosis be explained to new patients? Expert Dr. Lecia Sequist from Massachusetts General Hospital shares how she breaks down the the tests involved in non-small cell lung cancer (NSCLC) diagnosis and treatment, advice to patients, and best practices she’s learned in communicating information to patients.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“We know that not all patients are offered genetic testing. And if you have a diagnosis of non-small cell lung cancer, or especially the most common subtype of that called adenocarcinoma, genetic testing is most likely an important part of figuring out your treatment. So be sure to ask your doctor if that’s been done and if it hasn’t, should it be done.”

Download Resource Guide

Download Resource Guide en español

See More from [ACT]IVATED NSCLC

Related Resources:

Do Lung Cancer Screening Guidelines Differ for Certain Populations

Do Lung Cancer Screening Guidelines Differ for Certain Populations

Can Artificial Intelligence and Machine Learning Help Advance Screening for Lung Cancer

Can Artificial Intelligence and Machine Learning Help Advance Screening for Lung Cancer

What Are the Noted Disparities in Lung Cancer Screening and Access

What Are the Noted Disparities in Lung Cancer Screening and Access


Transcript:

Lisa Hatfield:

Dr. Sequist, you have a new patient coming into your office just diagnosed with non-small cell lung cancer. How do you explain to that patient? I’m sure they’re wide-eyed and fearful and afraid. How do you explain to the layperson what that is and then the subsequent treatment that they might be experiencing in the coming months with a new diagnosis?

Dr. Lecia Sequist:

Yeah, this is a very confusing time for most patients because they’re trying to wrap their head around what’s going on. They’re usually being fed information at such a rate. It’s like drinking from a fire hose, and it’s hard to take it all in. On top of that, they may not be feeling well physically. So I think it is important to repeat things, to pause a lot, to ask if there are questions, and to give people an opportunity to get back in touch with you with questions later, because, of course, it’s happened to all of us. As soon as we walk out of the doctor’s office, that’s when the question pops into our brain. But non-small cell lung cancer, it’s a very common cancer. And it basically is a type of cancer that starts in the lung, but it can spread to other parts of the body.

And some of the most important pieces of information that your doctor will need to help figure out a treatment plan along with you is to get a biopsy to confirm that the diagnosis is what they think it is. And that is usually an invasive procedure where a small piece of the cancer is removed from the body so that you can look at it under the microscope, and they can confirm that it’s that type of lung cancer. And then probably a series of scans or radiology tests where they’re looking at different parts of the body, maybe with different lenses such as a CAT scan or a PET scan or an MRI. Those are just different types of radiology exams to see if the cancer might have spread to any of the different places.

And for lung cancer, we usually try to look head to toe, essentially look at the whole body and get a complete picture of what’s going on. And the third important thing that doctors will need to come up with a treatment plan is to do something called genetic testing. This can be confusing for people because we’re not looking at their family. We’re not looking for genes that could have come from their parents or have been passed on to their children. We’re really looking at the genes of the cancer. And together looking at the biopsy, the genes that are activated within the cancer, if any, and where the cancer might be in the body, that helps the doctors put together a treatment plan of how to attack the cancer.

Lisa Hatfield:

Great. Thank you. Do you have any tips specifically for patients when they’re first diagnosed?

Dr. Lecia Sequist:

Yeah. My activation tip for someone with newly diagnosed lung cancer would be to make sure that they’re asking their doctor if genetic testing should be done on their cancer. We know that not all patients are offered genetic testing. And if you have a diagnosis of non-small cell lung cancer, or especially the most common subtype of that called adenocarcinoma, genetic testing is most likely an important part of figuring out your treatment. So be sure to ask your doctor if that’s been done and if it hasn’t, should it be done. 


Share Your Feedback:

Create your own user feedback survey

Myeloma Targeted Therapy: Why Identifying Chromosomal Abnormalities is Key

Myeloma Targeted Therapy: Why Identifying Chromosomal Abnormalities is Key from Patient Empowerment Network on Vimeo.

Charise Gleason, a nurse practitioner, provides insight as to why identifying chromosomal abnormalities is essential when it comes to targeted therapy as a treatment choice for myeloma.

Charise Gleason is a nurse practitioner specializing in myeloma and serves as the Advanced Practice Provider Chief at Winship Cancer Institute of Emory University. Learn more about Charise, here.

See More From INSIST! Myeloma

Related Programs:

 

Essential Tests & Imaging After a Myeloma Diagnosis

Lab Tests in Myeloma: Key Results to Monitor

Key Considerations When Choosing Myeloma Treatment: What’s Available?


