john
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Posts posted by john
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I think dysplasia means precancerous.
You did say there is a tumor there in though.
I am not sure how an onc can turn you down. I think there are laws out there that require a Dr to see you. I guess go to an emergency room if you have to.
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Tarceva is not really a chemo drug. It is a targeted therapy type of drug.
It targets a receptor called Epidermal growth factor.
It is one of the first fairly successful targeted therapies. Iressa was one of the first attempts at a targeted therapy and Tarceva was developed by another company after Iressa.
Tarceva seems to work better than Iressa.
Tarceva works best when a person's cancer has a certain type of genetic mutation. There is a test for this.
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Good to hear your lung function is good. The SUV is the standardized uptake value. It is a value that indicates how much glucose is "consumed" by the area.
An SUV of < 4 is supposed to be less likely cancer from what I understand or at least *might* indicate a less aggressive cancer.
I am not positive about the this but you might want to ask the Dr
Good luck
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I just found a site that showed the average doubing time for squamous cell to be 86-88 days. Median of 100 days for doubling time
Remember there is probably some error in the measurement of the tumor so the could be less growth
Is it a central tumor (like most squamous cell) or peripheral?
Error rate in measuring growth rate: 7%
Minimal difference observable by CT: 0.3 mm
Smallest nodules that can be reliably seen with CT: 2 mm
Good luck
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radiation as cat127 mentioned is for local control. Many recurrences occur locally so the radiation it to reduce the chance of a local occurence.
Chemo is systemic and will hopefully kill or stop any distant metastasis, but may not provide adequate local control.
I don't think chemo alone is sufficient from what I have read, but I am not a Dr
Are there any plans for surgery after the chemo? If this is the case make sure the surgeon is good because there can be complications caused by the chemo.
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BTW. Have you asked the Drs if you will ever be a candidate for surgery.
Proton beams have distinct physical advantages over conventional radiotherapy (x-rays) in the way the dose is deposited within the body. X-ray beams deposit the maximum dose within a few centimeters of the skin surface proximal to the intended target and continue to irradiate tissues beyond the region targeted for treatment. Tumors centrally located in the body typically receive 60 to 70% of the total dose administered with each individual x-ray beam. This is an inherent physical property of individual x-ray beams and cannot be altered despite sophisticated treatment delivery techniques such as intensity modulated radiation therapy. Proton beams, however, deliver approximately 50% of the dose proximal to the target, while 100% is delivered to the target region. The beam stops at the distal margin of the targeted region and all tissues beyond this area receive no dose. This stopping place can be made to occur at any depth within the patient and can be shaped to match the target area. Aerated lung tissue is less dense than other soft tissues of the body, and thus the stopping region of protons in pulmonary tissue is less precise than with other body treatments. Despite this difference, proton therapy has the potential to spare larger portions of lung tissue compared to x-rays. A review of the dosimetry of proton therapy in lung tissue with implications to treatment planning is provided by Moyers et al.4 These physical properties allow proton beams to deliver maximal dosages of radiotherapy to targets within the body while minimizing the dose delivered to surrounding healthy tissues.56 Proton beam radiotherapy has proven its efficacy in patients with tumors that require high doses of radiotherapy while simultaneously requiring limited doses to nearby critical structures, such as in the spine and the base of the skull.78
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BAC
in NSCLC GROUP
There are other trials for BAC you might want to research.
HKI-272
cetuximab (Erbitux)
HKI-357
EKB-569
take care.
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I think TNM staging classifies ipsilateral ("same side") pulmonary nodules as Stage IIIb
if it is on the other side of the lung "contralateral" then it is Stage IV.
I think if there is no lymph node involvement then a resection might be possible.
Also ask the Dr if the cancer is BAC.
There may be a chance of having a double cancer. Lung cancer of two different types. You could ask the Dr about this.
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Sorry, I misread your post. What treatment did you have before the new nodule showed up?
Take care.
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Radiation is a local therapy and chemo is a whole body therapy. Radiation will only work where the radiation is directed.
That is the main difference.
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http://www.biparsciences.com/BSI201.html
As Ned and Randy said.
Gemzar / carboplatin (chemo doublet)
Both gemzar and carboplatin are supposed to have less side effects that other chemo such as cisplatin.
with
BSI-201 it is supposed to target the PARP enzyme. Is there a test for this enzyme and does you mom have this enzyme?
