Tom Galli

Photolady, We welcome you. Your words "just diagnosed and no details" speak volumes to lung cancer survivors. We completely understand what is rushing through your mind as you navigate the sea of vast uncertainty and unpredictable outcomes that is lung cancer. We survivors here are the subject matter experts in lung cancer. Not by training, but by on-the-job experience. You will go down the path of "staging and typing" so your oncologist can decide on treatment. This could take up to a month. You'll have lots of questions. At this juncture I offer this for your consideration: if I can live, so can you. Stay the course. Tom

Gage welcome here! For Gage - do the Gilotrif side effects ease over time? My experience with a similar oral chemotherapy drug -- Tarceva -- was a continuation of what was called, in the drug literature, "skin rash" throughout the entire time I took it. Skin rash was a very inadequate way of describing my symptom. And it sounds inadequate also for your "plague." I had my Tarceva in combination with the conventional chemotherapy drugs Taxol and Carboplatin. So, after losing my hair, my "skin rash" morphed into the worst case of head, face and neck acne the world's ever seen. I looked like a zombie, most embarrassed to show what passed as my face in public. Gilotrif seems to be working so stay connected and let us know how you are doing. Stay the course. Tom

Buzzy, To your question -- possible for 2 nodules of a different type and unrelated in each lung. Yes, anything is possible. Search here for WebMd's discussion about lung nodules. And I want to reinforce Mary's explanation of how small 7 or 13mm is. 7mm equals just a little larger than 1/4 inch, and 13mm is a little bigger than 1/2 inch. To visualize, a 1/4 inch nodule would be about the diameter of the eraser on a #2 pencil. A 1/2 inch diameter is the size of the home button on an iPhone. These are worthy of concern but small. Stay the course. Tom

Buzzy, I hope the nodules are benign. Stay the course. Tom

Buzzy, Welcome here. You are right to be concerned about the nodules in your lungs. All nodules are red flags for cancer. Your appointment with a pulmonologist is a good next step but a better step for consideration would be a consultation with a medical oncologist. To easy your mind, topics you might explore with your pulmonologist are a biopsy or PET scan. A biopsy at this juncture might be the better route. Stay the course. Tom

Jesslaa, You are most welcome here. I want to reinforce a point Mary brought out. Many of us on this site and others are alive and well after being diagnosed staged IV. Staging for lung cancer, in my opinion, roughly translates to a determination if surgery is possible. If the tumor is a single mass and there are no distant metastasis, then surgery may be undertaken and may be curative. In my experience, I had a recurrence after what was supposed to be curative surgery, then twice more after 12 cycles of chemotherapy. Lung cancer treatment can often be a long game, but, as Mary says your "Mom can do this too." That is survive and thrive after a lung cancer diagnosis. Stay the course. Tom

Stephanie, Welcome here. This response will be brief because I am visiting family and constrained to an iPhone keyboard. To your Cesplatin - Alimta and Keyteuda treatment questions: the former is a first line (first treatment) "standard of care." That means it is proven to have the best response for people with adenocarcenoma as a first treatment. Keyteuda is a new immunotherapy drug and again has been shown to be most effective as second line (second treatment). You expressed concern about Cesplatin side effects. They can be harsh but there are ways to counter them. They are cyclic and arrive the same number of hours after infusion and if you chart their timing, your dad can start mitigating medication slightly ahead of arrival. This approach lessons side effect troubles. Treatment delay -- I've had more than a few. It took me about a month of diagnostic delay and treatment design. Your dad is slightly more than two. After a diagnostic reoccurrence, we delayed treatment for a month to participate in a booked vacation. This delay did not effect my outcome. Your dad is in the system now and treatment should settle down to a schedule. More when I can use a keyboard. Stay the course. Tom

