Still want me to have treatment

[patt]

They said I had adenocarcinoma, removed upper and part of middle lobe on right side, said everything else is clean. It was very early cancer but now they say they want me to take treatment because it has been proved nationally that it reduces the chance of return.

Anyone else hear of this? I don't understand. However, my surgeon seems to think that with or w/o treatment it can come back.

My operation was on May 24th without incident. I did well and feel fine....at least so far but I don't want to suffer more than I need to.

Thanks for the information, help, and prayers, Patt

[Kasey]

My opinion, Patt, AND I have seen research indicating, that adjuvant chemo is beneficial. So personally I would go for it! I'm sure Don M would agree. He had no followup chemo and he did have a recurrance. We get no guarantees, Patt, but give yourself every opportunity you can.

Kasey

[Debi]

Patt,

First of all, congratulations on your successful surgery.. you may not feel like it now, but you are one of the 'lucky' ones!!!

Secondly, I am going to suggest something that I suggest whenever someone is not entirely comfortable with their doctor's opinion - go for a second opinion.

I have written this before, I feel that doctors can suggest treatment but it is our bodies, and we ultimately make the final decision on what to do. To ME, adjuvent chemo was a personal choice, and I chose not to have it. That doesn't necessarily mean that its the right choice for you, or the person next to you - but for me, I believe and will always believe, even if my cancer comes back, that I made the right choice.

Post surgery for me, there were no reports or studies anywhere that adjuvent chemo would benefit a Stage 1A patient since only Stage 1Bs were included in the 2003 study, and that finding was not entirely conclusive for Stage 1s, although a benefit was found for Stage 2A and on.

I don't pretend to know the answer as to the benefits either way. I know Stage 1 cancer patients who's cancer came back with and without adjuvent chemo as I know Stage 1's who didn't come back with and without. I really never found evidence strong enough to push me into getting the chemo and I just was not in the circumstances where it would have been the right thing for me. Also my doctors had initially suggested not to have the adjuvent chemo.

Anyway Patt, I probably haven't helped you any. I just wanted to tell you that as much as I don't want to discourage anyone from getting chemotherapy, there always is room for a second opinion, at the very least to make you feel better about the first one. No matter what you end up doing, I hope that you continue to visit us here and keep us updated!!

[RandyW]

Early-stage (stages I and II) NSCLCs are usually treated with surgery and often followed by chemotherapy. In some cases, radiation is used. In stage III, where some cancer cells have traveled to the lymph nodes, chemotherapy is typically required. But such patients are at risk for having the cancer return, and doctors may delay surgery until they can see if the chemotherapy has been effective in shrinking the tumor.

National Cancer Institute

1-800-4-CANCER

www.cancer.gov

American Cancer Society

1-800-ACS-2345

www.cancer.org

American Lung Association

1-800-LUNGUSA

www.lungusa.org

Alliance for Lung Cancer Advocacy, Support, and Education

1-800-298-2436

www.alcase.org

Lung Cancer Online

www.lungcanceronline.org

[richinsdakota]

Yep..as stated, you have to decide whether to give yourself every possible chance to swat out any stray cancer cells, which is what the chemo is supposed to do.

And, another point,..since it is optional treatment, you can simply stop if it becomes too harsh for you....like I did. Had one full dose of taxotere, then stopped.

So, little to loose by giving it a try, and never know, might save your life.

Good luck in whatever you choose...Rich B.

[chloesmom]

Hi Patt,

I was a stage 1B in 2003 right after the publicity on the adjuvant chemo for early stage people came out. My surgeon said as a group his practice "mildly endorsed" the protocol. I did the chemo and since then the survival benefits have increased.

But, I was a stage 1B, and have not ever seen anything that said that chemo benefits 1A people. Also, as the others have said, chemo is not a treatment to be taken without careful consideration. It is not without risk, and it does take a lot of time for the treatments and the down time with the side effects.

However, I felt for me I had to give myself every single percentage point that I could muster, so I did the chemo. I worked through the whole 4 months, only taking off an occasional day other than the day of my treatments. I didn't feel great, but I wasn't really sick either. I traveled to a conference in Colorado midway through the treatment with no issues.

