Knowing that whatever caused a cancer to occur in the first place likely raises the risk of developing another cancer, researchers decided to answer the question, "how often does a second primary lung cancer occur?" And when it happens, what is the prognosis?
It's more than an academic question. For people living with lung cancer, it's good to know if there is any reason to worry - and to be on the lookout for any symptoms suggestive of a new lung cancer. After all, we believe that catching lung cancer as early as possible makes a difference.
In a new study, investigators looked at 2816 lung cancer patients --people with primary lung cancer-- monitoring them to see if they developed a second cancer. Overall, 139 people did develop a second primary cancer (nearly 5%.) As a quick note, in defining these cancers as "second primary cancers" it means that they are new cancers and not a recurrence or spread of the original cancer.
Of the 139 cancers, 69 were non-small cell lung cancers and 9 were small cell lung cancers. The median time between the time the first cancer was diagnosed and the second primary cancer occurred was 72 months.
The results were encouraging. When compared with people diagnosed with a first lung cancer, those people diagnosed with a second primary lung cancer had a better prognosis - even for stage 4 disease. The median survival (the time at which 50% of people have died and 50% are still living) was 57 months for those with a second primary lung cancer vs only 18 months for the control group diagnosed with a first lung cancer.
Why?
I'd like to think that having a heightened awareness of the possible symptoms of lung cancer, prompted lung cancer survivors to let their doctors know when those symptoms occurred. Of course, that's only speculation. It could be that the surveillance tests people go through after a diagnosis of lung cancer (those tests that cause fear and "scanxiety") picked up the second cancers sooner than for someone who didn't carry a diagnosis of lung cancer.
The answer to the original question is that 2.8% of the lung cancer patients in this study developed a second primary lung cancer over a period of 5 years. An earlier study found that almost 15% of people treated with surgery for stage 1 lung cancer developed a second primary lung cancer. But even as those numbers are large enough to cause a little fear, it's encouraging to hear that the prognosis for those who have to hear those words "you have cancer" a second time, is better than the first time around.
Sources:
Reinmuth, N. et al. Characteristics and outcome of patients with second primary lung cancer. The European Respiratory Journal. 2012 Oct 11. (Epub ahead of print).
Rice, D. et al. The risk of second primary tumors after resection of stage 1 nonsmall cell lung cancer. Annals of Thoracic Surgery. 2003. 76(4):1001-7.
Hi Lynne,
Having recently lost a wonderful advocate and friend in the LC community a few weeks ago, I fear this may hit too close to home but I believe it is important to address.
We are all told by doctors that Lung Cancer has a high recurrance rate, whether it be a new primary tumor or simply a recurrance. So, survivors are vigilant in getting scans to ensure that recurrances are caught early.
Warning, this is where the question gets really hard.
How can someone who is so vigilant, even ten years after diagnosis, go from NED to stage 4 to death in six months? Know that this question is in the spirit of education! I’ve had this question since April but have withheld it to spare this friend. Now I need the answer.
Lynne, I hope you are well, and finally getting back on your feet. I think of you often.
All the best,
K
I’m having a hard time accepting the statistics of recurrence. My best friend is an oncology nurse, and she says 4 out of 5 of her lc patients have a recurrence and it comes back faster and stronger. My teaching partner had stg 1 and after surgery was declared NED. 1 year later (now) she is stg. 4 and fighting for her life. I wish could believe the article, but I’m just not experiencing that in reality. Other cancers do fit that statistic, but lc is a monster. I pray that the new drugs out there will change this.
Hi K, I’ll email you privately so we can talk. lovejp — I can understand your confusion. The article wasn’t talking about recurrence, and instead was talking about people who develop a new separate lung cancer after having a first lung cancer in the past. This is different than a recurrence of the first cancer — which by definition, is still the same cancer. Your gut is telling you right. Lung cancer is a monster and I’m praying hard for funding to move research in the direction it needs to go. Yes, lung cancer recurs way too often, even early stage disease.
To answer both questions a bit, lung cancer does seem to often be more aggressive when it recurs. This may be due to mutations in the cancers that not only make them more resistance to treatment, but cause them to behave differently. As an example, our dear friend had BAC initially, but when it recurred it had “mutated” to an adenocarcinoma which has a much poorer prognosis than BAC.
If I haven’t answered your question, feel free to email me here at lungcancer.guide@about.com.
P.S. Thank you K for your well wishes. It means so much!
I’ve had Stage 4 lung cancer since may 2008, I have a gtreat team of doctors in the Cincinnati,ohio area. It has spread to my bones and now 3 small tumors in my left lung. My right lung is where it started and they removed my right upper lobe. It really upsets me that you see breast cancer campaigns everywhere, not that it isn’t important. But come on people. We need $$$$$ for research!!! Have a heart I was 46 when diagnosed. It costs $150.00 a day for research I read somewhere. We really need this help. I’, tired of pink pink pink!!!!!!