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pancoast tumor


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I am diagnosed with 111a T3 N2 squanous cell pancoast tumor. I am told it is very involved with subclavian vessels and was not a candidate for surgery. However, the radiologist seems to think with radiation and chemo once a week of Taxol and Paraplatin that I could become a good candidate. The mediacal oncologist does not seem to agree - he feels never a candidate. After 20 rad treatments I am to be scanned. Have had 10 so far and 2 chemo treatments. I suppose depending on what that shows will determine what will happen next. I am so very confused. Thought I was to have 33 radiation treatments. Now am told over 20 would make me never a candidate for surgery. Was not told that before. Seems like everyone treatiing me is not on the same team. Just need an unbiased expert opinion - from all I hae read (which is the only way I even found out about these types of tumors - no one told me on thing) sounds like a very bad scenario for me. I am 58, female and according to everyone I am in perfect health and condition - except, of course, I have lung cancer. Original tumor is 1.7 cm at the apex of the lung BUT mass of about 5 cm involving nodes in the middle of the chest. Any advice? Words of wisdom? I guess hope would be going too far. My family doctor has pretty much given me none!

Thanks for any insight.


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Hi Kasey -

Welcome, but sorry you have to be here. To me, your case sounds like a perfect situation for another opinion. Are you anywhere near a university medical center? That is often the best place to go for a consultation. Or perhaps your existing onc or family physician can suggest someone.

About not educating you about your tumor: tell your providers (all of them) to educate you. They should be doing this, but sometimes people forget or get too busy, and teaching falls by the wayside. You are using good strategies for seeing that you get the optimal treatment; stick with it. Find someone who can ask questions for you if you are not feeling well, like a close friend or family member.

It is difficult when the players don't seem to be using the same playbook. As the plan evolves and changes, sometimes the providers do not remember to communicate with each other. Or there may simply be a delay between the time you saw one doc and the time the information was actually received and read by the other doc(s). This can cause confusion and frustration. I suggest asking your med. onc to help coordinate the plans. Express your concerns about hearing conflicting information to your onc. Your physicians may not know that you are hearing different things from different people, and they will want to know this.

Hang in there, and best wishes to you. - Teresa

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That is a complicated situation you are describing. The best data is with Pancoast tumors and hilar (N1) lymph node involvement. The mediastinal lymph node involvement you are describing is likely what is giving your doctors pause. The variation in radiation dose is likely depending on if they are planning on doing surgery. If surgery is planned after radiation, the typical dose is 4500 cGy which I'm sure is where the 20 treatments is coming from. If no surgery is planned, then a typical radiation dose is 6000-7000 cGy (probably the 33 treatments).

Have you seen a surgeon? Only a surgeon should tell you if you are a surgical candidate or not and generally N2 lung cancers should be resectable after induction chemoradiation. Pancoast tumors are a special surgical situation so I'd make sure a thoracic surgeon who either specializes in lung cancer or has a lot of experience with that type of resection is involved.

Good luck!

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