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Question - if shrinkage occurs with drugs, surgery next?


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I have a question for you all. should we push for surgerical removal if drugs are shrinking the tumor?

What's the next step? I want to be aggressive, and I've always thought that surgical removal is best, but if the drugs are working, do we continue on that or push for surgery?

I'd love your thoughts, advice, results that you've had on this issue

thank you for your help!


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I've seen that some have had surgical removal after radiation and chemo shrunk things....I'm looking at your signature and it might be tough to comment: do you happen to have any more detail you can add about the multiple tumours found in the past or what those have been up to in subsequent scans? When you say Tim has gotten some reduction, are any of those multiple spots disappearing/gone? Why didn't they do anything during the August surgery (suspect there was just too many at the time to go for it)?

I'm also curious why you're hubby Tim is stage 4 -- I thought that was when things had moved to other locations throughout the body?

I'll just apologize in advance if you've covered these kinds of things in updates and such and I haven't retained it; I tried some quick searching around and couldn't find anything other than references to "things have shrunk"......I just don't know enough about what the details of that means.

Have your doctors offered any opinion on this?


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Sorry I didn't give more information - I tried to update the profile, but it didn't take.

Tim was operated on in August 2005 to take out the tumor that appeared on the CAT scan. When they got in they say multiple b b sized tumors on his lung lining (same lung as primary tumor), and didn't take anything out because he would need chemo anyway with the multiple locations, hence the Stage 4. Fast forward to now - no change in the "spots" on the lining, so the Dr. says they may just be scar tissue, because the main tumor has shown reduction over the last year. The Dr. is not keen on surgery, but says radiation may be a possiblity if he sees more shrinkage, however he is very happy with what the tarceva/avastin is doing and wants to continue with that. I have always thought that if you can have surgery, it is the best thing to do, hence my question.....

Any thoughts/opinions/suggestions?



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I am confused by the Stage IV designation, if the tumors were truly all in the host lung. Sounds more like Stage II. This would have to be clear before I could make definite comment.

If the tumors are all contained in the one lung, then perhaps surgery would be an option, and I would get a second opinon.

If there is any cancer outside the lung, no matter how small, the surgery will not remove all the cancer. It has already escaped into the body. And most oncs do not recommend surgery if all the cancer cannot be removed, unless as someone has pointed out it is relieving some problem. Doctors don't like to put people through surgery (all surgery is major in my book, because they open you up) if they can't reasonably get all the cancer. Chemo and radiation are normally recommended then. Don

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Often with non-smokers, the cancer they get is called BAC - bronchioloalveolar carcinoma

It will sometimes present itself as a large number of tumors in the lung.

Tarceva often works well for this type of cancer and in people are non-smokers, so I hope Tarceva helps.

If there are multiple tumors sometimes that indicates the lung as a secondary cancer not primary.

There is cancer of unknown origin also.

I do not know, I am not a Dr, but this might give you a few questions to ask the Dr

I am not sure how many cancer centers there are in Idaho. You might want to give the Ohio State University call before you leave to get a 2nd opinion

It is called the James Cancer Center.

As I said before though, the Tarceva often works well with non-smokers.

There is also a drug called HKI-272 that is in clinical trials

If the multiple tumors are in different lobes then it is M1 which means Stage VI.

If the multiple tumors are in the same lobe it is T4, which means stage IIIB

http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

There are certain exceptions to the don't do surgery for Stage VI. Certain solitary brain mets and unilateral adrenal mets.

Yes surgery is usually the best option if it is possible. If there are two many tumors throughout the lungs then it is probably not possible.

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