Lymph node where chemo can't reach?

[Michelle1980]

My dad was just recently diagnosed with lung cancer with a Cat Scan of his chest after he had been complaining of pain when breathing. Since then, he has had multiple tests (lung biopsy, pet scan, then a biopsy of the mediastinal lymph nodes). I'm not sure what stage his lung cancer is, but I think it is at least stage III.

Anyway, my dad told me that his oncologist told him that his pet scan indicates that he has cancer in a spot where chemotherapy will not help. Has anyone heard of this before? I'm hoping that my dad misunderstood the doctor. Doesn't chemo work everywhere that there is a blood supply to?

[raneyf]

The only place I'm aware of where chemo doesn't generally help is the brain. There are some exceptions to that, with Temodar (sp?) and I think some say Tarceva crosses the blood brain barrier.

[recce101]

Hi, Michelle, and welcome to the LCSC!

There is a "blood-brain barrier" which acts to protect the brain from chemicals in the blood, and this blocks or greatly dilutes most chemotherapy agents. I believe there is some research going on to develop chemo agents which will cross that barrier, but at present radiation (which has become very precise) is the main tool for dealing with brain tumors, including brain mets from lung cancer. I'm not aware of any other place in the body with a similar barrier, but there could be, I simply haven't heard of it. Here's an article on the "BBB" in Wikipedia (which I'm liking more and more as an up-to-date resource):

http://en.wikipedia.org/wiki/Blood-brain_barrier

By the way, our members uniformly recommend that patients take a family member or other close associate with them to appointments, especially if they'll be seeing an oncologist, surgeon, etc. This has nothing to do with the mental competence of the patient -- one can be sharp as a tack 24-7 and still miss something important, possibly because of thinking ahead to the next question. Voice recorders are also a great idea, and I've never heard of a physician who objected (wouldn't be my physician for long, I'll tell you that!). I also have a notepad lying on the exam table which I use to make notes or jog my memory about things I wanted to ask.

Again, welcome, and Aloha,

Ned

[Adrian]

Certainly haven't heard that "chemo won't reach" certain spots in the lung. As Ned pointed out, there is a good chance that something was lost in translation. For the sake of clarification, and to begin establishing a rapport with your oncologist, I would suggest that you or he email your onc. to pin down what was said.

Mind you, if he was referring to the brain, that would not mean that your father wouldn't be given chemo to deal with the lung primary cancer---He would get brain radiation first (which can be a one shot deal or done over the course of weeks depending on the extent of the brain mets) before moving to chemo---as is/was the case with my dad.

Anyhow, welcome, ask whatever questions you want and please keep us posted!

[DrWest]

I don't have much to add, except to say that as a medical oncologist, I agree with what people here have said thus far, that chemo should be able to reach pretty much everywhere the blood supply goes, with the biggest limitation being the brain/central nervous system. Chemo should cast a broad net for activity.

-Dr. West