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Dec. 6th interactive chat log.

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Dec. 6th Chat with Dr. West.

*Keep in mind that all of this activity occured in only 90 minutes!!

If anyone would rather have this sent to them in a word document, send me an e-mail and I will send you the chat log.

E-mail [email protected]

DrWest Has entered the room

KatieB[5]: Hi Dr. West!

skye[3]: welcome Dr. West.

iamalady[3]: Hello Dr. West

lewellen9581[3]: welcome sir

debishere[3]: good afternoon Dr. West

aurora06[3]: Thanks Dr West

DrWest[3]: Hi, I'm here. Want to get started?

audrene[3]: Hello Dr West

debishere[3]: Blessings!

anniemac[3]: Hi Dr. West

enyaw061032[3]: Welcome, Dr. West

DrWest[3]: thanks, it's good to see a crowd here.

iamalady[3]: I had surgery for a 9.5 cm undifferentiated large cell carcinoma in my right lung June 2005

DrWest[3]: OK, I'm ready when you are.

aurora06[3]: Your site has very helpful info Dr west

karen335[3]: wow, just going to observe

iamalady[3]: Have had 28 radiation treatments and chemo

KatieB[6]: OK. It's time to start.

aurora06[3]: Dr West, will you be talking about screening on your site

iamalady[3]: now there is a 4.3 cm spot glowing on a PET scan

DrWest[3]: thanks, I hope people do find the Onctalk site helpful

debishere[4]: is it that bad........ when I type fast, my spelling is terrible

aurora06[4]: yes, it's already growing

KatieB[6]: OK guys. If you want to talk outside of chat, you can PM each other. We are going to ask Dr. West questions now.

enyaw061032[4]: My first question is: how can I tell if I have liver mets?

DrWest[4]: For liver mets, a CT will often show it, or if that's questionable, a PET scan will usually clarify

Eileen4[4]: I had a lobectomy in July and am still very breathless. Will it ever improve or as this as good as it gets?

DrWest[4]: After surgery, I would have expected most of the improvement to happen by now. It may slowly improve, but probably not dramatically.

karen335[4]: what is protocol for stage IV with brain met

karen335[4]: thank you

karen335[4]: lung stable

DrWest[4]: single met is often treated with gamma knife if available, multiple mets more often with whole brain radiation. Chemo is not the best approach for brain mets

KatieB[6]: QUESTION: How can a patient know what to report to their “regular” doctor and what to report to the oncologist or should they stick to the oncologist only during their cancer treatments?

enyaw061032[4]: what are the chances that two masses that show up on cat scan could be inflammation or lymphoma or one be a lymph node?

karen335[4]: had cyber knife. Thank you very much

yellowbow[4]: What if brain mets comes back?

skye[4]: Dr. West have you any experience with Leiomyo Sarcoma lung cancer, if so what’s your opinion of curing it?

karen335[4]: appreciate your time

debishere[4]: chemo does not cross the brain barrier??????

KatieB[6]: Let's give the Dr. time to answer the previous questions before asking another

DrWest[4]: I think if it's anything chest-related, it's worth talking with oncologist. If it's unrelated med stuff, like belly pain and no history of abdominal disease, probably see regular doc first, or call onc if in doubt

skye[4]: ok katie , sorry.

skye[4]: we should have a list or somethin'.

DrWest[4]: leiomyosarcoma is really not lung cancer, but a kind of sarcoma, so I don't treat that. It's treated with sarcoma drugs, or if there are just a few lung lesions, sometimes surgically removed

lewellen9581[4]: with stage IV NSC lung cancer with mets to the liver and bones, do you recommend a brain scan before symptoms occur?

DrWest[4]: chemo doesn't cross BBB, at least not well. cornerstone of brain met therapy is radiation, occasionally surgery if 1 or 2 lesions

Eileen4[4]: I've started having arm pain while sleeping (it wakes) me up and wonder if this can be related to the lung surgery 5 months ago?

iamalady[4]: I had another needle biopsy that only showed inflammatory cells, but my doctors are not convinced. They think the cancer is back. I will have another PET scan in Jan. Docs say no more surgery or radiation... maybe chemo?

KatieB[6]: OK. Let's give Dr. West a chance to answer the previous questions.

iamalady[4]: opps sorry

skye[4]: ok thank you Dr. West ~ my cousin had a huge tumor in her lung , they did take out the tumor. but she still going to have more chemo. Her docs say it has a tendency to come back.

DrWest[4]: for the question of metastatic disease and do you need a brain scan, I used to not bother with it (don't ask, don't tell) if asymptomatic, but now that Avastin is approved and shouldn't be given usually with untreated brain mets, I would get a brain MRI and check before starting treatment

Nancy B[4]: concern about the news this am that Arenesp can cause heart attach & stroke. I receive 500 mg every 2 weeks. Is this OK?

DrWest[4]: for iamalady, it sounds like chemo would be the leading choice, but it's a detailed question and I can't give specific suggestions

lewellen9581[4]: he is recieving Avastin, so should he get a brain scan also?