Good luck
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I very rare cases when SCLC is caught very early surgery can be done. I think there can be no lymph node involvement
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Your Dr may bring up PCI also so you might want to do research on this.
It is good your are getting such a great response to chemo and the side effects have not been too bad.
I think that is why your Dr wants a couple more cycles.
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It can't hurt to get a 2nd opinion.
I believe the link below does show a slight improvement with more cycles for those who had a good response. Though I don't have a med degree so ... take it for what it is worth
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I just read that radiation can be given for "curative intent".
You might also want to ask about Tarceva since you are a non-smoker.
One thing to consider would be what Dr has the best reputation and with whom do you feel comfortable?
Radiation can cause fibrosis so both options (I think) can affect lung function.
Take care.
Surgery for Recurrent Lung Cancer?
Question
A 58-year-old female quit smoking 12 years ago. She has now developed a 1-cm recurrence in the opposite lung 22 months after aggressive surgery, aggressive radiotherapy, and chemotherapy for the initial tumor. The pathologist believes that this is a recurrence rather than a new primary. No other disease has been found. The performance status is 0 with an excellent pulmonary reserve. Is there any indication for surgical resection?
Response from Corey J. Langer, MD
Associate Professor, Temple University, Philadelphia, Pennsylvania; Medical Director, Thoracic Oncology, FCCC Oncology Department, Temple University, Philadelphia, Pennsylvania
If feasible, an isolated recurrence of previously resected pulmonary lung cancer merits re-resection.[1] In this instance, the patient's performance status is excellent, and her metastatic survey, presumably, has proved negative. At the very least, given the stakes, it would be prudent to proceed with PET scan or, if PET scan is not available, CT scans of the chest and upper abdomen and CT or MRI of the brain. If there is any indication of metastases, then planned surgery should be aborted.
In questionable instances, we will often treat patients with systemic therapy initially for 2-4 cycles, then resect. We do this for 2 reasons: to determine the sensitivity of relapsed disease to cytotoxic therapy, and to rule out the intercurrent development of early, treatment-resistant metastases, which would otherwise preclude resection.
If pulmonary reserve is limited, then wedge resection may be preferable to lobectomy. However, if the patient is sufficiently fit, anatomic resection is indicated. There are ample data in treatment-naive patients to show that proper anatomic resection of stage 1 non-small-cell lung cancer results in a lower incidence of local recurrences and improved survival. In an LCSG study, the local regional recurrence rate with limited resection was 15%, compared with only 5% for anatomic resection.[2]
By quitting smoking, this patient has demonstrated a commitment to good health practice. In addition, her commitment may translate into a decreased perioperative morbidity.
It should be noted that the final pathology will likely arbitrate between metastasis and a new primary. Even though the initial biopsies suggest a metastasis, immunohistochemistry of the final surgical specimen may potentially dispute this finding. Regardless, the new lung mass should be resected.
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Solitary pulmonary nodule. A nodule is less than 2cm (I believe). If it is greater than 2cm it is called a mass.
Most lung cancers are solitary nodules or masses. Multiple nodules are often (but not always) metastasis or something else and not a primary lung tumor
Sometimes a multiple nodules are lung cancer but I think it is less likely. If something is greater than 2-3 cm in the lung it is more likely to be cancer.
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From a Dr on the web:
Decision about managing SPNs may be influenced by numerous factors including the probability that the nodule is malignant, risks or surgery accuracy of biopsy techniques, fear that delay in surgical resection may forfeit the possibility of cure and the patients attitudes toward alternative approaches[2]. The management options for SPN are either observation i.e. the "Wait and Watch" strategy[19] or immediate thoracotomy[20] or biopsy of the nodule based on which decision is taken. If biopsy findings are not specifically diagnostic of either malignant or benign disease then either surgery is carried out immediately or the patient is followed up conducting serial chest films to determine rate of growth of nodule[2].
The proponents of immediate surgery argue that if surgery is delayed, it allows time for growth of SPN and therapy reduces the chances of a 5 year survival. However, there are no studies demonstrating a decrease in survival when a patient is kept under observation for few months to assess the growth of nodule. Observation is advisable when the risk of malignancy is low, the risk of thoracotomy is high, or when the patient refuses further invasive procedures[7].