I've seen the star of Bethlehem, very early on Christmas morning. While peacekeeping in Egypt's Sinai Desert, I would run before daybreak as soldiers are prone to do. Although the desert is quite cold in December, dawn running was a habit hard to break. I ran the camp perimeter to check the defensive positions and greet soldiers enjoying the banter in three different languages. Starting in the south perimeter and running counterclockwise, the predawn western sky was dark except for the stars that were so clear, they were painted on the black night sky. Passing along the northern perimeter, the sky lightened and my expectation was the sun starting its rise. But, no, not that day. Right on the distant horizon was a cosmic anomaly, a false dawn, but a bright shining nevertheless. I was looking at the star in the east seen by the Three Wise Men as they rode in search of Jesus. I would later learn, it was not a star but a rare conjunction of the planets -- Jupiter, Saturn and Mars -- all rising in the east slightly before being washed out by the rising sun. I am awestruck by that memory. Many years later after surviving a years worth of cancer surgery and while waiting the results of my first post-surgical diagnostic scan, my entire family gathered to celebrate Christmas. Mom, dad, four brothers, daughter, and a posse of nieces who overwhelmed my one nephew comprised the gathering. Despite my manifest uncertainty, we had a joyous time. I can count on a single hand the times my family gathered. With two Galli soldiers, someone was always missing on deployment. But Christmas in 2004 was an assembly formation, and the clan was all present and accounted for. We celebrated Christmas and my life. I am awestruck by that memory. Then started the clammer of lung cancer treatment. In my treatment years after the Christmas 2004 assembly, my life hovered in sadness and despair. I allowed myself to become overwhelmed by uncertainty, indeed I could think of little else. I forget there are only two things certain in the human experience: birth and death. Everything else is uncertain; outcomes are unpredictable. Treatment was working for I was granted extra life. There were many opportunities for joy but they were frittered away. I am awestruck by those memories. In common with all lung cancer survivors, having been born, I have only one certain human experience yet to deal with -- death. Its timing is uncertain with or without lung cancer. In my memories of active treatment, I chose to let life pass me by forever losing opportunities for joy. Today we celebrate a birth, a new beginning. It was announced by a star. I've seen the star. Let the joy of this birth be a new beginning for all lung cancer survivors. Let us live and find joy in the life we have and be awestruck by the memories of life well lived. Stay the course.

Yyg, Good questions about when treatment gets switched up. For those of us who cannot receive surgery, we received what is called the first line treatment and it is normally termed a "standard of care". That means this care has been proven to have the most beneficial effect to the type of lung cancer for the most patients. Your BF is receiving first line standard of care - chemotherapy (cisplatin and etoposide) and radiation. The radiation kills the lung cancer cells and chemotherapy inhibits their further spread. He'll have scans sometime midway through treatment and at the end of treatment to assess the effectiveness of this treatment. All lung cancer is persistent and many of us have failed first line standard of care treatment. So a second line therapy is administered. Often this is only chemotherapy. It may be the same type of chemo he is currently receiving if the scans showed a good effect on his tumors. It may be a new recipe (new chemo drugs). And, sometimes second line works. Often it does not and the treatment proceeds to further care. At this juncture, the intuition of the oncologist becomes important (my opinion). There really is not a third line "standard of care" but there is third line treatment. There could be adding a newly emerged drug to his current chemo recipe, joining a clinical trial, or another formulation. Alternatively he may receive a different form of radiation called stereotactic body radiation or protein beam radiation. Read about them here. But, this speaks to your question -- when to seek a second opinion. I'd definitely start seeking a second opinion after mid-treatment diagnostics half way through second line. I'd want to find the oncologist who has the best intuition about devising an effective third line treatment. Now this is my opinion. You ought to seek others. Stay the course. Tom

Wendy, Sorry I missed your post. Please give us news about your PET scan when your receive it. Merry Christmas! Stay the course. Tom

Yyg, I am one of those -- well let's say refined survivors -- who's been very luck to live long enough to have acquired a few lessons learned about lung cancer. First, and most important, you can't let treatment take over your life. I learned this the hard way because I fretted away three years of my life focused on little but treatment, depression, and misery. I now know I have control over what I think and feel about lung cancer. I can choose to bottom feed or choose to live in spite of my cancer and treatment. So, go on with your lives. Make plans, enjoy yourselves, be fulfilled. Look at your BF's forehead every morning and if you don't see an expiration stamp, enjoy the day. Second, if I can live, so can your boyfriend. You'll have many questions about cancer stuff and this is a good place to ask. The fact that so many of us are here ought to rekindle hope. Next visit, if you care, let us know his treatment plan. Doing so will allow folks who've had the same treatment to weigh in with their experience. Stay the course. Tom

