Can NSCLC and SCLC Be Diagnosed Simultaneously?

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Andrew Schorr and Carol Preston talk with Dr. David Carbone and Dr. Scott Antonia about the simultaneous diagnosis of NSCLC and SCLC. The specialists at Moffitt Cancer Center don’t accept reports without proper microscope slides in order to reach effective conclusions with their in-house pathologists. Research shows that neuroendocrine differentiation between NSCLC and SCLC is responsible for different prognoses at different stages, which explains the second onset of the disease. Both Dr. David Carbone and Dr. Scott Antonia believe that in this circumstance it is imperative to get second opinions and eyes to assess the prognosis diversely.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for y

Carol Preston:

From online, from Bob who said that when he was diagnosed with stage IV lung cancer two years ago, the biopsy indicated that he had non-small cell lung cancer. A year later, a second opinion facility analyzed the same biopsy and said it was small cell lung cancer.  How can you explain this, or can you explain this? 

Andrew Schorr:                  

Scott? 

Dr. Antonia:        

So most of the time, pathologists agree. And so we, at the Moffitt Cancer Center, I’m sure David’s place as well, tertiary referral centers, we don’t just accept reports of things.  So if somebody comes to us for an opinion, we insist that we get the actual microscope slides, and our own pathologists review things. And it’s not rare that our people disagree with the interpretation before.

Understand that there are certain markers that help pathologists understand what type of cancer it is.  But for neuroendocrine cancers like small cell lung cancer, there are also large cell cancers that have neuroendocrine differentiation. So it’s really size that you’re talking about. And so that can sometimes be a matter of interpretation by a pathologist.

So it still is why I recommend anybody who has a diagnosis of cancer, even if you decide that you will, and you know that you will be staying close to home for standard of care treatment, if it were me, I’d get an opinion at another place and just have everything looked at again because this sort of thing is not rare. It’s relatively uncommon, but it’s not rare.

Dr. Carbone:       

So just an addition to add to that, I totally agree. It’s important, in your second opinion, to have a second set of eyes look at the tissue.

But lung cancers can also be mixed tumors. If you look at a biopsy from one place in the tumor, it can be small cell.  And another place, it can be non-small cell. Or they can even change from one to the other. There are reports of adenocarcinoma changing to small cell or small cell changing to adenocarcinoma.  So it is important to realize that. But it’s also true that once you have lung cancer, you’re at high risk of having a second lung cancer.  

And people who are cured of lung cancer have about a 1 percent or 2 percent per year risk of getting a second lung cancer that could be a different type.  So if you’re two years from now, and you have another biopsy, and it’s a different type of cancer, it could be a second primary and should be treated potentially differently than you would treat a metastatic cancer from your first tumor. So all of these are things that a lung cancer specialist would be able to evaluate.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for y

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Page last updated on August 24, 2015