On the down side, I have a really difficult time getting an IV now because my veins are fried in one hand and I won't let them use the other (breast cancer--lymph nodes were removed on the other side and I don't want to risk lymphadema). My immune system was down for a long time after I finished chemo--I felt like about 2 years.

But, I'm still glad I did it. Give it some careful thought and make your own decision.

Cindy

[nonni]

Hi Patt....first ...let me say congrat's on your surgery and for doing so well....I.. like Debi was also blessed with stage 1A and had a right upper lobectomy in 2004...

Chemo was never even suggested to me...both my surgeon and onc said 'no chemo' for stage 1A...so of course I was not pushing it...I felt like since both doctor's agreed I was fine with that...

Jan ( who is on this board)and I went to a lung cancer medical seminar at John Hopkin's in Baltimore Md...some of the top notch doctors where there speaking about LC....After the seminar...Jan and I...'snagged' one of the doctors and asked him what he thought about chemo for 1A LC patients...he immediately shook his head "no'...nothing has been proven for 1a..1b yes but not 1a....Jan is also 1a...

Patt...maybe like other's said..a second opinion would be wise and make you feel more comfortable...whatever your decision I wish you well for many many years to come....

love you all..have a great day...hugs...PamS./

[Eileen]

I agree with Debi---get another opinion

I too was stage 1A and my surgeon said I did not need follow up---I checked the studies and found nothing about it helping 1A

so I also checked with oncology doctors and they too agreed---

chemo is not just an aspirin--it is poison and can sometimes cause more problems---so for your own peace of mind---please get other opinions and then make a decision once you have the others thoughts.

Hoping you have the same results as me --6 years this month!

[shineladysue]

Patt,

I can tell you that in 2001, my husband had his right lung removed. He was 1B because his tumor was 9 cm.. large. He had no other cancer and at that time chemo was offered as a trial. It wasn't known if it would help. Mike did not have it due to the fact he was so weak and he thought he couldn't make it .. anyhow his cancer returned 3 years later and he was diagnosed at stage IV... he passed away in March of this year.. At the very same time , a friend of his had chemo and surgery, an entire lung removed and she is still cancer free, nearly 5 years later. You will have to make the decision, but especially if you are 1B or better, I would strongly consider it... only my opinion.

God Bless,

Sue

[ztweb]

Patt,

Someone best described it to me this way...

Tumors are very smart, when they figure out that you are trying to get rid of them, they like to run away and hide..thus metasticize.

My dad is having whole brain radiation though he has no cancer there...it is preventative medicine.

God bless you!

[Donna G]

It has been recommended for several years now to have Chemo with Stage I disease. The incidence I believe in around 50 % of it showing up within a year if you don't. There is a doctor here in Minnesota who has been working for several years on a blood test to find "micro-metastasis" . If he is successful perhaps we would have a test that could accurately predict who these people are that need chemo but for now you are playing a huge game of chance.

Best wishes with your dicision.

Donna G

[Don M]

Patt:

if your tumor was 1a, the chance of recurrence is less than 5%. Chemo would probably be redundant because it would not increase your odds any, statistically. But there is still a chance that there would be some cells floating around in your body. You could try 3 or 4 rounds of carbplatin/taxol and bail out if it gets too rough.

I did not have chemo for my 1b cancer and it came back. I had a small tumor the second time. It was staged 1a after surgery. I was advised to do the chemo, since it was my second cancer. If it was my first, and it was a small tumor, I was told it would not make much sense to do it.

Your decision whether to do chemo or not hinges a lot on its stage.

If it were me, I would do the chemo even if it was 1a and bail out if the side effects got too bad. for instance, if my liver counts were not good, I would just quit rather than try to manage the liver counts. I could put up with fatigue and not feeling too good for 3 or 4 days in each round.

Another consideration is that there could be long term effects from chemo that may show up in the future that no one knows much about. As survivors live longer, this could be more of an issue.