KatieB[6]: There are three questions pending....let's give Dr. West a chance to answer the previous questions before posting another

DrWest[4]: I don't think the toxicity of aranesp is really much to worry about in the scheme of things. If you need it and you have cancer, you have bigger fish to fry than to worry about a heart attack or stroke

iamalady[4]: Thanks... so even with biopsy of inflammatory cells... if it is glowing on PET scan.. it can be the cancer back?

Nancy B[4]: Thank you

DrWest[4]: I'm losing track of questions. if I haven't answered, can you re-post and not take it personally. I'm not trying to ignore anyone

lewellen9581[4]: Katie, would it help if we went in the order our names are to the right of the screen?

skye[4]: i agree

DrWest[4]: inflammation can light up on pet, so I would always prefer to get a tissue biopsy to clarify whether there's actual cancer to treat. I wouldn't want to give chemo for inflammation

KatieB[6]: It would help if we waited for Dr. West to answer before posting new questions.

skye[4]: lol that is true too... katie

DrWest[4]: I've lost track of any pending questions. let me know what's out there still

enyaw061032[4]: what are the chances that two masses that show up on cat scan could be inflammation or lymphoma or one be a lymph node?

iamalady[4]: They are waiting for another PET in Jan. They say my breathing function is too low for surgical biopsy

Eileen4[4]: I'm reposting: I'm having arm pain every night (which wakens me) and wonder if this is related to lobectomy 5 months ago?

KatieB[6]: "there are questions pending, the doctor will let you know when he has answered all previous questions and more can be asked"

DrWest[4]: re: 2 masses on scan, that's a vague question that depends on the situation. I'd presume it's the same process. One could potentially be a node. I wouldn't presume lymphoma if not diagnosed before. But I have no details on your situation

DrWest[4]: iamalady, so they have no tissue diagnosis? it is just one spot? If it's growing, some radiation oncologists would give radiation to treat even without biopsy. Judgment call.

DrWest[4]: Eileen, you could be having a post-thoracotomy syndrome. It's not rare, but the main treatment is pain meds. It happens, but it's treated symptomatically and can be chronic

Eileen4[4]: Thank you.

KatieB[6]: QUESTION: Does ever having TB put you at a higher risk of Lung Cancer?

Kasey[4]: What is your take on a pancoast tumor that was treated with chem o and rad and then successful surgery to remove upper right lobe with adjuvant chemo/t is now 2 years since surgery. Do you think I can start breathing easier OR remain hyper vigilant?

iamalady[4]: Also a spot in my neck... one PET said lymph node... one said thyroid?

KatieB[6]: "there are questions pending, the doctor will let you know when he has answered all previous questions and more can be asked"

iamalady[4]: sorry Katie

DrWest[4]: Katie, I think there may be some data suggesting a small increased risk, but I think it would pale in comparison to smoking. THe bigger issue is just figuring out what old chest abnormalities on scans are old TB scars vs. something more

DrWest[4]: what else?

Lisa Smith[4]: I have a question for the doctor. I'm new to this Chat so bear with me

enyaw061032[4]: could you tell me the danger of having a biopsy by cutting my neck to probe the lung mass for a biopsy? Will opening that up make the cancer spread because air got to it?

DrWest[4]: Enya,

DrWest[4]: sorry, Enya, that's a very common idea but not correct. there's a small risk of infection, bleeding, pain, and lung collapse, but no evidence that it ever spreads the cancer, except sometimes with mesothelioma

DrWest[4]: other questions?

Nancy B[4]: Thank you, please come again - this has really been helpful to me-we sure have some bugs to be worked out.

Lisa Smith[4]: Can you tell me the best tarceva does with relapsed local nsclc. mom has been stable for 2 years,but now on tarceva

KatieB[6]: Should patients avoid sugars?

iamalady[4]: Basically, I just want to know if there is something I need to do before Jan

karen335[4]: too many in's and outs

audrene[4]: Hello Dr West

DrWest[4]: tarceva is standardly given at 150 mg to start with, and dose reduced if side effects are too great

Nancy B[4]: Somebody needs to shut the door

Lisa Smith[4]: how long does tarceva generally keep local recurrence stable if 1st line kept it stable for 2 years

karen335[4]: T stop it

enyaw061032[4]: Is it true that sugar is like a fertilizer for cancer?

lewellen9581[4]: can you clarify on the Avastin? My dad has NSC with mets to bones and liver, he has had a PET scan but the ONC doesnt do a brain scan until symoms are present. He is on Taxol, Carboplatin, and Avastin

DrWest[4]: regarding sugar, no, there's no evidence that sugar "feeds the cancer", and it's far more of a concern for patients to be losing weight. I tell patients to eat in moderation and not worry about sugar, just be healthy

SandraA[4]: Tarceva recommended for Stage 4 adeno with BAC charateristics. He is still smoking but cut back-is it better to use alimta

aurora06[4]: chat room overload??

yellowbow[4]: yea

patti38915[4]: hello

Snowflake[4]: I thought it was my machine with the gamer boy.

