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Question about cell type...Dr. Joe..please help.


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When I was dx'd the path report said 1.5X2cm mass found in lung. Adenocarcinoma with poorly differentiated boarders and clear cell characteristics. Also said lymph node #5 was involved after imunohistological stains. All lymph nodes on the left side were removed along with the upper left lobe. You can see my profile below. My chemo and radiation were not done at the same time and I only had 3 rounds of chemo every 3 weeks. Is there anything else I should be doing? Iressa? Anything? I guess I am getting nervous about my CT/PET scan next week. If I were your patient, what kind and how long would my chemo be?

Thanks in advance....hope you have the time. I truly appreciate your participation on this board. I don't mean to "pin you down" just making sure I did the right thing and that I shouldn't be doing something else now.


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Hi Nushka, it sounds like the treatment you have had is very appropriate. When you read about people getting chemotherapy and radiation together, that is usually done instead of surgery, to "downstage" the tumor to make surgery possible, or in people who were not able to have all of the cancer removed at the time of surgery. In someone like you who had all of the cancer removed (a "complete resection") the added toxicity of chemotherapy and radiation together has never been shown to be worth it.

In terms of the amount of chemotherapy that you received afterwards, that is also very reasonable. Most studies have arbitrarily used 4 rounds although there is one study that used 3. Honestly, I very much doubt there is a significant difference between 3 and 4 rounds of treatment.

In terms of what additional therapy to do now, I would not recommend any specific treatments. Iressa is being looked at after treatment to prevent recurrences but is definitely not proven and I would consider it experimental for that purpose. Also Iressa is not without risks. So the standard treatment at this point is exactly what you are doing....nothing.

Now I have generally recommended that my patients take low dose (81mg) aspirin unless there is a contraindication. There is a suggestion that it reduces the risk of both breast and lung cancer and strong evidence it decreases the risk of colon cancer. Not to mention the benefit in reduction of risk for heart attacks and strokes. I also suggest that selenium supplements might be reasonable, there is evidence that patients who take selenium have a better chance of not getting a number of cancers including lung cancer. There does appear to be a slightly higher risk of skin cancer with it though. I have also used Celebrex based on intriguing early studies suggesting an anti-cancer/anti-angiogenesis effect. This is definitely NOT proven however and the link between Vioxx and heart attack has made me really lean away from this until we have some better evidence that it is beneficial for lung cancer.

So basically, I think you have had very appropriate therapy and would recommend exercise, a healthy diet and lots of hugs and kisses to those you love!

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Dr. Joe,

Thank you so much. I will get some selinium but may I ask how much I need to take? I am already on aspirin 81mg a day. I also take CoQ10, alpha lipoic acid, C,E,B, fish oil, calcium with D. :lol: I feel like I need to buy stock in the vitamin suppliers. I feel much better knowing that I am at the right point in my treatments....you have no idea how much better I feel reading your post. My scans are next week and I assume I am just getting very nervous about it. I finished my treatments Aug 7, 2003, so I am just over a year out from that. I also take Mag-Ox to help with tachycardia and many other meds (all of the above has been prescibed for me). I never take anything over the counter.

I will say an extra prayer of thanksgiving for you tonight Dr. Joe. I wish my oncologist was as understanding and took as much time explaining what is going on. Again, Thank you.


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I'm not sure what I think about omega-3, I'm not sure what the mechanism is either. My understanding of the theory behind them is that they have an anti-inflammatory effect as well as immunomodulatory effects that may be beneficial to reducing cancer risk. NSAIDs (esp. COX-2 inhibitors) are a little different in that they actually effect many of the pathways of carcinogenesis and proliferation. For example, COX-2 inhibitors have anti-angiogenic properties by inducing endothelial cell apoptosis. They also directly impact signal transduction pathways such as the ras/raf-1/ERK pathway which a lot of the new STIs are targetting.

The statins are pretty controversial. In animal models, they actually increase the risk of cancer although most studies do show that they may have a benefit in reducing the risk of getting cancer. Again, not sure that the mechanism has been worked out, the also do seem to induce apoptosis along the MAP kinase raf/MEK/ERK signal transduction cascade (seems like everything does these days), but do it in a different way than COX-2 inhibitors.

Sometimes I feel like I need to go back and get my PhD in molecular biology to understand what all of the new agents in cancer do. What happened to just screwing up the DNA? So easy to understand!

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