*Only for medical professionals to read and reference
Note: Individual cases can not be regarded as common phenomena!
Small cell lung cancer (SCLC) is a low-differentiation high-grade aggressive neuroendocrine carcinoma, with a 5-year survival rate of only about 7%. Without treatment, it may deteriorate rapidly, and life expectancy may even be as short as a few weeks. However, the "miracle" came to an 80-year-old man, whose SCLC was completely relieved spontaneously without treatment !
case was published in Thoracic Cancer magazine
80-year-old man who gave up treatment after diagnosis of SCLC
This is an 80-year-old man who came to the hospital due to hemoptysis and hoarseness. For 50 years, he has smoked 20 cigarettes a day.
Chest X-ray examination showed that there was a prominent lesion in the left hilum (Figure 1a). Chest CT showed a malignant tumor in the upper left lobe, and enlarged left hilar and mediastinal lymph nodes (Figure 2a, b). Because the exogenous lesions were not clearly visible, the bronchoscopy biopsy failed. The doctor performed video-assisted thoracoscopic surgery (VATS) on the patient and removed the sub-aortic lymph nodes.
Pathological examination results showed SCLC (Figure 3), and the clinical stage was limited.
Figure 1:
(a) Chest X-ray examination showed lesions with prominent left hilar contour; (b) Chest X-ray examination of lesions with prominent left hilar contour disappeared completely
Figure 2: (a And b) Chest CT showed left upper lobe tumor, left hilar and mediastinal lymph nodes enlarged; (c and d) Chest CT showed the previous tumor lesions completely disappeared
Figure 3: Pathological examination results. (A) Resection of the sub-aortic lymph nodes by VATS. Pathological examination showed that small and round tumor cells grew densely and flaky, with sparse cytoplasm and scattered chromatin [(b) hematoxylin and eosin ,100×]. Tumor cell chromaffin A [(c) immunohistochemistry , 200×] and synaptophysin [(d) immunohistochemistry. 200×] positive.
Due to his older age, the old man refused chemotherapy and radiotherapy and was discharged without treatment.
Limited-stage SCLC accounts for about 30% of SCLC, and its prognosis is not optimistic. The median survival time is only 15-20 months. Chemotherapy and radiotherapy are the standard treatments for limited-stage SCLC. How long can this old man live after giving up treatment at such an age?
visited again for 52 months and the tumor disappeared completely
More than 4 years (52 months) later, the old man came to the hospital again due to his inability to eat and his body was severely weak.
"Miracle" has appeared! Chest X-ray examination did not show a prominent lesion in the left hilum (Figure 1b). Chest CT scan confirmed that the previous SCLC in the upper left lobe, mediastinum, and hilar was completely remitted (Figure 2c, d).
It is understood that since the last visit to the doctor, the old man has not undergone surgery or received chemotherapy or radiotherapy. Instead, he drank beetroot juice every day. There was no complaint of any neurological diseases, and no abnormal neurological signs.
is as simple as that, the tumor has spontaneously and completely resolved! Seeing this, do you think this old man is very lucky?
However, luck cannot always be there. CT and gastroscopy of the abdomen found that the old man had advanced gastric cancer. This time he refused treatment again. The old man died 40 days later.
So will gastric cancer be caused by SCLC? In this regard, the author pointed out that the old man’s advanced gastric cancer is clinically and histologically judged as not related to SCLC, and it is difficult to find any relevant evidence in the literature.
Why does the tumor spontaneously remission?
The mechanism behind the spontaneous remission of malignant tumors is unclear, and may involve immune and cytokine repair processes, differentiation, apoptosis, surgical trauma (surgery or biopsy), infection, and hormone mechanisms , Inhibit angiogenesis or paraneoplastic sensory motor neuropathy.
So why did SCLC spontaneously alleviate in this case? The author analyzed this
01 Paraneoplastic sensory motor neuropathy
It has been previously reported that paraneoplastic sensory motor neuropathy is one of the mechanisms of spontaneous remission of SCLC. In patients with sensory motor neuropathy, specific anti-neural autoantibodies respond to tumors and the nervous system, and this inflammatory response is related to the anti-tumor immune response. Most cases of spontaneous remission of SCLC are accompanied by neurological symptoms, but in this case, the patient has no neurological abnormalities. Therefore, this reason was excluded.
02 Surgical trauma
Surgical trauma, including bronchoscopy biopsy, can lead to spontaneous remission of SCLC. Cole reported 176 cases of spontaneous remission of cancer, of which 40% were related to some type of surgical trauma. The healing process associated with trauma leads to increased immune resistance to tumor growth and may induce spontaneous remission.
03 Dietary supplements
Although it is still doubtful whether dietary supplements have anti-cancer effects, many cancer patients will supplement vitamins or minerals after diagnosis. Beetroot contains betaine and betaine . An in vitro study reported that nanoparticles biosynthesized with beetroot extract as a raw material have antitumor effects on lung cancer; another in vitro study showed that beetroot extract has antitumor effects on lung cancer in mice. In this case, the patient started drinking beetroot juice after the cancer diagnosis, did not receive chemotherapy, and did not take other herbal supplements. However, no scientific conclusion can be drawn about the connection between the spontaneous remission of cancer and the consumption of beetroot juice.