DrWest[4]: Early detection is available on the trial at my institution, and I support it on trial but don't think we really have all the evidence to say every former smoker should get it. I am not anti-screnning, but we don't have all the answers, and there are bad things that can happen from finding too much non-cancer on scans that people worry about and get surgery for

Lisa Smith[4]: Can you tell me the success rate of tarceva. how long does it generally work for local recurrence stage iiia

iamalady[4]: How bad is it to drink an occasional beer or glass of wine?

KatieB[6]: Hi Patti. There are questions pending for Dr. West. He will let you know when he is ready for another question

karen335[4]: thanks Katie, hb

patti38915[4]: are the questions about cancer

DrWest[4]: re: BAC in a smoker, I think either alimta or tarceva are fine choices. if someone still smokes, probably would do chemo first, but it's just a question of which first and which next

enyaw061032[4]: I was told in July I was "cured" - had bronchoalveolar stage 1a, now 4 months later, told have two or more masses. How can that happen so fast?

DrWest[4]: iamalady, drinking a modest amount is fine. I usually recommend against it the same day as chemo, too much work for the liver to metabolize

patti38915[4]: what can one do to get their husband with cancer, eat so he will be strong enough for treatment

iamalady[4]: Thanks.. and thank you for your other answers I will leave and give others a chance. Thank you again

DrWest[4]: enya, it's surprising, but I would never tell someone they were cured right after surgery. I'm very sorry, but there's treatment options

DrWest[4]: patti, is the problem general weakness or appetite or other medical problems?

audrene[4]: when Mets to the brain are diagnosed.. is the makeup of the cells the same as the primary cancer?

patti38915[4]: he has had part of his lung removed due to cancer

patti38915[4]: and has lost so much weight and is too weak to start his chemo

DrWest[4]: I owe people some answers. Please re-post. Sorry, the enter/exit issue is sending the screen moving too fast to read and write at the same time

DrWest[4]: cancer to the brain is the same cancer as was elsewhere in the body

KatieB[6]: It should be fixed now. There were too many people

debishere[4]: How do I present a question?

deeswi[4]: How much stock should my Oncologist put in a 400+ and rising CEA

DrWest[4]: patti, that's a tough one with no good answer, except to see a pulmonologist to see if they can get on medications and a pulmonary rehab program to get stronger

karen335[4]: ty Katie

KatieB[6]: There are previous questions. Dr. West will let you know when

he's ready for the next one.

Lisa Smith[4]: Can you tell me how long tarceva generally works for recurrent local nsclc. what are options when it stops working

enyaw061032[4]: what would be a good treatment for bronchoalveola cancer?

skye[4]: no problem Dr. West just ignore them on your list ~ click on their names then at the bottom there’s a box says Action hit ignore an you can't see the people flooding the room.

patti38915[4]: he is already on the program and is not waiting chemo, but not strong enough

DrWest[4]: re: CEA, it's not proven, but I wouldn't like to see that. I don't think I'd treat on the basis of a number, but it would get me looking at scans closely for a change

KatieB[6]: Let's give Dr. West a chance to answer the previous questions before posting new ones.

DrWest[4]: enya, chemo is an option, but many oncologists start with EGFR therapies like Tarceva now. There may be clinical trials available

patti38915[4]: now waiting chemo

Nancy B[4]: Dr West, you are sooooo very patient - I wish I lived in WA. Thank you for your time this evening.

patti38915[4]: katie b please tell me when i can speak

DrWest[4]: what else? I can't see other questions out there

KatieB[6]: RE: Kasey[4]: What is your take on a pancoast tumor that was treated with chem o and rad and then successful surgeery to remove upper right lobe with adjuvant chemo/t is now 2 years since surgery. Do you think I can start breathing easier OR remain hyper vigilant?

audrene[4]: re-post when Mets to the brain are diagnosed.. is the makeup of the cells the same as the primary cancer

DrWest[4]: yes, the brain mets are the same cells as the original cancer

maureen[4]: what do you think of the effectiveness of cisplatin

aurora06[4]: Can cancer cause platelets to fall very low WITHOUT treatment

patti38915[4]: my hysband is already on the lung treatment program but too weak for chemo because he wont eat

audrene[4]: Thank You Dr West

DrWest[4]: Kasey's question; that's getting out to a good place, every scan a better prognosis for no recurrence

DrWest[4]: maureen, I think cisplatin isn't the easiest drug for lung cancer, but it's good, probably a bit more effective than carbo, but more side effects. I use cisplatin when treating for cure, but not necessarily if unable to cure, because side effects also count a lot

DrWest[4]: aurora, I've seen counts drop from the cancer, not often; much more often from chemo

lewellen9581[4]: May I ask now?