Don M

[Debi]

Donna,

You know I think alot of you and by no means mean to contradict you, but I really feel uncomfortable with numbers like "50% of people get a recurrence within a year if they don't have adjuvent chemo after surgery." I have researched the web, spoken to doctors, including posting to our own Dr. Cunningham in Ask Our Experts when it was up and running, and at NO point have I EVER heard that 1/2 of the Early Stage survivors are going to get their cancer back if they don't have adjuvent chemo. In fact, the doctors that I have really narrowed down, like what Pam had said earlier, do NOT see a clear benefit of adjuvent chemo for Stage 1A. That doesn't mean that there isn't one and the doctors just aren't sure, for those of you who feel like chemo is the answer, I am not debating that and by ALL means, respect your choice.

I hate to bring up statistics, but I feel the necessity to at this point. Here are some excerpts from the web- this one from NCI -

In the U.S. today, less than fifteen percent of lung cancers are discovered in stage I, and only 7% are found in stage IA. Early stage detection is very important. Only 12% of Americans with lung cancer currently survive 5-years following diagnosis and initial treatment of lung cancer, but cure rates in patients diagnosed in stage I are much higher, and more than 80% of patients in stage IA experience long-term survival.

This one from Lung Cancer.org:

Research indicates that when lung cancer is diagnosed/detected in an early-stage and surgery is possible, the five-year survival rates can reach 85%.

Stage 1b has slightly lower rates but still range around 64%-69% from what I have seen on the web, adjuvent chemo can raise those odds about 5% higher or so.

So I'm not sure where this 50% number comes from, and I apologize if I seem combative. I am just confused.

My point is that we just all need to make clear-cut decisions for ourselves based on the facts and our hearts whether that means getting chemo or not getting chemo.

[Donna G]

Here is one article. Read down it says the overall survival rate of Stage I is " 50- 70 %.

A new program to help patients and their families deal with lung cancer, the most common cancer killer in the U.S., and other cancers of the chest has been developed at Southern Illinois University School of Medicine in Springfield.

The new Thoracic Oncology Program at SIU, or TOPS, brings lung cancer specialists into a weekly clinic setting at the SIU Cancer Institute. The program, which started seeing patients this fall, is designed so several specialists evaluate patients with possible or confirmed cancers on the same day and then develop a consensus treatment plan for each individual. Treatment may include surgery, radiation therapy or chemotherapy. Cancers of the chest include those in the lungs, esophagus, thymus gland and pleura, which is a membrane in the chest.

"This SIU clinic brings together specialists from several disciplines focused on treating various thoracic cancers, including lung cancer, in order to provide the best outcome possible for our patients in central and southern Illinois," said Dr. Stephen R. Hazelrigg, professor of cardiothoracic surgery and medical director for TOPS. "We also have support services for patients and families such as a regular support group meeting, nutrition counseling and smoking cessation programs."

Other team members represent medical oncology, radiation oncology, pulmonary medicine, diagnostic radiology, pathology, nursing and social services. Diagnostic radiology, pathology and radiation therapy services are being provided by community physicians. The team can provide first or second opinions to new patients as well as evaluate in-patients at Memorial Medical Center or St. John's Hospital in Springfield.

The mortality rate for lung cancer is greater than the three most common cancers combined -- breast, colorectal and prostate. Approximately 171,900 new cases of lung cancer will be diagnosed in the U.S. this year, while more than 430 patients with lung cancer die each day. The overall five-year survival for lung cancer is only 12-14 percent. Annually, lung cancer kills more men than prostate cancer and more women than breast cancer.

Nearly 90 percent of lung cancers are caused by smoking and secondhand smoke. Increased risk also can come from exposure to carcinogens such as radon and asbestos.

"Smokers can reduce their chance of developing lung cancer if they stop the habit, says Dr. Akshay Sood, an SIU assistant professor of pulmonary medicine and member of TOPS. "An additional benefit from smoking cessation is the reduction of coronary artery disease and emphysema."

There are few early warning signs for lung cancer, though many patients have no symptoms when they are diagnosed with lung cancer. Symptoms can include a persistent cough, coughing blood, shortness of breath or wheezing, and recurrent bouts of pneumonia.

Early detection is critical. Testing patients at high risk for developing lung cancer means tumors can be found while small and more easily treated. The five-year survival rate for the earliest possible lung cancer, stage 1 disease, treated surgically is 50-70 percent.