Cummings et al[21] proposed the use of decision analysis based on the probability that the nodule is malignant. Using Bayes Theorem and four variables i.e. age, history of cigarette smoking, diameter of nodule, and prevalence of malignancy is SPNs, an estimation of malignancy was calculated. The average life expectancy in years of various strategies was then compared. In patients with a calculated probability of malignancy greater than 75% to 80% early thoracotomy appeared slightly superior to the needle biopsy. In patients with probability of malignancy less than 75% to 80%, needle biopsy was slightly superior to immediate thoracotomy. Observation was suggested when the likelihood of malignancy was less than 5% or the risk of surgery was high. In most of the circumstances, the differences between strategies were so small that it was a "close call"[2].
If surgery is contraindicated because of poor lung functions, age or coexistent cardiovascular disease or results of CT scan, further management is influenced by symptoms and probability of malignant disease. Management of SPN is complex and should be individualised. The basic guidelines to be followed are presented as algorithm for management of SPN[19] in [Table - 3].
Finally, the role of the physician is crucial in the management of an SPN[22]. Informing the patient and family about each option and their uncertainties as well as about the immediate and long term risks and benefits of each step is extremely important. It is also important to assess and respect the patient’s anxiety, fears and attitude. Active patient participation in decision making allows these factors to be incorporated into the patients decision. Each patient must be dealt with on an individual basis. In short, we must treat the patient and not the SPN[22].
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Getting a 2nd opinion like you are doing is a good idea. If it is a low uptake tumor, then it should be not very aggressive.
There are bunch of factors that determine the percentage of being malignant versus benign. You could ask the Dr what the percent chance it is malignant. This may help your decision.
Good luck
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CT is for measuring size and how it looks. A PET measures the metabolic activity.
In the past PET was not used to determine if tumor was responding to chemo. Recently I believe there has been studies that indicate PET can be used to measure response to chemo.
PET uses a measurement called SUV (Standardized uptake value). This measures the amount of uptake by tissue of the sugar.
A SUV of greater than 4 (may indicate a tumor)
I don't think you can compare CT to PET. It is like comparing apples to oranges.
You could compare PET#1 vs PET#2.
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Surgery is the best option for a cure.
There is another survivor on this web site that had a whole side of the lung removed and now is competing in mountain bike races at a pretty high level.
You could ask a bout wedge resections where they don't take as much lung out but ultimately the surgeon will know best
The surgeon will also probably do a lymph node disection. Ask if the surgeon routinely does a full dissection versus sampling. I have read that a full dissection is best but you might want to ask the Dr
Best of luck. It is good that what ever it is it is caught early and I hope it is benign
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I think the general consensus these days for Stage IIb is to have chemo. You can ask the Dr about this.
Good luck
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Not that it matters but PCI is WBR.
http://www.lchelp.org/l_community/viewt ... 1b52decb77
I think there have been trials for low dose PCI, but the response-dose curves show that below a certain dose it does not work.
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I thought PCI was offered mostly to limited SCLC not extensive. But it does appear that PCI is offered for both now and even w/o complete remission.
PCI does not guarantee to stop brain metastasis but it seems to reduce the chance (a study showed 14% PCI vs 40% non-PCI)
http://www.cancer.gov/clinicaltrials/re ... =&keyword=
http://www.asco.org/portal/site/ASCO/me ... ctID=30335
Good luck with the decision
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Maybe also another think to look into is Radio Frequency ablation. Using this they just zap the small tumor, so lung function should be preserved better with this.
Though not many Drs do this and it is quite early in practice
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I have never heard of this. Was he ever on EPO (procrit) for anemia?
the article below says pulmonary fibrosis can cause high hemoglobin. It can be caused by COPD also.
I would guess that COPD is causing it.
hemoglobin transports the oxygen in the blood I don't think it is related to blood not clotting/Avastin but I don't know for sure.
Questions reference drugs.
in NSCLC GROUP
Posted
Radio Frequency Ablation zaps just the tumor. There are questions whether the margins are big enough using this technology.
There has to be enough margin around the tumor to ensure everything is treated or a recurrence will be likely.
RFA is good probably only for people with poor lung function who can not have a wedge resection or lobectomy.
Also during a lobectomy many lymph nodes are commonly removed. With RFA I am not sure if this can be done. Removing the lymph nodes I believe increases ones changes of keeping the cancer away.