KatieB[6]: yes

patti38915[4]: i think ill leave don’t know when to talk to get an answer

DrWest[4]: I'm here

KatieB[6]: Patti- Ask your question

patti38915[4]: why cant my hubby eat, he just cant gain any strength

DrWest[4]: I'm open for Qs

Lisa Smith[4]: I have a question.

debishere[4]: Dr. West: I have gained 50 pounds and am having a hard time getting it off......... do you see a problem with taking diet pills ? I know thats a crazy question. I have never taken them before but I feel terrible and dieting is hard as I have not smoked for 2 years!!!

lewellen9581[4]: please clarify on the Avastin, NSC with mets to bones and liver, ONC doesnt want to do a brain scan unless symptoms occur, he is on Avastin, Carbplatin and Taxol. Should I push for a brain scan?

patti38915[4]: went to the oncologist today for treatment and was too weak

patti38915[4]: he got some of that today

DrWest[4]: I would get a brain scan on any patient on Avastin; there's risk of bleeding in the brain if patients have untreated brain mets

patti38915[4]: and yes on hydrocodone

patti38915[4]: and breathing treatements also

debishere[4]: I gained the 50 pounds after surgery during chemo.........!

DrWest[4]: debi, I don't see any big problem with diet pills if necessary

lewellen9581[4]: thank you DrWest

debishere[4]: thanks~

DrWest[4]: I see a lot more people losing weight with chemo than gaining it, but we see everything

patti38915[4]: he has sqamous cell casriona

DrWest[4]: patti, it sounds like he's doing all the right things.

debishere[4]: I think it was the Decodron that was the culprit

KatieB[6]: Lisa Smith- do you have a question now?

patti38915[4]: thanks, had surgrey 2 months ago

maureen[4]: thank you for yu answer on cisplatin I just completed a regiment of cisplatin and navalbene and thank god I had few side effects.

patti38915[4]: thanks so much dr west

DrWest[4]: oh yeah, decadron is great for weight gain, cheaper than megace, but we don't like to have people on steroids too long

DrWest[4]: maureen, I think that was a very fine option

debishere[4]: LOL

Lisa Smith[4]: yes, thank you. mom is in tarceva for recurrent local nsclc. how effective is it and how long do people usually take it before it stops working. what is the 3rd option after tarceva

karen335[4]: Is very low dose Decadron. 0125, .25 per day safe for long period of time?

karen335[4]: .025

DrWest[4]: lisa, tarceva duration of benefit is quite variable. It averages 3-4 months, but some do well without progression for more than a year or two, if they're lucky. After that, if a patient is well enough for more chemo, that's an option. I'd use alimta or taxotere, whichever they haven't gotten yet

lewellen9581[4]: isnt cyproheptadine (sp?) sued as an appetite stimualte?

DrWest[4]: karen, I think that's probably not a big deal, but I don't have patients on it. Why on so low a dose for so long?

DrWest[4]: re: cyproheptadine, I've never used it that way, not familiar with that as an option for appetite

karen335[4]: Very sensitive to it and swelling after CK

karen335[4]: brain

DrWest[4]: If you need it, you need it. Decadron is great for if patients need it, but I want them on as little as they need at any time

debishere[4]: Dr. West I want to thank you for your time tonight, do you have any special charities that I can make a donation to, in your name to show my gratitude?

KatieB[6]: Snowflake- Do you have a question

Judy-OK[4]: Evening

DrWest[4]: that's great. not necessary, but Joan's legacy. And visit Onctalk anytime if I can help

Snowflake[4]: Dr. West, I took Iressa on a trial for two months before my oncologist removed me due to the extent of my side effects (he'd only seen one person with a worse rash). Is there any place where long-term side effects on monitored on drugs that are no longer used where I can keep up on some of the "issues" around it and what to keep watch for?

DrWest[4]: I'm still here and open if I can help

Nushka[4]: I was diagnosed with adenodcarcinoma with clear cell characteristics. Had surgery, chemo and radiation. That was in 2003..my oncologist has released me but it has been a year since I have had a full ct/pet...should I ask for one more?

debishere[4]: oh great, I am familuar with that organization! Thanks

KatieB[6]: Two questions are pending. One from Snowflake and one from Nushka. Let's give Dr. West the opportunity to answer before posting new ones.

DrWest[4]: Snowflake, perhaps you can try a low dose of tarceva. I don't know of any info on long-term side effects of iressa or other lung cancer drugs.

Chanwit[4]: Any history that Tarceva completely cured anyone?

DrWest[4]: I don't know that a PET/CT is necessary, but I would generally follow with a CT from time to time

joanie55[4]: I am having an ommaya reservoire put in tomorrow a.m. to treat cells in the lining of my brain. It is a clinical trial. Know anything about it??

lewellen9581[4]: Dads bone cancer did not show up on MRIs or x-rays, it showed up on PET scan, what does that mean? Good or Bad?

