Tom Galli

Walfredo, Do initial CT scans have a relatively good track record of predicting lung cancer or finding a primary tumor? I certainly can't offer a definitive answer. In cases like my initial diagnosis with a very large tumor blocking my main stem bronchus, then yes. There is also ambiguity with the PET scan. Here is my explanation on PET findings. Unfortunately, the only definitive way to make a positive lung cancer diagnosis is with a tissue biopsy. The pathologist looks at the tissue sample under a microscope (histology exam) and notes the characteristic shape and size of lung cancer cells. Then, for most folks these days, the sample is sent for further laboratory biomarker testing. Primary tumors sometimes are hard to find but if your biopsy shows non small cell, small cell or large cell lung cancer, you should undergo treatment. I wouldn't know how your radiologist determined your rare lesion (lung carcinoid). I know all this is unsettling; I've been down the "scanziety" path many times in my treatment history. One does not cope but hope springs eternal. Stay the course. Tom

Walfredo, Welcome here. I'm certainly not a doctor but the operative words in the CT report are in paragraph 1 of the Impression: "pulmonary carcinoid." Here is an explanation of what a pulmonary carcinoid is. So you have a tumor (lesion) in the right lower lobar bronchus. Is it metastatic lung cancer? The radiologist suggests your age and location of the lesion raises that possibility but it remains a possibility until a biopsy is performed. Unfortunately, for more information, you'll need to wait for the results of your bronchoscopy. I hope it is something other than lung cancer. Stay the course. Tom

Cheryl, Welcome here and glad to learn you've finished chemo. I do hope your PET scan conveys good news. Stay the course. Tom

Sajid, I'm very sorry to learn of your wife's diagnosis. To your questions: is lung cancer curable and does the coughing go away? The answer to both is yes, although cure is not normally used in our community. Here is an explanation of the various terms associated with lung cancer prognosis and here are some suggestions for mitigating coughing. You mention targeted therapy and that is indeed a possible treatment. But there is another method that is moving the survival curve substantially--immunotherapy. The bio-gene testing or biomarker testing should reveal if either or both of these methods are a way forward for treating your wife's lung cancer. I was diagnosed in February 2004, well before the advances in targeted therapy or immunotherapy. I had five failed treatments before a precision radiation treatment--CyberKnife--dealt with my lung cancer. Unfortunately persistence and patience are treatment fundamentals, but if I can live, so can your wife. When a treatment plan is devised, there is every reason to hope that it will mitigate your wife's lung cancer. Treatment may also reduce the need for supplemental oxygen. I look forward to you telling us about your wife's successful treatment that results in NED--no evidence of disease, our gold standard result. Stay the course. Tom

Chris, Coughing after lung cancer surgery is unfortunately a side effect but it rarely lasts. Therefore, I'm not sure chronic coughing is something to be worried about. How does one relieve temporary coughing or coughing when encountering adverse environmental conditions? Here are some suggestions. Stay the course. Tom

Kelvin, What is my treatment history? Here it is. Stay the course. Tom

Kelvin, Sorry to learn of your mother's diagnosis; I was also diagnosed Stage IIIB in February 2004 and had a multitude of treatments. Some worked and some did not. But, I'm here. I can't share a happy story for I find no happiness in lung cancer but my hopeful message for your mother is if I can live, so can she. Stay the course. Tom

Stay the course Lizzy!

CH, As a retired civil engineer, I remember Radon entering my vocabulary in the mid 1980s. In certain parts of North America, there is very high risk of Radon accumulation in buildings, especially homes with below grade basements. I believe it is now classified as the second leading cause of lung cancer. I would suggest your children have a low dose CT scan and participate in annual screening as a result of their exposure. Medical insurance coverage won’t likely recognize the risk and may not cover the screening cost, but low dose scans have come down in cost so they are reasonably affordable. Great news about your husband’s treatment. Let’s hope his end of treatment scan shows NED. Stay the course. Tom

Bro, Very sorry to learn of this development. I think many of us here have had recurrences after treatment. They are never good news. Stay the course. Tom