"We are working to bring advanced technology quickly into the evaluation of patients in order to assure they are started in the right direction, with appropriate diagnosis steps and treatment recommendations," explains Dr. Manuel Valdivieso, director of the SIU Cancer Institute and TOPS member. "We want to realize more success for our patients by the judicious incorporation of different treatment disciplines, including access to national cooperative group clinical trials."

Hazelrigg also says the TOPS team is working to include compassionate and patient-centered care, which includes various related services. These include advice about nutrition, special exercise programs, coping help as well as treatment for possible depression, and home and hospice care.

The support group for lung cancer patients and their families meets the third Tuesday of each month and usually features a guest speaker. More information about the support group is available by calling the SIU Cancer Institute administrative offices at 217-545-6818 weekdays.

The Thoracic Oncology Program at SIU is based at the SIU Cancer Institute, which is located in the Baylis Building (first floor), 747 N. Rutledge St., Springfield. To contact the TOPS program about new or follow-up patients appointment or to request information, call 217-545-7422 weekdays.

- 30 -

[Nushka]

I was not IA. I was IIA and treated like IIIA. I wanted to be agressive. I cried when I found that my oncologist, the head of the department of oncology at Vanderbilt and MD Anderson all recommended chemo AND radiation for me. I had both and am still clear 3 1/2 years later. I know our stages are not the same but I would still do exactly what I did. Yes there are side effects but I feel that I am alive because I took all precautions.

My oncologist now says that my surgery probably was my "cure" but that he still feels that we did the best thing we could have done. He says all lung cancer patients need at least a small amount of adjuvant chemo just as a precaution.

Now that I said my two cents worth it is, of course, up to you. Get another opinion from elsewhere. Send them your slides (cell types vary even in adenocarcinoma) and your surgical report. Often they will give you an idea of what they would suggest from just that.

Nina

[Donna G]

Personally I belong to a lung cancer support group and have friends that are over 5 yrs with no chemo. So it has got to be your decision. Sure wish our researcher had that blood test ready and available so we would know who was at high risk. See below.

Wishing you the best. Donna G

I

Detection of occult micrometastases in non-small cell lung carcinoma by reverse transcriptase-polymerase chain reaction.

Salerno CT, Frizelle S, Niehans GA, Ho SB, Jakkula M, Kratzke RA, Maddaus MA.

Department of Surgery, University of Minnesota, Minneapolis V.A. Medical Center, USA.

BACKGROUND: The 5-year survival rate following surgical resection of Stage I or Stage II non-small cell lung carcinoma (NSCLC) is 30% to 50%, probably because of undetected occult micrometastases (OMs) at the time of surgery. Other investigators have detected OMs in bone marrow and histologically negative lymph nodes from patients with NSCLC using immunohistochemical staining to cytokeratins and cell surface glycoproteins. STUDY OBJECTIVE: To develop and evaluate an assay based on the reverse transcriptase-polymerase chain reaction (RT-PCR) for the detection of OMs in NSCLC. PATIENTS: Twenty-eight patients with benign or malignant thoracic pathology. Samples of primary tumors and lymph nodes were collected at the time of surgical resection or mediastinoscopic lymph-node biopsy. RESULTS: Using RT-PCR to detect messenger RNA (mRNA) transcripts for MUC1 (a cell surface glycoprotein present in lung tissue but absent from normal lymph nodes), OMs were identified in 33 of 88 lymph nodes determined to be free of tumor by hematoxylin and eosin staining. Eleven of 11 control mediastinal lymph nodes from patients without malignancy failed to express detectable MUC1 transcripts. Dilutional experiments demonstrate that the assay can detect one MUC1-positive NSCLC cell in 1x10(7) MUC1-negative cells. A comparison of our RT-PCR assay to immunohistochemistry specific for the MUC1 glycoprotein suggests that RT-PCR may be more sensitive than immunohistochemistry for the detection of NSCLC OMs. CONCLUSIONS: This study demonstrates that RT-PCR for MUC1 mRNA can detect the presence of MUC1 mRNA in histologically negative lymph nodes from patients with NSCLC. The prognostic significance of these findings is currently unknown.