Nushka[4]: thank you

KatieB[6]: Three questions are pending. Let's give Dr. West a chance to answer before posting a new question

Snowflake[4]: Thank you for your input, Dr. West. I am currently not taking anything as I am almost four years out.

DrWest[4]: Chanwit, sorry to say no. I have a couple of patients on for 2-3 years, but nearly all eventually have the cancer grow through at time point. These drugs haven't been around long enough to call anyone cured.

DrWest[4]: Snowflake, good for you. Something must be going very well if you're four years out

KatieB[6]: joanie55[4]: I am having an ommaya reservoire put in tomorrow a.m. to treat cells in the lining of my brain. It is a clinical trial. Know anything about it??

audrene[4]: Dr. West .. is there a test to see if lung cancer exists before it gets out of control since there are initially no prior symptoms

DrWest[4]: re: bone findings on PET, I don't think it necessarily means anything good or bad. Sometimes, though, it's hard to tell inflammation from cancer. the professional PET readers can usually tell, they say.

DrWest[4]: there's the debate about CT screening, but nothing yet beyond that still controversial issue

audrene[4]: thank you

KatieB[6]: Question: A lot of patients don’t hear about clinical trials until it is a last resort- when their condition may not qualify. When in a patient’s dx. do you suggest they look into clinical trials?

DrWest[4]: Joanie's Q: Ommayas are the standard way to get chemo into brain. We haven't had a lot of luck treating in the brian with chemo. But I definitely support trying in a clinical trial

lewellen9581[4]: he is having sever pain, na dis unable to use bothe legs, the tumors show on both hips and lower spine, he overall appears very healthy, but has low quality of life due to the pain and imobility

joanie55[4]: They suggested this which happens to be at Sloan which is my hospital. They are treating exactly what i have

DrWest[4]: I am very supportive of patients asking about trials. They pretty much guarantee that patients will get at least the best standard treatment, and maybe better. And the people who do clinical trials tend to keep "up" on the latest things going on. And you tend to be monitored very well. So I always support asking about trials.

audrene[4]: Guess I'm paranoid as my husband did not survive his SCLC

DrWest[4]: for pain in the legs, pain medicine (narcotics) as well as radiating painful bone lesions is often helpful.

DrWest[4]: Joanie, Obviously Sloan is pretty good at treating cancer.

DrWest[4]: what else?

aurora06[4]: Wouldn't it make more sense for someone who wants screening now since they may feel at risk than be a lot scared later when things are more advanced?

Tom K[4]: Dr. West, Do you recommend brain MRIs as part of follow up for NSCLC 3a paitents in remission with no symptoms. If so, how often?

joanie55[4]: Yes, and i feel I am lucky to be ab le to participate. Thanks so much

KatieB[6]: Two questions are pending from Aurora06 and Tom K.

skye[4]: audrene, my uncle had sclc passed within 6 months

DrWest[4]: I think it's good to get screened if at high risk, preferably on a trial. My mom is a very long-time smoker (no, really), and I'd encourage it for her. She's pretty fatalistic, though.

lewellen9581[4]: he is on huge ams of pain meds, and they want to do radiation, but the only way to do it is for him to lay on the metal table, and that is impossible to him He tried and the pain was so severe he started shaking and they had to send him to the ER

debishere[4]: Is stage 3a considered "advanced"

debishere[4]: ?

aurora06[4]: Even non smokers should have screening available to them

DrWest[4]: Tom, I don't usually do brain scans if no symptoms. If eligible for the trial of prophylactic brain radiation, I recommend that as an option.

skye[4]: what is s spiral scan and how accurate are they?

KatieB[6]: There are questions pending. Let's give Dr. West a chance to answer and he will let you know when he is ready for new questions.

onlyone Has entered the room

Tom K[4]: Thank you

sharigillespie[4]: Is Stage 4 lung cancer always terminal?

skye[4]: yeh debi - stage IV is the last stage

KatieB[6]: There are questions pending. Let's give Dr. West a chance to answer and he will let you know when he is ready for new questions so that no one will be missed.

DrWest[4]: Stage 3A is generally considered locally advanced, but is generally treated to try to cure it, which we can't do with stage 4, or stage 3B with a pleural effusion that has cancer cells in it.

Snowflake[4]: Debi, I was diagnosed IIIa almost four years ago and am cancer free.

DrWest[4]: the problem with never-smokers and CT screening is that the vast majority of things you'd find won't be cancer, so you end up chasing down a lot of benign findings and doing lots of unnecessary surgeries to find a very rare needle in a haystack.

skye[4]: that is wonderful , snowflake

karen335[4]: Never staged here

DrWest[4]: stage 4 lung cancer is not considered curable, although we do have people who survive into the "years" range, but not as often as we'd like

yellowbow[4]: Husband had brain surgery in June from nsclc and radiation now back again 21cm and neck all swollen and almost whole body. going to get scans of neck and spine. Is surgury for brain best again?

karen335[4]: Can be Chronic though

sharigillespie[4]: how long does it take lung cancer to spread to the bone?