Justin, My CyberKnife assault on my 3.5cm lung nodule took but 3 consecutive days, 20 minutes each session. The scan after 6 months showed no evidence of disease. Stay the course. Tom

Justin, Your's has been a hard road but you've arrived at a fine destination. Let us hope for continued improvement! Stay the course. Tom

Nur, Aside from hypertension, your mom's symptoms appear to be consistent with end state lung cancer. Again, I'm not a doctor so I can't comment on the use or appropriateness of medications but her mental behavior--sometimes saying inappropriate things--is unfortunately typical. During time when your mom is lucid, tell her of your recollection of fond childhood memories or important family milestones. Give her a daughter's peace of mind that she excelled as a parent. This part of life is difficult for all of us. Ensure your mom is as comfortable as possible. Stay the course. Tom

Great news Minh. Stay the course. Tom

Arisa, Welcome here! Before I comment on options, I want to complement you and your mom on diagnostics tracking her nodule. That is, in all cases, the right thing to do. Mom's TB complicates an answer about options. TB can often produce lung nodules and even these can change (or not) year over year. In fact, your mom's 1mm progression is so small it might be lost in the accuracy range of the CT equipment. Consider two things--7mm is the size of a typical camera on a modern cell phone and this makes it a hard target for successful needle biopsy (to Lou's point), and small nodules if metastatic often do reliably produce SUV uptake so a PET scan can be problematic. I'd ask a thoracic surgeon, interventional pulmonologist, or interventional radiologist about the possibility of a successful guided transthoracic needle biopsy for a definitive diagnosis. Here is some information about needle biopsies. And here is information about pulmonary nodules. If her practitioners decline to perform a biopsy, keep on tracking things with a CT. One more thing. I've survived 18 years after diagnosis and my yearly monitoring scans still show nodules. I call them my "phantom" nodules because they appear and disappear randomly. To retain my sanity, I use the diagnosing radiologists report about location and chart them on a spreadsheet. So far, nothing new. Just a waxing and waning of nodules scan after scan. Why? Who knows! Stay the course. Tom

Lizzy, Hey, now that's good news. Love the sound of a brain met frying under intense radiation! Stay the course. Tom

Justin, Let me see if I can get @Lisa Haines to wade in. She might be of some help. Stay the course. Tom

Minh, I we’ll know the back-to-back-to-back thoracic surgery shuffle. I had 3 open thoracotomies in the span of 6 months. Then three rigid bronchoscopy stent insertions (all failed). So I know what you are going through. But consider that was 18 years ago in the “dark” ages of thoracic surgery, well before VATS and other less invasive procedures were developed. I’m still here and if I can live, so can you! Stay the course. Tom

Well done Susan! Now go get 6 more years. Stay the course. Tom

Jamie, Welcome here. I've very happy to learn you've completed your first line treatment, and the post treatment scan showed a reduction of your tumor. To your questions: does SOB get better over time? I'll suggest two answers because both are relevant. Tumors in the lung destroy lung tissue and treatment does not restore that tissue. Therefore, after successful treatment, one will have less respiratory capacity. But that does not necessarily impact on fitness level or breathing efficiency. It is possible to improve one's aerobic capability after lung cancer treatment and aerobic exercise is the method for improvement. So shortness of breath can get better over time if you work to improve your aerobic fitness. Breathing exercises are valuable because they teach filling the lung to capacity with each breath. We are often "lazy" breathers. So training to fill the lung completely can eliminate shortness of breath. You can test this by using a pulse oximeter. Place one on your finger at rest and note your oxygen saturation percentage. Then start breathing deeply and note the near immediate improvement in O2 saturation. On your question about biomarkers, the one's you cite are common with squamous cell carcinoma. Most information about biomarkers and Targeted Therapy pertains only to a small percentage of those diagnosed with adenocarcinoma. Squamous cell does not responded to Targeted Therapy. But you do have a relevant immunotherapy marker (PD-L1) that is an indicator that your prescribed Imfinzi or Durvalumab immunotherapy may work. I do hope so. By the way, we have a very comprehensive section in our forum that is devoted to discussion about Durvalumab. Find it here. Lung cancer staging is relevant only in 2 instances: diagnosis database population and surgical treatment decisions. Everyone diagnosed in the United States becomes a statistic in a National Institute of Health cancer database, and the diagnosed stage is recorded as part of that data record. Lung cancer patients staging from I through IIIA can be evaluated as candidates for surgical treatment. Those diagnosed stage IIIB through IV are generally not treated surgically. When treatments reduces or eliminate tumors, one's staging does not decrease (say from Stage IV to Stage III). Your first line chemo-radiation was systemic therapy meant to address the entire body (chemotherapy) and the localized tumor (radiation). Systemic first line treatments are normally prescribed for those with stage IIIB and higher staging. Could your tumor shrink with Imfinzi? Absolutely. It can shrivel up to nothing but scar tissue and I hope it does. Keep your positive outcome and avoid Dr. Google's survival statistics. They are not relevant and here is why. Stay the course. Tom

