Mom, 64, dx w IIIa NSCLC

[Ktamdgirl]

Hi All,

I am new here. Hoping to take a break from googling and actually get some advice and hear stories from those who have actually been through this before:) 

My mom was diagnosed with stage IIIa adenocarcinoma yesterday at Johns Hopkins. She was originally told about 1.5 months ago that the mass she had(less then 1 cm) was operable and stage 1. Had PET scan to confirm no additional metastasis. She went to thoracic surgeon to schedule surgery and was told he had to do a bronchoscopy and medianoscopy to "confirm" there was no cancer spread in lymph nodes. Well, results came back and there were microscopic cancer cells in one out of 6 lymph nodes in her mediastinum. This is considered single station lymph node involvement from what I understand. 

So her dx went from 1A to 3A which has been really hard. But we are moving forward and she had her second opinion appt yesterday at Hopkins and that is where we will stay. They are recommending chemo (carboplatin and Alimta) once every 3 weeks for four rounds. After that she will have scans to confirm the cancer has responded appropriately and then they will move forward with a lobectomy. If the samples they send off after surgery contain cancer cells, they will then do radiation. The reason they are unwilling to start w radiation right off the bat in conjunction with chemo is because she has a history of  autoimmune disease and radiation can be really rough on people with preexisting AI  disease. They did say afterwards if there is cancer remaining, at that point the benefits of doing radiation would outweigh the cons.

Wow, that was long winded! I apologize. I was wondering a few things. First, if any of you had a similar diagnosis (stage 3A with microscopic single stage locally advanced spread). Second, if you did, what was your treatment plan. Third, even if you didn't have same diagnosis, has anyone done things in the same order?

I would appreciate any and all comments:) This has been tough on all of us but we are grabbing the bull by the horns and moving forward!

[Mally]

Ktamdgirl hi and welcome here ...i am nearly 4 months post surgery for a lobectomy and a wedge resection and like your mum i was told stage 1a and the surgery would be all i needed but after the pathology results which they tested 20 lymph nodes and 7 had cancer cells i became a stage 111a and now im having chemo and over half way through and mine is carboplatin/gemcitabine combo and ill get a scan at the end of treatment ..im 62 yrs old so we are very similar

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[Tom Galli]

Kyamdgirl, welcome here. 

Thirteen years ago I was initially diagnosed with stage IIIA Squamous cell NSCLC. My scope did not show lymph node involvement but I was restaged IIIB due to the size of my tumor. Initially, the surgeon declined to operate claiming the tumor intruded too far into my trachea. 

My oncologist and GP ganged up on him to treat aggressively. I had 30 doses of radiation with weekly taxol and carboplatin chemo. That shrunk the tumor enough to allow surgery (right pneumonectomy) but I had post operative complications. 

Then after the complications were resolved scans noted tumors in my left lung. All I had was chemotherapy until the surprise FDA approval of stereotactic body radiation therapy (SBRT) that fried my recurring tumor. 

So similar but no lymph node involvement. Treatments: first line conventional radiation with adjuvant chemo,1 years worth of surgery (long story), second line chemo, third line chemo with an addition of Tarceva, and SBRT. Lesson from my treatment: lung cancer is persistent and your mom needs to be more persistent. 

I don't know the order of treatment matters and given your mom's autoimmune complications holding radiation in reserve might be a good thing. She is at one of the best hospitals for treatment, especially given her complications.  

You'll have more questions and this is a good place for answers. 

Stay the course. 

Tom

[Meloni]

Hi Ktamdgirl,

I'm sorry about your mother's diagnosis. Like Tom says, you're at a wonderful facility for treatment. 

February of 2016, I was diagnosed with Stage IIIA adenocarcinoma. The primary tumor was in my right middle lobe and only measured 13mm (1.3cm), and three mediastinal lymph nodes were positive (I'd have to check my labs to recall the specific ones). 

I ultimately received treatment similar to your mother's current plan. My radiation was received concurrent with chemo (same combo of chemo as your mom), because I had no pre-existing barriers. Also, I was initially a non-surgical candidate, so my chemo was split during treatment. I received two rounds pre-surgery, and two rounds post-surgery. 

I like Tom's description of the doctor's ganging up on one another. That is similar to my team as well. Sometimes the oncologist and radiologist gangs up on my (extremely talented) surgeon to operate on something, and he concedes, but then Dr. Surgeon (who is very lung cancer oriented), turns around and convinces Dr. Oncologist to put me on the TKI that they were hesitating on. 

ANYWAY, I'm digressing. My point is, they have a plan for for treatment, and depending on variables, the plan might change. For example, if your mom needs an extra break in between chemo sessions to recover her blood counts, they already know it's a possibility. If she needs extra help working through the nausea and fatigue, they've got resources for that. 

Sorry I have to cut this off, have to leave for an appointment. You are very fortunate to be at a fantastic treatment center! Hope to hear from you soon! <3

 

 

[Myra Rapport]

Hi and thank you for all who are sharing,

I heard about chemo - has anyone had experience or know someone who used one of the target therapies or immunotherapy?

 

Many thanks to participants and Tom and all the moderators

M

[St Michael]

Welcome ktamdgirl.

 

I am sorry to hear of your mothers diagnosis. My mother was diagnosed with stage 3a adeno-squamous lung cancer about 6 months ago. She was first told she had stage 2 but when they found that one lymph node in her mediastinum was positive, they restaged her to stage 3a. Three total lymph nodes involved were positive. She is a non smoker.

 

She received two months of cispaltin and pemetrxed chemo, which shrunk her 2cmx 2.5cm tumor enough to be removed via lobectomy. She had the three positive nodes and seven others removed during the lobectomy. She has the EGFR mutation. She received radiation after surgery for 30 treatments. She is sore from the treatments, but recovering and alive.

 

My hopes are that she is and will remain cancer free and god forbid there's a recurrence, enough time will have passed for better treatments. My prayers are with you and your mother. Let me know if you have any other questions.

 

god bless