DrWest[4]: spiral CT scan is a low radiation CT and is a lot of info for a very fast scan and minimal radiation dose. They're what we use for all of the screening trials.

audrene[4]: There may not be hope for a cure in stage 4 but there is hope of extending life. which was done for my husband.

karen335[4]: yellow, I had two brain surgeries

DrWest[4]: we consistently help, even if we can't cure, stage IV patients

Snowflake[4]: Audrene, there is always hope, when you lose hope, you are lost.

KatieB[6]: Questions pending from Yellowbow:

Tom K[4]: Do you think LC survival rates similar to breast and colon cancer will happen in the forseeable future?

audrene[4]: true .. but he was told the truth from the beginning

aurora06[4]: Seems to qualify for the screening trials you must have the symptoms suggestive of stage 4, age, smoking, cough, etc

DrWest[4]: cancer may never spread to bone. There's no rules. some love the bone and go immediately, so people can have lung cancer for years and never get bone involvement. No real pattern

skye[4]: thank you Dr.West

DrWest[4]: screening trials generally have qualification of number of years smoked

DrWest[4]: what's yellowbow's question

debishere[4]: Is Large Cell considered to be one of the types of cells that mets quicker......... and to what areas?

KatieB[6]: yellowbow[4]: Hushand had brain surgery in June from nsclc and radation now back again 21cm and neck all swollen and allmost whole body. going to get scans of neck and spine. Is surgury for brain best again?

debishere[4]: sorry.......... darn it I asked out of turn!!!

sharigillespie[4]: thanks Dr. West. They found it in my Mom’s hip bone first then in the lung. Was just trying to piece together a timeline with when her pain started.etc

DrWest[4]: no, we don't know lots about large cell in particular. Just treat it like other types of NSCLC. It's not singled out like squamous cell to not get avastin.

Nushka[4]: what do clear cell characteristics mean? its been almost 3 3/4 years since dx.

DrWest[4]: I don't know if I'd recommend multiple brain surgeries. Would probably consider radiation as a leading option, but it's a more detailed situation than I can really do justice without knowing details.

DrWest[5]: I usually think of clear cell characteristics describing kidney cancer, and have rarely heard it describing lung cancer, so I wouldn't consider it a major factor. Not nearly as important as the fact that you're 3.75 years out, which is HUGE.


DrWest[5]: what else?

Snowflake[5]: Yay, Nina!

aurora06[5]: family history and risk?

Tom K[5]: Do you think LC survival rates similar to breast and colon cancer will happen in the foreseeable future?

lewellen9581[5]: is it possible for Stage IV to go into remission?

Nushka[5]: thank you dr. west and snowflake

aurora06[5]: great question tom

DrWest[5]: family history isn't usually a significant factor. We're just starting to learn about genetics of lung cancer, but it's a much smaller player than in some other types of cancer, as far as we can see.

yellowbow[5]: The Dr didn't want to do radiation again. Sent to another Dr and He wanted to do surgery and put pericardium from Kurdiver Spelling (dead person) said cancer would not come back?

DrWest[5]: Tom, I do think we're getting better bit by bit every few years, but it's a harder, more resistant cancer, so I don't see that happening. But still real progress.

DrWest[5]: Yellowbow, that sounds like a very tough situation for which I don't have a great answer.

Welthy[5]: Dr. -- Why is it in so many families if it isn't genetic?

aurora06[5]: Is it harder b/c it's typically found so much later?

DrWest[5]: I'm sorry for what you're going through.

karen335[5]: Any new targeted meds for LC - Are they in the works and how soon to br released?

yellowbow[5]: Thank you Dr West

DrWest[5]: there's familial patterns of smoking, and it's a common cancer anyway, but we haven't seen any really tight relationship.

Welthy[5]: Thank you -- interesting.

DrWest[5]: karen, nothing coming out in the next 6-12 months, as far as I can see, but lots of things being tested that may help modestly, add to what we have.

yellowbow[5]: Karen335 hope you are fine

aurora06[5]: what are other factors beside smoking? Many non smokers develop lc as well

karen335[5]: ty yellow

sharigillespie[5]: Dr. West, how long may someone have lung cancer and not know it? As I mentioned, they found it in my Mom's hip bone first.

karen335[5]: Thank you Dr. West

debishere[5]: is it time for another question Katie?

DrWest[5]: radon, passive smoke, the EGFR gene mutation, and plenty we just don't know. I see a lot more women with no smoking or minimal smoking history with lung cancer, and there's work being done to see if hormones (estrogen) affects risk of LC.

KatieB[7]: yes

debishere[5]: Should I be concerned about whole body bone and joint pain as possible mets. or chalk it up to weight gain, age and weather and just not worry about it?

aurora06[5]: why is lc lagging so far behind in earlier detection

DrWest[5]: Possible to have lung cancer for years, but most times would think along the lines of months. SOme grow fast and some grow slow. half of lung cancers aren't detectable until they've spread, which is one of the limits of why we don't do better.