Amay, I well understand frantic and scared, also sadness and anger. All are, unfortunately, common symptoms with lung cancer. I feel hampered in that I don't really understand the UK medical system so I can't help you in discussions with the registrar. In truth, I don't know what a registrar is in your medical system. We deal directly with our physicians and hospitals without intervention (for the most part) from third parties. Eric Byrne is a UK moderator of our forum. Perhaps you might message Eric, explain your discussion with the registrar, and see if he can help you negotiate approaches that might be beneficial to your mother. To connect with Eric, click on "Staff" and select the envelop icon under his name. I'll message Eric in advance and give him a heads up. Stay the course. Tom

AMay, Your mom's completed first line treatment -- the standard of care for non-surgical treatment -- and unfortunately her outcome is typical for lung cancer: little or no improvement. So to your question what is next. Targeted therapy: if her tumor displays markers (initial biopsy diagnosing adenocarcinoma may have included testing for tumor markers) that suggest a mutation, it may respond to targeted therapy. Here is information. Chronic disease: if her current first line treatment shows shrinkage, it may be possible to design a program of infusion with carboplatin and vinoreibine that is administered to hold her tumors in check. Some I know have been having chemo for years and it continues to hold tumors where they are thus allowing a near normal life. Clinical Trial: I don't know much about the UK medicine system but perhaps your mom qualifies for a clinical trial -- introduction of new treatment means or process into the medical system. Here is information. Immunotherapy: Do explore it. Do talk to a doctor. New advances are happening everyday. Here is information. But, even this is outdated because of frequent medical advances. I set my Google News App to report on lung cancer advances and almost everyday something new pops up in immunotherapy for lung cancer. How did it work for me? After metastasis to my left lung after a right pneumonectomy, my oncologist's approach was to keep trying chemotherapy as long as it showed an effect on the tumors till something "popped out of research." The something for me was CyberKnife. I had six cycles of taxol and carboplatin and after recurrence, six more cycles with the addition of the oral chemotherapy drug Tarceva. These knocked back my tumors but did not eliminate them. The CyberKnife did. This treatment spanned 28 months for me so persistence and patience was required. I completely understand you wanting it gone but you are involved in a cricket match, not a horse race. Lung cancer is persistant and you and your mom need to display more persistence. Stay the course, and do have a joyous Christmas! Tom

St. Michael, Now you will enjoy the best Christmas. Mom home and NED - no evidence of disease! Wonderful news! Enjoy and. Stay the course. Tom

Ngc4au, If I am interpreting your post properly, you dad has likely Stage III A or B non-small cell, squamous cell, lung cancer. I believe I understand it is inoperable, and his doctors are recommending radiation and chemotherapy as "first line treatment." Moreover, he is scheduled for a mediastinoscopy -- a small instrument inserted into the chest at the base of his throat -- to examine and perhaps biopsy additional suspicious areas in his chest. You mentioned his suggested treatment is radiation and or chemotherapy. If this is the case, your dad's treatment is "the standard of care" when surgery is not possible. I had it and many others on this site had it. Mine was done to shrink my very large tumor in hopes of allowing surgery. Others have had it as curative treatment. What should you be doing? Research. I'd start here and here. As a result, you'll likely have questions and feel free to ask away on this site. We are the lung cancer experts, not by education but by experience! What should you expect from treatment? Extra life. How long? Mine is nearing 13 years after diagnosis with stage IIIA non-small cell, squamous cell, lung cancer. Others of this site have far longer periods of survival with even stage IV disease. So what does your dad do with his extra life? That is the question I suggest you ponder and discuss. My suggestion is live. I'd help your dad realize that it is possible to enjoy life and undergo treatment at the same time. Here is information that may be useful for your dad and family to read. Stay the course. Tom

Michelle, We share a type (squamous) and treatments: surgery - check; radiation - check; chemo - check; and Tarceva - check. Check also on hair, eyebrows and eyelashes. But, I am now at the survival stage where hair loss is old age balding rather than infused chemicals! Good to have you here and wonderful that you are persevering with your treatment. If I can live, so can you, and we've got a lot in common. Stay the course. Tom