Transcript:

Charise:                       

So, testing for chromosome abnormalities or changes are important when it comes to targeted therapy.

And we used to think of this more in that relapse setting. But we also look at it upfront now, because it tells us more about the path of myeloma. And there are reasons to check throughout at relapse, again, to see if something’s changed. So, with targeted therapy, we can use the translocation (11;14), for instance.

Many patients have a translocation t(11;14). It’s not a high-risk feature. But we know on clinical trial we have a drug that we’re using called venetoclax that those patients can be very sensitive to.

And so, we’re looking at this not just in translocations but in sequencing for other abnormalities or gene mutations that can help guide us with these newer therapies. And you see that across all cancer types at this point. So, you can get very specific with a patient’s type of myeloma – that this drug is going to work better because you have this mutation.

So, we look at it upfront. It guides us for risk stratification: standard risk versus high risk. And then we look at it in that relapse setting. Do we have a drug or a clinical trial that this patient will respond better to because of those abnormalities?

When we’re risk stratifying, we know standard risk, medium risk, and high risk. Those are those translocations, those gene mutations, that we know about.

But newer testing, like sequencing, gives us a lot more mutations that we don’t even know what to do with them all yet.

We don’t necessarily have drugs for all of them, but it does help guide us down the road. So, right now some common are the translocations, but also deletion 17p, which we’ve known about for a while. But maybe you see a BRAF mutation, which you typically associate with other types of cancers, but we see that in myeloma as well.

So, it helps us look at is there a drug that our myeloma patient might benefit from because they have a BRAF mutation, for instance. 

Essential Imaging and Chromosome Tests after a Myeloma Diagnosis

Essential Imaging & Chromosome Tests After a Myeloma Diagnosis from Patient Empowerment Network on Vimeo.

Charise Gleason, a nurse practitioner, explains why tests such as bone marrow biopsy, FISH test and full-body imaging are considered essential for patients after a myeloma diagnosis.

Charise Gleason is a nurse practitioner specializing in myeloma and serves as the Advanced Practice Provider Chief at Winship Cancer Institute of Emory University. Learn more about Charise, here.

See More From INSIST! Myeloma

Related Programs:

Myeloma Targeted Therapy: Why Identifying Chromosomal Abnormalities is Key

Lab Tests in Myeloma: Key Results to Monitor

Key Considerations When Choosing Myeloma Treatment: What’s Available?


Transcript:

Charise:                       

The essential testing that a myeloma patient should undergo following a diagnosis is – obviously, you’ve had those diagnostic test labs, the 24-hour urine, some scans, but the specific things that we need are a bone marrow biopsy.

That includes cytogenetics and FISH, and we can talk a little bit more about that. You also want full-body imaging. We used to always use a skeletal survey, which was an X-ray of the long bones. But, really, the standard of care now is a whole-body scan.

So, depending on what your oncologist or your institution has, that would be a full-body CT scan, a PET-CT scan, or a full-body MRI. So, one of those tests is recommended. It’s not unusual if you have a PET. Like our institution, we use PET-CT. So, for a newly diagnosed patient, we’re also going to get an MRI of the spine for a further snapshot.

What we’re looking for with a full-body imaging is we want to make sure that there aren’t any lytic lesions.

So, with an X-ray, you have to have about 30 percent bone loss before it’s going to show up on an X-ray. So, those traditional X-rays that we used to use could actually miss an active lesion. So, in that diagnosis, we want to know that there is no active myeloma. And those other scans are going to be more specific to that.

So, the cytogenetics of a bone marrow biopsy are going to tell us more about the biology of the disease. So, cytogenetics actually grows out the pairs of cells. And so, that’s why that portion of the test can take a while to get back.

At our institution, it can take two to three weeks, because you’re actually growing out those cells to look at the chromosomes. And remember these are chromosomes, or genes, of the plasma cells. And so, we’re looking for those abnormalities that might be present. So, you think about it more for the biology of the disease.

When we’re looking at FISH, we’re also looking… That test shows a little bit different. It comes back quicker. It shows two different phases of cell changes.

And so, it will tell us about chromosomes as well. But do you have any additional chromosomes – so, that would make it a hyperdiploid narrow. It tells us if there’s a loss of a chromosome – so, you’re missing one, a hypodiploid. It also tells us about translocations – so, when you’ve had a piece of a chromosome change and go to another cell. And so, that, for instance, would be like that translocation t(11;14) or translocation t(4;14). So, it’s essential to have that testing to tell us about that, because it helps guide treatment. And as we talk more about targeted therapy, these things really can come into play.