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What constitutes Lung Cancer Patient as Inoperable


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I wanted to understand this better and hopefully the rest of you know the answer. If a person has stage IV lung cancer does that automatically make them inoperable.

My issue is I want my Adrenal tumor out and it can physically be removed by a surgeon but my oncologists have not recommended it. Do any surgeons remove tumors on patients with Stage IV. I called ST Francis Hospital in Hartford and left them a message to call me as they have Cyberknife and maybe I could take care of the nodule in my Adrenal gland that way but now sure if they will do it either. I just want it out at this point.

Any opinions welcome.


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I'm not 100% on this so hopefully someone with more knowledge will follow me up....

My mom also has NSCLC stage IV. Initially the Dr spoke of surgery when they thought they were only dealing with her primary tumor in the upper right lung. We were told she would not be a surgical candidate when further tests showed the cancer had spead to her other lung and several lymph nodes. So I have to assume it has alot to do with where the cancer has spread to. (At least it did in the case of my mom)

Hope this info helps.

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Hey Lilly,

I have heard of stage 4 survivors that have received surgery. But, they may have been diagnosed after surgery. I honestly don't know. You may want to ask Dr. West at Onctalk.com.

I was stage IIIB and it was determined that surgery was not an option for me because, although localized, the cancer had crossed the medistinum opposite side of the tumor into a node.

Good Luck in finding the answer you are looking for!!!

God Bless You Two!!


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Hi Lilly,

We had a member (Ray A, recently passed away) who had both adrenal glands removed. Below is one of his posts. I'm at stage IV and I'm pretty (been awhile since we talked about it) sure my doctor told me if I had mets to the adrenal glands I could have it removed. I would ask the doctor what are you options or perhaps seek a second opinion? Hope this helps.



I like to say hello to all my old friends and let them know I m still kicking. I had surgery in sept to remove my adrenal gland. Was tumor free for a few months but it came back in my other adrenal gland. Looking to remove that one hopefully this month.

God bless us all



RAY A Born 9/2/59

diagnosed 7/5/02 nsclc stage IIb left lung Removed 7/19/02

check up 11/22/02 "clean"

PET scan done 5/10/03 mets to adrenal glands.

Starting Chemo on 6/13/03 carbo/taxel

MRI on 7/30/03 found 3 met on brain

COMPLETED 14 whole head rad ON 8/18/03


10/03 CT scan & MRI

adrenal glands shrunk from 1.9cm to .9cm

MEts to head (3) 2 gone. big one (2cm) half the size.

12/19/03 DONE CHEMO CT/PET Scan done 02/04


CT scane done 04/04 Returned in Adrenal gland starting Taxotere

Ct scan done 6/4/04. Taxotere is working. shrunk %20CT scan and Pet scan done 8\6\04

Adrenal gland tumor grew 15%

Starting Alimta and had surgery to remove adrenal gland. Had second surgery to remove other adrenal gland. DOING GREAT!!

3 Years and counting

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I know of at least one person who had stage 4 lc that involved distant mets to the adrenal only had surgery after the disease was brought under control by chemo and radiation. I can't remember the details. It has been over a year since I read their story, but I think they did the surgery at Columbia Presbyterian Hospital.

Don m

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There's no standard role for surgery for stage IV NSCLC, as you probably know. However, there are some documented cases of long-term survivors for patients with a solitary adrenal metastases or a solitary brain metastasis, as the only source of metastatic disease. Solitary is the operative word here.

It's not that surgery can't be done, but it's a significant surgery, with potentially serious side effects and recovery time. If someone has other areas of metastatic disease, it's too likely that they'll have disease progressing in other places while they're recovering from surgery. So if there's a single metastatic lesion, it's a fair consideration, but the value of focusing on one specific lesion isn't very if there's a high potential for significant side effects from that local treatment and the war is with other areas of distant disease.


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Thank you Dr. West for explaining. I originally was scheduled for an adrenelectomy and once they found the mets to my brain they cancelled it. I do agree that a surgery is risky if a long recovery time is involved but an adrenalectomy is performed laporascopically which has a three day or less recovery. I have made an apointment with St. Francis Hospital in Hartford, CT with the CyberKnife team to see if they think it makes sense to radiate it.


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There are very rare cases when surgery is appropriate from what I have read.

One case is an isolated brain met with no lymph node involvement.

The other case is a unilateral adrenal met.

The NCCN guidelines give the removal of these a grade of C on a scale of A .. F

So the "grade" is just average

http://www.chestjournal.org/cgi/content ... suppl/244S

It seems to me that Ki-67 or some measure of doubling time and grade should be used. Surgery seems more appropriate for lower grade tumors

Dr West please provide your opinion.

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you know, I think if I had stage 4 disease with limited mets, I would take standard treatment to control the disease and kill of the residual disease with cyberknife. That way I could conserve my lung capacity. I would not lightly give up a lung for the remote or average chance of a cure. If the odds are greater that there would be a recurrence, with the stage 4 situation, I think I might prefer to manage it with cyberknife. I don't see why this would not be a reasonable approach if the mets are very limited in the first occurrence or any recurrence. Of course, giving up the adrenals and using a scope is not as drastic as bye bye lung.

Don M

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