Gunjan Jha, Welcome to LUNGevity! Anyone with good quality of life after treatment for advanced lung cancer? Yes, plenty of us here! Read some of our stories in the "Share Your Lung Cancer Story" portion of our site. Our treatment experience is almost parallel. I also had pre-surgical chemo (taxol and carboplatin) and radiation. Then my entire right lung was removed. Tumors appeared in my remaining lung and was again treated with taxol and carboplatin. A year later, a single tumor was found and I had additional taxol and carboplatin with a then new oral chemotherapy drug called Tarceva. About 8 months after this round of chemo, the left lung tumor reappeared and I had CyberKnife treatment. So diagnosed in February 2004 and NED (no evidence of disease [what we now call cure]) in March 2007. Three years of treatment to achieve NED. So my first view of treatment is that treating lung cancer is like watching a cricket match. They are long matches! Lung cancer is persistant and prepare for not only a next line of treatment but the line after and the line after that. You are right, there are remarkable advances in Targeted Therapy and now immunotherapy and many here have experience with these new treatments. These treatments are primarily aimed at your type -- adenocarcinoma. Here is some information on targeted therapy and immunotherapy that you may find helpful. Now let's talk about the most important thing you mentioned in your introduction: "good quality of life." I believe that if one chooses treatment, then one is choosing life. Treatment often extends life but when I was in treatment, I didn't take time to appreciate my extension. I didn't take time to enjoy myself. I became too mired in treatment and failed to realize it is possible to enjoy life and undergo lung cancer treatment. It is a lesson learned that I pass to you. If you enjoyed activities before lung cancer, then strive to enjoy them with lung cancer. Find things to enjoy each day -- that is the secret to good quality of life. Stay the course. Tom

Daughter, Surf around our forum and you will find many stories of hope. Most of us have been right where your mother is now. I've lived nearly 13 years since diagnosis with Non Small Cell Squamous Cell Lung Cancer. I've had surgery, chemo, and a CyberKnife. I also lost my hair - twice. Also lost my eyebrows and eyelashes but all grew back after treatment was complete. Here is my hope - if I can live, so can your mother. Here is a blog I wrote some time ago that highlights the importance of hope. Stay the course. Tom

Fauq, We share a diagnosis and a right pneumonectomy. Unfortunately surgical complications precluded me from having adjuvant treatment. That is likely why I was diagnosed with three tumors in my left lung after finishing a nightmare of surgery. I had a total of 18 infusions of taxol and carboplatin. Carboplatin and cisplatin are similar but I've read cisplatin is more difficult to tolerate. So, to your questions: The first time is most difficult, the remaining three will be OK. Maybe, hopefully, but that was not my experience. During infusion symptoms and side effects for each were exactly the same during my treatment. In fact, side effects occurred the same number of hours after each infusion (nausea - 12 hours; joint pain - 18 hours and etc). Each of us is different but I wouldn't plan on the remaining 3 infusions to be easier than the first. As far as travel goes, my infusions were spaced every three weeks. Side effects started the day after my infusion and continued for about 3 days. So if you plan to spend a week without traveling, you should be fine traveling after your week of discomfort. But, again, everyone is different so be flexible with your travel plans. In particular, one of the effects of chemotherapy is reducing the red and white blood cells in your body. This makes you susceptible to colds and flue so during the week after infusion, try and stay away from people to avoid getting sick. Stay the course. Tom

Joseph, Unfortunately, all my surgeries have caused what my doctors call a reactive airway. During periods of high poor air quality, I cough. In the pollen season, I cough. And, of course, every cold goes right to my chest and I cough a lot. I use inhalers also but during periods of poor air quality and pollen, I take my daily inhaler while I'm in a steaming shower. I also follow the instructions for using my inhaler in terms of completely emptying my lung and hold my breath after I inhale the medication. While in the shower, I breathe deeply and the inhaler medication and steam breaks up my congestion and then eases it throughout the day. But, some days, I need a couple of steamed showers. This technique only applies to congestion in the airway or lung. If you mother has a dry, non productive cough, inhalers and steam may not work. If that is the case, I suggest she consult with a pulmonary medicine doctor or pulmonologist. There are treatments that the pulmonologist may prescribe that are more suited to a dry - irritated cough symptom. Stay the course. Tom