II

Post-Surgery Chemo Raises Lung Cancer Survival

Two-drug combo offers hope for those with early-stage disease.

By Serena Gordon

HealthDay Reporter

E-mail this article

Subscribe to news

WEDNESDAY, June 22 (HealthDay News) -- In one of the first real advances in lung cancer treatment in years, researchers report that chemotherapy after surgery to remove early-stage lung cancer can boost patient survival.

The study found the combination of two drugs, vinorelbine and cisplatin, initiated soon after surgery to remove non-small-cell lung cancer tumors, increased five-year survival rates by 15 percent and overall survival rates by 31 percent.

The findings were first presented at the American Society of Clinical Oncology's annual meeting last year, and have quickly become the standard of care for people with early-stage lung cancer. The full study now appears in the June 23 issue of the New England Journal of Medicine.

"Surgery is not the primary and only care any longer," explained study author Dr. Timothy Winton, an associate professor of surgery and division director of thoracic surgery at the University of Alberta in Edmonton, Canada. "A short course of chemotherapy led to significant improvements in survival and recurrence-free survival. This is extremely good news for lung cancer patients and is a major advance," he added.

Lung cancer is the leading cancer killer, causing more deaths than breast, prostate and colon cancer combined, according to the American Lung Association. More than 160,000 Americans will die of lung cancer this year, and 172,000 will be diagnosed with the disease.

In the past, the only treatment option for early-stage non-small-cell lung cancer -- the most common form of lung malignancy -- was surgical removal of the tumor. According to an accompanying editorial in the same issue of the journal, five-year survival rates after surgery alone range between 23 percent and 67 percent.

The problem with surgery alone is that it can leave traces of malignancy behind. Those hidden cancer cells can then travel and grow in other sites, such as the brain, where they become even more deadly.

Past studies on post-surgery chemotherapy had shown little or no benefit, or the benefit was so small that it didn't outweigh the risks of chemotherapy. But, according to editorial author Dr. Katherine Pisters, of the University of Texas M.D. Anderson Cancer Center in Houston, many of those studies were small and were done with older, less active drugs. Also, she said, diagnostic imaging wasn't as precise as it is today, so many cases in those older studies may not have been properly staged.

To try to correct for those limitations, Winton and his colleagues focused on people diagnosed with early Stage IB or Stage II lung cancer. They also began the chemotherapy regimen within six weeks of surgical tumor removal.

"We wanted to have a significant impact on microscopic, undetectable disease," Winton said.

The study included 482 patients. A total of 242 underwent four cycles of chemotherapy with vinorelbine and cisplatin over a 16-week period, while the remaining 240 patients had no additional treatment after the surgery.

The chemotherapy combination was generally well-tolerated, according to Winton, though two deaths were associated with the medications. The most common side effect, experienced by 88 percent of the treated group -- was neutropenia. Neutropenia is a decrease in the number of neutrophils, a type of white blood cell that helps fight infection. Other side effects included fatigue, nausea, vomiting and constipation.

Overall survival was increased 31 percent for the treated group, the researches report. Those treated lived an average of 94 months vs. 73 months for the surgery-alone group. No one in the surgery-alone group achieved relapse-free survival, while those in the treated group averaged nearly 47 months without a relapse.

Five-year survival rates were also up for those who received chemotherapy: 69 percent compared to 54 percent for the surgery alone group, according to the study.

"Up until now, chemotherapy after surgery was controversial," said Pisters, who noted that several additional studies have since confirmed this study's results. "This is the most encouraging news in lung cancer treatment in a long time."

This encouraging news comes on the heels of last week's disappointing news about the targeted lung cancer drug Iressa. That medication initially looked promising but, according to the FDA, it produced a response in just one in 10 patients. That suggests Iressa may only be effective for a select group of patients with a specific genetic mutation.

Winton said the vinorelbine/cisplatin combination doesn't appear to be that selective and should benefit a wide range of patients. However, he did add that researchers are creating a "biologic tumor bank" to determine whether patients with certain genetic markers benefit more or less from the treatment.