CH, The surprise and shock of a lung cancer diagnosis is almost universal--a Stage IV diagnosis, especially so. Once it was akin to a death sentence. Now with immunotherapy (Keytruda) and the combination chemo treatment (Alimta and Carboplatin), there is every reason to expect good results from the mid treatment scan. Hope is indeed a good thing but very fortunately, it no longer substitutes for effective treatment. Immunotherapy is a game changer, saving lives for the often late-stage diagnosed in this community. You've done your research and good for you. Your husband's port installation will take the drama of accessing a vein out of the treatment equation. That is so very important! Let's call in the immunotherapy troops @Lisa Haines to share the good news treatment results with CH. Stay the course. Tom

Nur, My opinion on vitamins as cancer therapy--while taking vitamins is sometimes necessary to supplement people with dietary problems, nothing I've read suggests that vitamins have any effect on lung cancer, any type of cancer for that matter. A dry cough that often persists is unfortunately a symptom of lung cancer. The tumors in the lung and perhaps in and around the airway are irritating, thus causing the coughing reflex. There are several home remedies you can try. Use a steam kettle to generate a flow of steam and place a towel over your mom's head and position her to be close to the flow of the steam. Have her breath the steam deeply. This sometimes eases the coughing and breaks the persistent cycle. There is a long-used medication that should be available in Uzbekistan called Albuterol Oral Inhalation. It is a class of drugs called a bronchodilator and it works by relaxing the lung tissue thus relieving the irritation. This drug is available as a stand-alone inhaler, or in ampules to be used with a device called a nebulizer. There are many of these machines available for sale on Amazon. I would not use the battery powered devices. They are not very reliable. Sometimes in the United States, doctors offices lend these devices to patients when prescribing Albuterol. When I was prescribed Albuterol treatments, my frequency was 6-times per day. I wouldn't know about difficulty moving one's arm. It could be related to a spread of cancer to her spinal chord and an interruption of nerves to the arm or it could be completely unrelated to lung cancer. Is there any pain when your mom's arm is moved? Is the pain in her arm or at the base of her neck? Stay the course. Tom

