Adrian

Cyndy, very sorry to hear about the increase in pain. Luckily, this is the type of situation where radiation can really help recover function and diminsh pain---and fairly quickly.

Sheri, Katie is correct. If he dided with out a will then you need to check the laws of intestacy in your state. Typically, if you are the only child, you are entitled to 1/2 of your father's estate and his widow the other half. This could get very ugly, but his pronouncement that he will distribute the estate (as he sees fit?)is crap as there are laws that will determine this distribution.

hi Lisa, Yes, I believe that means that it is most likely a lung primary---specificially of the cells which generate mucuous. In terms of treatment regimen etc., the key question is now: "is surgery an option?" Though tumor size is relevant to that possibility, the main issue is the cancer staging based on the existence or non-existence of spread to lymph nodes or other organs which will be determined from a pet/ct and mri. Best, please ask any questions you want, we are all still in the process of learning what this disease is and how to deal with it.

yes the biopsy is a means of examining the offending tumor cells. Fundamentally your statement is correct: the biopsy sample is tested so as to determine the cell type that has become cancerous. From the biopsy they can determine if the cancer is a lung primary and if so, what sub-type of lung cell has gone awry. accordingly, they will tell you if the cancer is small cell or non-small cell---if it is non small cell it can be adenocarcinoma, squamous cell cancer or giant cell cancer, with adeno being the most common. they will tell you this as well. They will also tell you the cell differentiation. I've never been quite clear on what it actually means though i suspect it has to do with the extent to which the tumor cells can be distinguished from surrounding healthy tissue. Here there are three possibilities: poor, moderate and well differentiated. The better differentiated the better. Finally, assuming the biopsied tumor is lung cancer, a pet/ct scan and possibly an MRI will be needed to determine whether and where metastisis have occurred. best, please keep us posted.

I truly truly empathize. Please stay strong. The blood clot can be resolved fairly easily and while liver mets are not a happy thing, they are managable if they stay small. please keep us posted.

better is ALWAYS better. As a precautionary measure, however, I would if I were you, insist on brain MRI.

Out of curiosity, is it unresectable IIIa? By that I mean, did they tell you that they could not remove the tumor by surgery?

yes that is a fairly aggressive first line treatment. Alimta, however, is thought to be milder than gemzar ot taxol which are ofte the other drugs used in combination with carboplatin or cisplatin in the first line setting. Cisplatin is a bit more effective than carboplatin but is condisred somewhat more toxic. since youre in a clinical study, you cant mess with the regimen, but the only thing Id want added potentially would be avastin.

Familiar and then some. Please fill in the details re: first line treatment regimen and we can tell you what we know. Adrian

hi nomadoawn, regarding the Avastin, its approved for use in non-small cell LC and the jury is still out on its use in small cell. There may be some clinical trials in which it is being tried in small cell setting. Please keep us posted on the MRI results.

My sister and I have been following your posts over the last few months, as the way you describe your dad and your relationship with him is so similar to our relationship with our dear father. We have been struck by the love and strength with which you have surrounded your father. We endeavor to do the same. We feel so deeply for you and empathize. Our condolences.

The onc will likely (or you need to ask him about) an MRI of the brain to see if there are any emerging lesions there. If so, be assured that both the stereotactic radiation and whole brain radiation are very effective means of dealing with a brain met. Of course, if its not that, chemo is "tough medicine" and people can feel its effects for a while---but if symptoms are worsening as you suggest, it is important to be proactive to rule out other possibilities. is she using avastin as maintenance? Avastin can cause pretty bad headaches in some people.

Hi Sloanie, sorry you're here, but welcome. If the spot on her tailbone is from the primary lung tumor then technically she is stage IV. If that is the case, then generally they won't surgically remove the lung tumor and combo radiation/chemo or chemo alone become the standard treatment approach. In the stage IV setting, radiation is typically used only when a tumor or lesion is causing painful sympotoms or is otherwise threatening to cause damage. Otherwise chemo as a systemic treatment is the usual route for a lesion on the tailbone etc. You did not state what her exact chemo regimen is, so I cant say much about that till you fill in the name of the chemo. (I'm guessing its carboplatin/gemzar or carboplatin/taxol, either of which are extremely common first line therapies for NSC). There is another anti-cancer medicine that is now FDA approved to be used with both of those chemo regimens which is called Avastin which is a very good thing to add in to the mix. You might consider asking your mom's onc about his thoughts on using Carboplatin/Alimta/Avastin in the first line. Also, because of the lesion on her tailbone, the bone strengthening drug called Zometa may be appropriate too. 6 cycles does sound like a long time before taking follow-up scans. Lots of people on three week chemo cycles do three cycles then scan (=9 weeks between scans).