The author believes that the spontaneous remission of SCLC in this case may be related to surgical trauma and drinking beetroot juice, but the exact mechanism is still unclear.
Is spontaneous cancer remission rare?
Spontaneous cancer remission refers to the remission of malignant tumors after untreated or obviously inadequate treatment.The incidence rate is currently inconclusive, about 1 in 100,000.
The earliest documented spontaneous tumor remission occurred in the late 13th century. A patient with osteosarcoma disappeared after a severe bacterial infection. In the late 19th century, American doctor William Coley discovered that fever may induce tumor regression. He developed the bacterial vaccine Coley Toxin, which successfully reduced the tumors of many patients. At present, there have been thousands of cases of spontaneous tumor remission in the literature.
01 Melanoma
A female patient who has suffered from malignant melanoma for more than 13 years. At 19 months after diagnosis, she has progressed to stage IV melanoma with a poor prognosis. However, after repeated fevers, most of the tumors resolved, and the remaining tumors remained stable.
02 Non-small cell lung cancer
A 69-year-old woman was diagnosed with lung adenocarcinoma with right adrenal metastasis (stage IV non-small cell lung cancer). However, one month after diagnosis and before starting any treatment, CT and PET examinations revealed that the primary and metastatic lesions were significantly reduced. The patient underwent surgical resection and was still free of lesions at 14 months postoperatively.
03 Breast cancer
A 44-year-old woman, 11 years after breast-conserving surgery, CT examination revealed a mass in the upper left inner quadrant of the breast. Cytological examination revealed a malignant tumor. However, one month after the fine needle aspiration, tumor regression was observed, and ultrasound examination confirmed that the tumor had shrunk. Pathological examination showed no tumor cells in the mass. The patient's breast cancer resolved spontaneously.
04 Lymphoma
A 59-year-old white male with infraorbital follicular B-cell lymphoma presented with a painless mass on his left cheek. Five and a half months after the diagnostic incision biopsy, the lymphoma achieved spontaneous remission.
Recently, the British Journal of Haematology also reported an incredible case: a Hodgkin lymphoma patient was infected with the new coronavirus.After 5 months, the tumor in his body almost disappeared.
Summary
Although there have been many cases of spontaneous remission of cancer, they are still a minority. After suffering from cancer unfortunately, some people may inevitably have anticipation, hoping that a "miracle" will happen to them. But for the vast majority of cancer patients, the most important thing is timely and standardized treatment. Don't bet your life on such a small probability event~
References
[1 ]Song SH, Ha CW, Kim C, Seong GM. Complete spontaneous remission of small cell lung cancer in the absence of specific treatment: A case report. Thorac Cancer. 2021 Aug 20. doi: 10.1111/1759-7714.14124. Epub ahead of print. PMID: 34415108.
[2]Rudin CM, Ismaila N, Hann CL, et al. Treatment of Small-Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians Guideline. J Clin Oncol. 2015 Dec 1;33(34):4106-11. doi: 10.1200/JCO.2015.63.7918.
[3]Chang WY. Complete spontaneous regression of cancer: four case reports, review of literature, and discussion of possible mechanisms involved. Hawaii Med J. 2000 Oct;59(10):379-87. PMID: 11789163.
[4]https://www.verywellhealth.com/spontaneous-remission-of-lung-cancer-a-rare -miracle-3971875
[5]Haruki T, Nakamura H, Taniguchi Y, et al. Sponta neous regression of lung adenocarcinoma: Report of a case. Surg Today. 2010 Dec;40(12):1155-8. doi: 10.1007/s00595-009-4195-2.
[6]Wrotek S, Brycht Ł, Wrotek W, Kozak W. Fever as a factor contributing to long-term survival in a patient with metastatic melanoma: A case report. Complement Ther Med. 2018 Jun;38:7-10. doi: 10.1016/j.ctim.2018.03.009 .
[7]Ito E, Nakano S, Otsuka M, et al. Spontaneous breast cancer remission: A case report. Int J Surg Case Rep. 2016;25:132-6. doi: 10.1016/j.ijscr.2016.06 .017.
[8]Peeters M, Geusens J, Van der Cruyssen F, et al. Case Report: Spontaneous Remission of an Infraorbital Follicular B-Cell Lymphoma: Case Report and Review of the Literature. Pathol Oncol Res. 2021 Apr 8;27:642433. doi: 10.3389/pore.2021.642433.
[9] Why do some cancers disappear without treatment? https://www.pd1.cn/kangaizhishi/10101.html
[10]Challenor Sarah,Tucker David,SARS-CoV-2-induced remission of Hodgkin lymphoma.[J].Br J Haematol,2021,192: 415.
[11] The lesion disappeared completely,Spontaneous relief! Perhaps it is related to these three reasons! https://www.sohu.com/a/485216140_121130330
The first publication of this article: Medical Oncology Channel
The author of this article: Sharon
Responsible editor: Sweet
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