Nur, I am very sorry to learn about the lack of hospice care in your country. Basically, hospice care focuses on eliminating pain and discomfort as the disease progresses and bodily functions start to shut down. Again, please recall that I am not a physician so do not consider my suggestions as medical advice. When lung cancer is not treated, it almost always spreads to other parts of the body. This spreading (called progression) is what causes symptoms to appear. Lung cancer commonly spreads to the brain, bones, liver and other organs. The first realization that cancer invaded your mom's brain is generally dizziness or difficulty walking or talking. There will not be pain associated with a spread to the brain, but there can be substantial immobilization effects. She may need help walking; indeed she may need a wheel chair. So be mindful of your mother's steadiness on her feet and deterioration of speech or movements of hands and arms. When cancer spreads to the bones, pain symptoms often appear. This pain can be quite disruptive. Late stage treatment is prescribed in the form of morphine given orally or by injection. A general practice physician ought to be able to help you obtain morphine and suggest the appropriate dose. The object is to administer just enough morphine to eliminate pain but keep your mother aware. Obviously as the cancer progresses and pain increases, the morphine dose will need to be increased but again a general practice physician ought to be able to help with dose adjustments. Older folks do tend to under report pain or discomfort. I experienced that with my mother. But facial expressions are hard to hide. Watch your mom's face as she tries to shift in bed, walk or perform other activities. Her wincing will tell you she is experiencing pain even if she doesn't admit it. There will come a time when feeding your mom solid food should be halted. As the body declines, the intestinal system slows then stops working. So constipation may set in. Moreover, constipation is a common side effect with morphine (all narcotic pain killers). So ask your mom's general practice physician about starting a course of laxative medication along with morphine. The idea of moving to a liquid diet may be a good one. Certainly, do not limit the amount of water your mom way want to drink. Palliative care is a medical discipline that minimizes the pain and discomfort from side effects caused by medical therapies. For example, I had palliative care to deal with severe joint pain as a side effect from chemotherapy. Palliative care is not curative nor is it hospice care. As the disease spreads the amount of weakness and fatigue your mother experiences will increase. That increase should be expected so your mom appearing less active in future days can be characteristic of cancer spreading. No one can forecast the amount of remaining life one has with any precision, even in situations with extensive metastatic cancer. Sometimes, for example, the cancer stops metastasizing without treatment. This kind of remission cannot be predicted or forecasted. How do doctors forecast lifetime remaining with end state disease? There is unfortunately a lot of data available on the stage (extent) of cancer and time before death. These data are not very accurate but they are accurate enough to suggest months or weeks of remaining life. That is very likely the way your mom's doctors derived their forecast. I wouldn't hazard a guess of how much lifetime your mom has. What might be most important now is to focus on the quality of remaining life rather the amount of remaining life. Spend as much time as you can with her. Talk about family memories and enjoyable events so she can relive her life experience in her mind. Surround her with family and friends and let her know she is loved. Stay the course. Tom

Paul, Surviving Stage IV disease for any length of time is something to celebrate. You've already beat the mean survival rate so why not make the 5-year mark and beyond! I'm happy they discovered the ALK mutation and that it is a treatable form. I don't know much about Loriatinib. Perhaps someone with experience can chime in and give use their insight. Stay the course. Tom

Nur, Answering your questions is so very hard. Unknown to us is your mother's attitude toward life. More plainly, sometimes these conversations border on how one wants to die. So while we might understand the nature and extent of your mom's disease, and her age, and other health complications, we have no insight into the prospective of your mother. How she thinks? How she feels about life? This is the terrible situation that Lou speaks of. Your mother has a very large tumor, spanning several lobes of the lung, with a pleural effusion, and with apparent disease spread to many lymph nodes. This description of your mom's cancer might stage at IV, not treatable by surgery in my country. The lymph node involvement suggests there might be cancer in other areas of her body (her brain for example) or small metastatic areas in other organs. Normally, someone in my country would have a PET scan and brain MRI certainly before a surgical decision. I'm not sure removing your mom's lung would improve her outcome. Again, keep in mind I am not a doctor. If your mom is at Stage IV, she would need to have systemic treatment (chemotherapy perhaps coupled with radiation). But to begin systemic treatment a biopsy would be required to determine the type of chemotherapy needed to fight her disease. Your relatives are right to point out how arduous chemotherapy can be. I had 18 infusions and each was a nightmare to endure. But I had these treatments at age 53 and I was in relatively good health when I began treatment. I can't imagine having chemotherapy being frail and unable to hold a spoon. I don't know your mother. I don't know how she would accept information about a disease that will likely end her life. But, you should not sit and watch your mom die. We have an end-of-life treatment called hospice care. This provides pain relieving drugs and other medical services to ease the process of passing. Is hospice care a treatment available in Uzbekistan? If so, arranging such care for your mother whether you tell her about her diagnosis or not is something you can do to ensure your mom feels no pain or discomfort from her cancer. Stay the course. Tom