If someone were to say that in regards to my dad, if I didnt attack them, I would say "Thank you for your kind words of support during this, the most difficult time of my life, I only hope that I have the chance to repay the favor."

our best theory at the moment, which we will have more info on this afternoon, is that dad's massive and continuing weakness and fatigue is the result of mild hypothyroidism. His labs this week showed that one of the two thyroid hormones (T3) was out of the normal range on the low end (but not by much). Our research indicates that even mild hypothyroidism can be symptomatic and that a T# medication can resolve the issues rapidly. Given the labs, its our best theory for now, just hoping that the onc and endocronologist who was consulted feel the same way.

ditto on the radiation. im surprised that the onc. hasnt put you in that direction yet (be sure s/he understands the extent of her pain). re blood trnasfusions: chemo and messed upo blood counts go hand in hand. There are red blood cell boosters, white blood cell boosters etc etc etc. that help out. Transfusions are also used as is your mom's case.

I'd probably make fun of my dad if he started saying that. I'd be like "yeah dad, I heard that too, lets hope you start feeling like crap again."

his cough is productive? my father's is dry---but as a cough suppressant, codeine is beneficial for both cough types.

Ry, hydrocodone or codeine proper? Dad uses hydrocodone, but I've heard codeine may work better. Can you tell me the details on that med?

Wow thats "good" news. Avastin is not establsihed YET in the SCLC context and so you are getting treatment beyond the current standard of care. I truly truly hope that it is an effective addition to your sister's continuing fight.

the cough is very tricky. Couple possibilities. Some people swear by Cherratussin which is prescription strength suppressant and expectorant. Sometimes prednisone, a cortizone based steroid, is used to reduce inflammation in the lungs and can reduce cough as well. As your onc. has pointed out, the best treatment for tumor related cough is treatment of the tumors themselves. So hopefully the radiation will lead to relief. That said, radiation can sometimes cause pneumonitis, in which case, again, prednisone would be prescribed.

well, my understanding is that wbr usually takes precedent over treatment for bones. That said, if a bone scan (or pet/ct) were to come back hot, perhaps the dr. would consider adding zometa into the mix now, or would radiate the bone tumors (if they even exist)concurrently with the brain. but i should also add that the fatigue could well be a function of the surgery and the hip pain etc. is not necessarily being caused by bone mets. hope your onc. and radiologist provide you guidance, Adrian

My father had significant appetite problems and fatigue issues for quite a while. Especially given the recent WBR, you may want to ask the doc about getting him on a steroid such as decadron. The its primarily used to reduce swelling (and is often prescribed after WBR to reduce brain swelling), many people, my father included had a marked increase in appetite for the weeks he was using it (2 to 4 mg daily). Long term heavy use of decadroin can apparently get complicated, but in the weeks to months range, dec might be the answer.

First things first. If he feels warm to you, it is improtant to take his temperature and see where he's at. Fevers are important to monitor because they can be the sign of infection which requires your oncologists attention (i.e. so that he can put him on antibiotics). Coughing: My dad has had a recurring and persistent dry cough. He has tried: Robitussin, Cherratusin (which some people swear by), Tessalon Pearls (which other people swear by) and some acid reflux medicnes which the doctor thought would help. None of it really did. Two nights ago, however, for the first time my dad drank ginger tea after a coughing fit at 4 am and said it soothed his cough better than any medication he had taken to date. Obviously, no promises, but it certainly wouldnt hurt to try that and see. I know I'm hoping it offers my dad some continuing relief from his cough.

my father has no experience with procrit, but he did have several aranesp injections. It too lifts red blood cell and platelet counts and the side effects are apprarently similar. Around the time of the aranesp, his other treatments whad remained constant, but his fatigue became quite severe. As for Alimta, its one of the two fda approved second line chemos in the nsclc setting (taxotere being the other). Alimta is the newer of the two. My dad's first line was carbo/gemzar/avastin. after mixed results he's now on alimta/avastin. He's had one cycle and he's four days in and seems to be doing pretty well side effect wise so far.