The bottom line, however, is that "we've never had anything in the lung cancer setting with this much benefit," said Pisters. "If you have surgery for lung cancer, you need to find out if you're a candidate for chemotherapy." She recommended that these patients discuss the findings with their physician.

More information

To learn more about lung cancer, visit LungCancer.org.

(SOURCES: Timothy Winton, M.D., associate professor, surgery, and division director, thoracic surgery, University of Alberta and University of Alberta Hospital, Edmonton, Canada; Katherine Pisters, M.D., associate professor, department of thoracic, head and neck medical oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas; June 23, 2005, New England Journal of Medicine)

Copyright © 2005 ScoutNews LLC. All rights reserved.

[Eileen]

I think they are lumping 1A in with 1B and coming up with that stat---

the same with the other they lumped 1 and 2 together---

every stat I ever read for 1A has it 80% or greater

can you find anything for 1A alone?

thanks

[Eileen]

I found one study---but it was for 1B--rather than clog up the board, I am just posting the link

http://www.cancer.gov/clinicaltrials/re ... cancer0604

[enyaw061032]

I have stage 1a, and my surgeon, primary care physician, pulmonologist all said that I did not need chemo because the cancer had not spread anywhere, it was removed, and there was no benefit in having chemo, and chemo would just do more harm than good, with no benefits. I am l-1/2 years out, and all my scans have been NED (NO EVIDENCE OF DISEASE). I have been to a several doctors (for nerve pain, acid reflux, leg and hip pain from nerve pain, and all of them said I do not need chemo. I think the best thing for you to do is discuss this with your surgeon (who was the one who saw what you had and removed it, and the surgeon also had a pathologist biopsy everything, lymph nodes, etc. to see if the cancer got out of the main area.

Barb

[Debi]

Well, I guess we all gave Patt some food for thought. Just goes to show that there are many schools of thought out there, and many articles and sites on the web to support any 'argument' one can make.

I guess the bottom line is Patt, review your options, research them, find a doctor that you trust and then, like anything in life, make your decision.

The great news is, that whichever path you take in your treatment, there is always someone here that has done it. And even if we haven't, we are still here cheering for you- You can't ask for more than that!!

[Maryanne]

I don't know what your staging is. Usually if you are stage 1A they say it is not beneficial to have chemo. However, if IB and up then yes.

Maryanne

[marym]

Patt,

Congratulations on the sucessful surgery. The followup of chemo seems worth it. Since most chemo is easily tolerated - I'm on my second with few ill effects, it won't change much how you feel. Other than needing a little more sleep, I do all normal activities - and I'm stage IV.

Whatever you decide, best wishes.

Mary

[jang]

Patt,

Just had to post my two cents... Stage 1A and 1B often get lumped together and that's why the statistics look bad. I have been told by several doctors and oncologists that chemo could cause more harm than good for stage 1A and that it is recommended for stage 1B. I would go get a second opinion to put your mind at ease.

[Kaffie]

I had my 6 month CT scan last month and when I went in to see my doctor for the results he said he'd recently been to a conference and there is now evidence of stage 1A benefiting from chemo.

I took it and I am glad I did. I wish there were some magic wand to wave over us and tell us which of us are going to get lucky and which are going to get the dreaded recurrence but I have to agree with Rich B, all it takes is ONE cell to break away from the original tumor and it will park itself either in a lung or on another organ in your body and begin multiplying.

It's a tough choice and a very personal one.

Kathy

[john]

The doctors should be able to give you more information on your cancer which may help your decision.

If there are factors such as high mitotic rate, vascular invasion or if the cancer is a high grade cancer then it might make more sense to do some form of adjuvant therapy (either chemo or another trial)

There are other options besides chemo such as vaccines or other targeted therapy, though most are not approved yet and so are usually given through a clinical trial

In one study I read, 1% of patients died from the chemo so there is some risk with chemo. Platinum based chemo can cause hearing problems, neuropathy and can be hard on the kidneys

If the pathology report says that the cancer is slow growing or has a "low mitotic rate" chemothreapy may not work, because chemo works best against fast growing cancers.

Just my 2 cents. Good luck