Primary and mets

[BoBennett]

I’ve read on several occasions that its not the primary lung tumor that causes the demise it’s the mets. Are there cases where the mets leave and then the primary grows, then the primary ultimately causes death. My primary is causing absolutely no problems.

In my case the bone mets “healed” and the primary increased by 19%, 3.7/4.5. Along with a new infected subcarinal node. I’m wondering if I need to look at an Onc that thinks surgery my have some benefit. I’m in excellent health and my lung are in exceptional shape. I’m worried that ongoing chemo might not be the best choice.

Any thoughts on this.

Thank you

Bo

I think this is great that you professionals would take your time out to advise, its uncharacteristic and refreshing.

[teresag]

Hi Bo,

Lung cancer without mets can kill, so I would not say it's always the mets that cause demise. After all, we do need a certain amount of lung function, although it's surprising how much "extra" we are built with, just in case of emergency. So there are definitely situations where the primary tumor is the immediate cause of death, but usually, people who have a primary tumor large enough to substantially restrict lung function or cause other serious problems also have mets.

Usually, if surgery is one of the options, it is recommended. If you are a good candidate for surgery (i.e., someone who is likely to improve after surgery, not decline), then most cancer specialists would recommend that you have it.

I would suggest talking with the oncologist who suggested surgery and asking if a referral to a surgeon is still one of the options.

Best wishes to you, Teresa

[kimblanchard]

Bo, from your description you have stage 4 lung cancer with not only a primary tumor in the lung but involvement of the subcarinal lymph nodes and bones. If you find an oncologist who thinks surgically removing your lung tumor is a good idea, I'd keep looking. Have you had radiation therapy to deal with the tumor in the chest? If there is no evidence of cancer elsewhere (would want a PET scan to confirm) then radiation to the primary might be a reasonable option. Otherwise medication (chemo, iressa, tarceva, etc) to keep the cancer controlled everywhere would still be most appropriate.

[BoBennett]

Thanks, Teresa and Joe for the responses. Yes it is Stage 4. Originally it was diagnosed, probable mediastinal involvement, as well as the bone mets. The mediastinal area was downgraded in August, the bone mets healed and then in early November a Cat Scan showed a specific subcarinal node problem as well as a slight increase in tumor size.

If you find an oncologist who thinks surgically removing your lung tumor is a good idea, I'd keep looking

. Is this meaning surgery is not a good option?

No I haven’t had radiation, the Oncs thought is, its out of the lung and too late for anything else except chemo. He says surgery is not an option. I understand that thought. I just like a little conformation that chemo is the best and only option, since that is all I’m getting. I had a comparitive PET in august and there is no indication of cancer anywhere else.

Thanks for your input

Bo

[teresag]

Bo, somehow I missed that you were Stage IV. Dr. Joe is absolutely correct and you interpreted the advice correctly: surgery is not helpful for Stage IV NSCLC. Sorry if my response was misleading.

The best to you and yours, Teresa

[BoBennett]

Thanks Teresa

Bo