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For Dr. Joe: Why not surgery?


kim

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Hi Dr. Joe,

I know there is really no reason to wonder why since my mom is gone, but I was wondering why they couldn't do a resection on my mom. She had limited small cell to begin with. I know there are many factors that affect wheither or not it can be done. My mom's tumor was on the outside of her right lung, medially close to esophagus, and lymph nodes. It was about to size of a plum according to the physician. There was no lymph node involvement. Was it more likely the location or size or possibly very low lung function post op that was reasoning for no surgery? I think if I had to loose part of or a whole lung, I'd want it to be the left, or does it matter? Could it have been the risk of rupturing the tumor during surgery?

Again I know it really doesn't make a difference now, and it really won't bring on any anger even if this was a possibility, this all happened the way it did for a reason, I believe anyway, so could you just tell me what you think, so I can get it out of my mind? I know I didn't give you much info, and I'm sorry for that. Just your opinion would be appreciated.

P.S.

She probably woudn't have gone through with surgery anyways, she hated the thought of being cut open. Just my medical background curiosity getting the better of me! :D

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Hi Kim, The key fact is that your Mom had small cell (SC) carcinoma. The research has shown that it responds best to chemotherapy, in fact, it responds better to chemotherapy than NSCLC does.

As far as which lung, it is better to lose part of the left lung, very generally speaking, because the right lung is larger and therefore does more "work" than the left. Also, there is no evidence that surgery causes metastasis, although this is believed by many laypersons. If your Mom had NSCLC, her poor lung function may have made surgery impossible anyway. Tests are done to determine lung function and if these show that losing part of the lung would be more likely to harm than help, surgery will not be an option.

Hope this helps a bit until Dr. Joe chimes in. - Teresa

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What Teresa said. A randomized study looked at resection of small cell lung ca after chemoradiation and showed no benefit in survival but increase in complication rate. Primary surgical treatment is also ineffective unless the tumor is very small and peripheral and even then it is unclear if surgery plus chemoradiation is better than chemoxrt alone. Your mom's doctors by the sound of it did the best known treatment.

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Thanks guys!

I think now I can let that issue go! Her onc. doctor and radiation doc. were wonderful, and made every effort to help my mom. They both took care of my grandmother too. (NSCLC) They couldn't have gotten any better care! I mean, every time my mom went in for radiation her rad. doc. gave her big hug and always called her, "her girl". It takes special people to do what you do, THANK YOU!!!! :D I'm a respiratory therapist and I'm just greatful that I could tell my Dad when enough was enough. She wouldn't have wanted the trach or the G-tube (trachea and esophagus were being pushed on by tumor, couldn't swallow and had very loud stridor when just breathing). Thanks again for the input!

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