DrWest[5]: debi, if the scans look OK, I'd trust that. Plenty of reasons, and diffuse (whole body) isn't a typical pattern for mets.

debishere[5]: thanks Dr. West

aurora06[5]: would they be detectable with spiral ct?

DrWest[5]: LC lags behind because the technology of imaging moves very fast, the trials need thousands of people, and there's lots of money involved.

DrWest[5]: spiral CT is the main scan being used for CT screening.

karen335[5]: my oncologist saw a shadow in 98 on a mammo scan, questioned it with specialist. Specialist said it was nothing

DrWest[5]: Most things visible in 1998 wouldn't be cancer if you're writing to me now. Unless you're writing about breast cancer.

karen335[5]: Very interesting, also connection between Psoriasis and LC

Welthy[5]: What connection?

DrWest[5]: I don't know about a connection between psoriasis and LC

Nushka[5]: what are some symptoms of pituitary mets? I have headaches that seem that seem worse when I have to hold my head back or look up....isn't the pituitary at the base of the head in back?

DrWest[5]: nushka, no, behind the eyes. vision changes, energy loss. Should be visible on head CT or especially MRI

karen335[5]: I was asking, several peeps have asked about connection, rapid cell growth

Nushka[5]: thanks

KatieB[7]: We have about 20 minutes left. Question?

audrene[5]: why is it with treatments.. chemo .. the mass in LC shrinks only to come back 4 wks later larger then before while still in treatment. I'm referring to SC

debishere[5]: I had a chest xray Q year ............. one year it was clear and the next year it was 4cm. Do you consider 4cm as small, medium or large?

DrWest[5]: small cell tends to be very responsive initially and then much harder to get to shrink later. Some SCLC stays shrunk for months or longer, and others not at all or just weeks.

lewellen9581[5]: can stage IV go into remission?

audrene[5]: thank you

DrWest[5]: half empty or half full? I'd consider 4 cm medium, but that's not legally binding.

lewellen9581[5]: what do you consider "terminal" Cancer?

debishere[5]: very interesting answer, thanks!

DrWest[5]: stage IV can shrink and stay controlled for a long time, but not as often as I'd like. I generally don't talk about remission in lung cancer, we usually use that term for responsive leukemias, etc, when there's no evidence of disease. Usually, stage IV disease don't go away completely. But it can stay non-progressing for a long time.

DrWest[5]: terminal would be a situation where the cancer will limit survival. I would usually think of it in terms of the 6 -12 month range.

lewellen9581[5]: thanks after only 1 round of chemo Daddys liver function test came back all clear, we are very optimistic

DrWest[5]: chime in, I'm sitting here, and my fingers are rested.

Chanwit[5]: How many cancer cells in a 4cm NSCLC tumor?

DrWest[5]: that's great, lewellen.

DrWest[5]: I don't know. I only took enough math to get into med school.

lewellen9581[5]: thanks

KatieB[7]: lol

aurora06[5]: 6-12 months. Would that be with or without treatment

lewellen9581[5]: lol

Welthy[5]: Why is BAC the only LC where they have conducted lung transplants?

DrWest[5]: aurora, I wouldn't make that distinction. either way.

karen335[5]: Have had no change in lung since 10/2003

audrene[5]: knowing a person is terminal.. When is the best time to call in Hospice

debishere[5]: rofl................ Dr. West you guys are terrible at IV sticks and blood draws too.......... but darn it, we can't survive without you

DrWest[5]: because LC usually progresses before patients can get through the extensive work-up and wait for a transplant.

audrene[5]: as in 6 mos or later

Welthy[5]: thanx

lewellen9581[5]: hospice here wont come in unless treatment has been stopped

audrene[5]: thx

DrWest[5]: I would call hospice when anticancer treatment is more likely to be harmful than helpful. Waiting until the last days is not as helpful as when it's getting into the "less than 6 months" range, if you can tell.

DrWest[5]: I haven't placed an IV in a long time, but the nurses I work with are great at them.

audrene[5]: when we called hospice in he lasted 3 mos

KatieB[7]: QUESTION: Do you recommend PCI for sclc patients?

harn[5]: I was fortunate in that I did not need chemo and remain NED. However, I feel a bit ignorant about how docs decide which chemo they offer for NSCLC initially and later as the disease progresses

debishere[5]: hospice can do so much more now with " family counseling, spirituality issues, pain management, assistance with medical supplies etc

lewellen9581[5]: DrWest, do you know how pain pump work? Does it go through the VAD?

debishere[5]: assistance

Snowflake[5]: Maybe I can see one of your nurses next time I need to go for contrast or a blood draw...

KatieB[7]: Questions are pending, let's give Dr. West a chance to answer.

DrWest[5]: harn, many drug combinations work about the same initially, but only a handful have shown meaningful benefit after prior tretament: alimta, taxotere, and tarceva

audrene[5]: hospice was wonderful..

