Clinical Diagnosis

The Diagnosis

-in Clinical Terms –
Metastasis adenosquamous carcinoma

-in other words – Non-Small Cell Lung Cancer (Primary) with Brain and Adrenal Gland metastasis.

– the quote below is from American Journal of Clinical Pathology

Adenosquamous carcinoma of the lung is a rare subtype of non–small cell carcinoma of the lung, constituting 0.4% to 4% of cases. The definition of adenosquamous carcinoma indicates a carcinoma showing components of adenocarcinoma and squamous cell carcinoma, with each comprising at least 10% of the tumor.1 The prognosis of adenosquamous carcinoma is generally worse than that of adenocarcinoma and squamous cell carcinoma of the lung; however, new therapeutic options have been found for adenocarcinoma of the lung that could potentially impact adenosquamous lung carcinoma

I am in Stage Four as the cancer has spread from the left lung to the adrenal gland as well as my Brain.

My hospital record indicates the following:

Indication for
……..presented to express care with subacute hemoptysis and fatigue, found on CT 1/17 to have spiculated mass suspicious for bronchioalveolar carcinoma, admitted for further work-up including biopsy and arrangement of oncology treatment given high risk for loss to follow up s/p right frontal craniectomy for resection of brain mass.

Hospital Course:
Admitted to medicine service for work up and clearance for surgery. A brain MRI 1/19/18 was performed and a 4.2 cm mass in the right frontal parietal lobe with surrounding edema and mass effect of 12 mm R to left with e/o impeding uncal herniation with left lateral ventricular trapping as well as other areas of metastatic foci. She was placed on decadron and keppra. She underwent a right adrenal biopsy biopsy by IR 1/20/18 and returned positive non-small cell carcinoma composed predominantly adenocarcinoma.

1/29/18 She underwent a right frontotemporal craniotomy and debulking of tumor and tissue biopsy of the mass returned positive for metastatic adenocarcinoma. The patient was ambulating w/o assistance POD 1. Unfortunately the patient received a visit from a family member who was carrying the flu virus. The patient developed a low grade fever and some sneezingly shortly after and tested positive for influenza b rapid screen 2/1/18. There was a mildy leukocytosis 1/29/18 9.4- 1/30 12 with continued low grade fevers max 99.1*F but remained on RA with normal O2 sats.

Given that the patient is non-toxic appearing, hemodynamically stable, clear lung sounds, and her desire to go home she was assessed by PT/OT who cleared her 2/1/18.

Hearing that I had a brain tumor was one of the most surreal moments of my entire life.  I knew in that moment that my prognosis was not good, even worse than just Lung Cancer by itself, but being that brain cancer is not my “primary” type of cancer, I felt somewhat fortunate.

I have NSCLC which is more common (85%) or so of those diagnosed have Non-Small Cell.  Of that, 20% affect squamous cells and 80% adenosquamous cells.  My cancer has tested positive for both cell types, mainly consisting of adenosquamous cells and the fact both are present is very rare.  I’m told like less than 1%.

Before targeted therapies (I’m taking Tagrisso (Approved by the FDA in 2017)) the survival rate at five years was 1-4%.  Today, I read its up to 40%. However, being I’m Stage 4 and with the Brain Mets, my prognosis poor. I have not discussed this with my doctor. I told him I didn’t want a prognosis.  I do….but I don’t.

Tagrisso “doubles” the time patients live, so basically, if I make it to 2019, medically speaking, it will be a miracle because my prognosis with Stage Four NSCLC with Brain Mets at diagnosis is 4.4 months.  Tagrisso extends that to 9 months.  But again, the average age at diagnosis is around 70 so being i’m 20 years younger, I’m really hoping and praying to beat this.

On a positive note, I’m 48 (49 in April) and the median age of lung cancer being diagnosed is around 70.  The fact I’m in relative good health gives me great hope that that I will be here longer than 9 months.

May God have grace and shine down upon me and those I love.