My Small Cell Lung Cancer

A 67-year-old white female was seen in and evaluated in the Sarasota/Manatee area for small cell lung cancer in the fall of 2009.

The patient was found to have limited stage disease (disease confined to the chest) documented by CT PET fusion scan. MRI scan of the brain was normal. She was treated with a platinum based regimen in combination with VP-16. After 3 cycles of therapy repeat PET scan demonstrated a complete response. Radiation therapy was given to the brain in prophylactic fashion. Chemotherapy was continued after radiation was completed. She completed 6 total cycles of therapy. Shortly after completing all treatment the patient and her alarmed family brought the patient to the office due to the development of new adenopathy in her neck and a swollen face. Given her initial diagnosis of small cell carcinoma involving the mediastinum the possibility of recurrent disease with superior vena caval syndrome was raised. The patients physical exam demonstrated a swollen face, normal lung exam and no evidence of airway compromise. The patient at the end of our meeting told me that she had received a flu shot approximately 10 days prior to our office visit. At the end of our office visit the patient said:

“I AM TERRIFIED THAT MY CANCER HAS RETURNED; IS IT POSSIBLE FOR MY CANCER TO RETURN SO QUICKLY?”

[tabs tab1=”Diagnosis” tab2=”Significant Findings” tab3=”Pharmacology” tab4=”Management” tab5=”Comments”]
[tab num=1]The patient at the time of this office visit with us was thought to have recurrent lung cancer; however I considered the possibility of an adverse vaccination reaction and placed the patient on a medrol dose pack (steroids for inflammation).[/tab]
[tab num=2]The patient’s physical examination was quite impressive and strongly suggested recurrent disease. A repeat PET scan was done which was interpreted as showing disease progression consistent with recurrent metastatic cancer in the neck. However the patient was seen again 5 days later and her physical examination was normal.[/tab]
[tab num=3]Occasional severe reactions can occur after vaccinations. This patients physical findings completely normalized after 5 days of oral corticosteroid use. Her adenopathy disappeared and the swelling of her face resolved.[/tab]
[tab num=4]This patient had another repeat CT PET scan 3 months after her vaccination reaction which was normal.[/tab]
[tab num=5]In recent review of over 12,000 positive CT PET scans it was determined that approximately 25% of positive PET scans in oncology patients are false positives. This patient had a very dramatic adverse response to a vaccination with rapid resolution. She remains disease free more than 6 months after completion of all therapy.[/tab]
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