Nushka[5]: I have not had radiation since aug 2003...my shortness of breath (sob) is however getting worse and my cardiologist has since found a new murmur in my aortic valve...how long does radiation continue to work on the cells

DrWest[5]: I do recommend PCI for SCLC patients with limited disease who had a good response and don't have cognitive problems like prior stroke, etc.

debishere[5]: some people do not have the correct information regarding hospice

DrWest[5]: radiation works against the cancer for up to about 3-4 weeks after it's done.

skye[5]: true debi.

KatieB[7]: We have about 10 minutes left. Questions?

DrWest[5]: The pain pumps that hospice use can go into a long-lasting IV, or a port-a-cath, or sometimes they just have it go under the skin.

Tom K[5]: Dr. West, thank you for spending time with us tonight.

Nushka[5]: Dr West...thank you so much for your time and efforts with us. We appreciate it very much.

debishere[5]: some physicians " present physician excluded" are afraid of over medicating for pain and do not understand pain management or end of life care

debishere[5]: its really sad

Welthy[5]: Aurora asked a question earlier about why LC is so aggressive. Is it because it typically is diagnosed so late or would all cancers be this aggressive given later diagnosis?

DrWest[5]: that's nice of you to say.

debishere[5]: (((((((((((((((Dr.West))))))))))))))))

audrene[5]: Thank You from me also Dr. West

DrWest[5]: lung cancer is aggressive and deadly both because it is diagnosed as advanced all too often, but also because it is more resistant to our treatments than many other cancers.

skye[5]: Yes thank you Dr.West, i have learned a lot

enyaw061032[5]: Thank you so very much, Dr. West.

Welthy[5]: Thanks Doc.

anniemac[5]: Dr. West treated my husband, Tim McIntire. He is very generous with the pain meds. It helped a lot.

skye[5]: yeh it is very sad, debi.

aurora06[5]: Maybe b/c it is found later?

DrWest[5]: that's terrific. This was fun, even if a little scary. Like drinking from a firehose.

audrene[5]: LOLOLOL

aurora06[5]: Ha

KatieB[7]: It was a new experience for us too. We are so grateful for you.

karen335[5]: annie, I remember you and Tim

skye[5]: lol doc

lewellen9581[5]: thanks he is on high doses of pain meds right now and they are looking at the possibility of a morphine pump to get him through radiation

yellowbow[5]: LOLOLO

anniemac[5]: Good to see you here.

DrWest[5]: Hi, Anniemac. Tim was a lovely man.


aurora06[5]: Will continue to visit your site. Thank you.

anniemac[5]: This site helped us so much when he was ill.

lewellen9581[5]: thank you DrWest

KatieB[7]: (((annie)))

anniemac[5]: It's great to see you here.

anniemac[5]: Thank you from the bottom of my heart, Dr. West.

audrene[5]: Dr West would you please give us your site link

Snowflake[5]: It's good to see you again, Annie.

DrWest[5]: you are all very welcome. I will work with Katie to make myself available regularly, so this isn't going to be the only chance to talk.

KatieB[7]: it is http://www.onctalk.com

Welthy[5]: Katie -- are you saving this "chat" to post somewhere for those who missed?

KatieB[7]: You can go there directly and there is a link to him in our ASK THE EXERTS forum

debishere[5]: I would also like to thank KatieB for being a very wonderful facilitator for Dr. West

karen335[5]: Thank you from the heart Katie and Dr.West

DrWest[5]: if so, will you edit the typos?

audrene[5]: I'll look forward to the next time

KatieB[7]: Welthy, yes, I will copy it and put it in the Experts forum.

audrene[5]: thanks

Welthy[5]: LOL Doc

KatieB[7]: Dr.- I will try my best! LOL

Welthy[5]: Gracias

Snowflake[5]: LOL - I work with lawyers...and fix the typos.

DrWest[5]: OK, we'll do it something like monthly.

yellowbow[5]: This was great thank DR WEST

KatieB[7]: We had the chat set high at 5,000 occupants and we crashed after 500 tried to log in. It was crazy there for a minute.

KatieB[7]: Sorry about that. No more blips for next time.

Welthy[5]: Thanks so much Doc for devoting time to us -- it gives us help to clarify all of those "pesty" questions!

debishere[5]: well I think it was wonderful...............

debishere[5]: and well organized!

DrWest[5]: My pleasure. It's nice to know I can help. I'm going to go home and see my kids.

Snowflake[5]: Not bad for the trial run, Katie. You fixed it quickly.

debishere[5]: no one could have done a better job!

KatieB[7]: Ok. We will call the interactive chat with Dr. West- closed.

Welthy[5]: Katie B Rocks!

enyaw061032[5]: Katie, you are so appreciated

Nushka[5]: give them a big hug from grateful people

debishere[5]: LOL

KatieB[7]: You guys can stick around and chat with each other for as long as you'd like

skye[5]: thanks katie for doing this for us. *hugs*

yellowbow[5]: Thank you Katie

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