St Michael, As strange as it may seem, I can't answer your question about adjuvant therapy. I had so many complications from my pneumonectomy that I never received it. After nearly a year's worth of surgery, my first scan showed metastasis to my remaining lung and I started down the path of first, second and third line chemo treatments. But, from what I know, radiation is not normally associated with adjuvant therapy and thus the concern about progression to lymph nodes in the chest. Hopefully, the pathology report will shed some light on further lymph node involvement. Celebrate a successful surgery and a wonderful Christmas. Wish your mother my best Christmas wishes and tell her I am praying for her continued good fortune. Stay the course. Tom

Jospeh, Ok you've disclosed a few more elements of information that help me understand. First my belief --philosophy -- of cancer treatment. It often results in extra life. How long, we don't know. It sounds like your mom has benefited 1.5 years of extra life already from previous treatment. She sounds better off than me because I still have coughing bouts nearly 13 years after surgery. I have other problems also but when I stack those problems up, they don't top the benefits of extra life to me. I'm only 66. Your mom is in her 80s. What is tolerable for me may be intolerable for her. Maybe that sheds light on your mom's reluctance to pursue additional treatment. I would avoid the topic of life expectancy. It is not the length of time remaining that is important to cancer patients, it is the joy they can experience while living each day. Your mom appears to favor joy over length. I do also. I doubt your doctor could be very precise in defining when lung cancer symptoms will start to interrupt life activities. Symptoms and affects vary so much from person to person. I think the African safari is a grand idea. One caution, however, those that have thoracic surgery often are uncomfortable on long flights because of cabin pressure altitude. At a cabin pressure altitude of 6,000 feet, one's chest expands against the lower pressure, and this expansion causes me pain in the area of my incision scars. This symptom is pretty typical. Ensure your mom consults with a doctor on techniques to address this symptom. I take pain medication before a long airline trip and plan a down day to recover the first day after a long flight. So it is a manageable problem. Depending on the type of surgery your mother had, it may be a non problem. So here is a strategy. Ask your mother what's next after Africa. Get her involved in planning the next great adventure. Stay the course. Tom

Femie, Unfortunately, I am kind of an expert in lung cancer surgery. I didn't have one, I had 4! So, let's get into it. Pillows - check. Audition them at the local mattress store before you get admitted for surgery. You'll need to sleep elevated. Sleeping - will be a problem when you get home. Ensure you leave with a sleeping aid. My most difficult sleeping experience was staying asleep. I'd sleep for about 2 hours then couldn't fall back to sleep because of the pain. I finally settled on taking a couple of Benadryl tablets (after consulting with my Doc) to help me stay asleep. I also got a script for Ambien. Getting out of bed - you'll need to engineer a new solution. My pre-surgery method of hoisting myself up by my elbows failed miserably. I need to learn how to roll out to a standing position. Practice before surgery. Lifting - plan on not lifting anything heavier than a tooth brush with the arm closest to the incisions. Plan on feeling pain when you do. I am right handed and had a right pneumonectomy and consequently a lot of unnecessary pain. Dressing assistance - it took me about 10 days to put on a dress shirt unassisted. The same with a t-shirt. Anything that required lifting my arms or bending over to tie shoes hurt. Showering or bathing - not until staples or sutures are removed. Plan for it and you may need home assistance changing your surgical dressing, depending on the type of surgery and or dressing. Most important. My experience was a worst case. The modern surgery methods that are minimally invasive will cause far less discomfort but be prepared for some. Stay the course. Tom

Joseph, From what you wrote, your mother likely has a recurrence of lung cancer. Even 15 mm is small, less than 1/2", not inconsequential but small. Here is information on Targeted Therapy for EGFR positive tumors. Some of these drugs are pretty potent in terms of side effects and maybe that fact and your mother's age are what is driving the oncologist recommendation. Is this the first scan (you mentioned she'd been getting scans every few months) that shows increasing nodules? Of course, you mother's wishes in terms of now wanting further aggressive treatment are likely what is driving the doctor's approach. I'm not sure I helped you much. I don't know how much your mother's wishes is driving the doctor's treatment plan. It is a good question for the doctor. Stay the course. Tom