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Advice about my dad


Blazemom

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Hello.I am new to this forum and am hoping to get some advice about my 84 year old father, who was recently diagnosed with Early Stage Small Cell lung cancer. A nodule was inadvertently discovered on his lung when he was in the hospital in January for a GI issue. He has since had several biopsies with the following results: He has a 2 cm tumor at the base of his left lung near the chest wall and another at the top of the left lung. There seems to be some discrepancy as to the size of this second tumor. All along we have been told this second one was very small. At the appointment with the Radiation Oncologist today, the doctor said it is 5 cm and did not offer a reasonable explanation for the change (it has not grown). So it is either very small or 5 cm.

My dad also has some "areas of concern" in the right lung. They did not activate on the PET, and up to the time of our appointment with the Radiation Oncologist, we were told they would treat only the two left ones and just watch the right side, which were speculated to be probably just scar tissue from pneumonia. A Broncoscopy has also been done and determined there is no spread into the lymph nodes.

My father isn't a candidate for surgery because of previous heart problems. We went to the appointment with the Radiation Oncologist today thinking my dad would be getting set up for a radiation treatment plan but that isn't what happen. This doctor said that if he were to do treatment, he would use something called Stereotactic Body Radiation but he expressed a lot of reservations about going forward because: (1) he isn't sure how to deal with my dad's defibrillator (whether to turn it off, move it, remove it, etc.); (2) he now believes it is necessary to biopsy the nodule on the right lung that is close to the chest wall near the esophagus; (3) he is concerned about the risks associated with this type of radiation, particularly the long term risk of Pneumonitis.

We are currently getting a biopsy scheduled for the right lung now but whether it turns out to be cancer or not, it seemed to my mother and me that this doctor was saying he would probably hold off on treating my father in any case and take a wait and see approach. As for other types of treatment -- chemo, immunotherapy, targeted therapy -- he seemed to say my dad would not be a candidate unless the cancer becomes more advanced. This sounds like kind of a crazy approach to take, especially considering that my father is in an early stage of disease. He is currently completely asymptomatic and it seems that it would make the most sense to try to give him the best shot at recovery BEFORE it advances.

I do understand this doctor's concerns but it's hard to believe there aren't other treatment options. We are at a top cancer hospital and were a little disappointed that none were offered. We are considering getting a second opinion but I wanted to ask for thoughts or guidance as well from others who are going through this.

Thank you for any comments anyone may be able to share.

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Blazemom, welcome here.

Wow!  This is a complicated case; his age and heart are complications.  These are my thoughts.  I've had Stereotactic Body Radiation Therapy (SBRT) and it worked, well.  I believe the radiation oncologist is trying to rule out disease in the right lung before preparing for SBRT and this makes sense.  Thus the right lung biopsy.  If SBRT can be administered, it will consist of 3 to 5 say 15 minute sessions with no session prep and is an extremely effective way of dealing with 2 small tumors.  And, your dad's are small.  Here is some information about SBRT. (select "what are the different types of external beam radiation therapies (EBRTs)"

The defibrillator does represent a problem but a doctor to doctor consultation with a heart specialist ought to yield a solution.  If the right biopsy reveals cancer, then things will get very complicated.  You mention he's been diagnosed with Early Stage Small Cell lung cancer and suggest this diagnosis results from a biopsy.  Here is information about small cell lung cancer and treatment options.  I'm no doctor but have known many lung cancer patients with heart problems.  Treatment with chemotherapy may be complicated.

I'm a Pennsylvanian by birth and the state does indeed have good hospitals.  But, google "top 20 cancer hospitals in the US" to confirm your dad's hospital makes the list.

Stay the course.

Tom

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Thanks Tom.  I will read the links you provide tomorrow when I'm not so exhausted.  I wanted to just quickly answer to thank you for your reply.  I wasn't sure if I was permitted to name the hospital but we are in Philadelphia and the hospital begins with an F and is a dedicated cancer hospital. 

If the third tumor on the right side turns out to be cancer, then treatment may be complicated, that is what he said and you are confirming that.  But complicated to the point that it may actually be untreatable? 

Thank you again for your quick reply.  Glad to hear that SBRT worked well for you.

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Blazemom,

I wouldn't be qualified to answer if your dad's disease is untreatable.  I only know his treatment difficulty is compounded by age and heart problems and that was the basis of my pointing out that chemotherapy may be complicated.

I would at least seek a second opinion, perhaps from an other hospital on the top 20 list because of the complexity of your dad's case. I do like the SBRT approach because it would be easily tolerated. Hopefully that avenue is available.

Stay the course.

Tom

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Thanks.  I believe we will be seeking a second opinion to be sure there are no other treatment options after the Broncoscopy on the right lung.  BTW, I can't get the link to work for info and treatments for small cell lung cancer.  I know I can just google it but I would like to see what you have directed me to so if you wouldn't mind providing the link again I would appreciate it.  Thanks again.

Valerie

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