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As I am looking around this site I can see that I have a long way to go in the education department. It is encouraging and at the same time discouraging because treatments seem so varied and complicated. So far my hubby's NSCLC is adenocarcinoma, probably StageIII. His tumor is in the upper left lung, very large, 8cm. He has a lot of pain, it is pressing against the side of the lung, his ribs I guess. On oxycodon for that. He goes tomorrow for PET scan and CT scan to check for any spread. He goes next Monday to get a port put in for chemo. We don't know any more as of now, doc said if there is no spread to other parts of the body he will get radiation also.

He said it is inoperable. My question is how do they determine that? it is large now, but what if it shrinks to half the size or less, can't they consider surgery at some point? And second question is: if we get a second opinion, do we just question treatment, or should we even question diagnosis?

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If one had a tumor that has been staged at 3a, the typical treatment path is concurrent chemo and radiation with the chemo at a reduced dose until the radiation is done and then a stronger chemo treatment. Then if there is significant shrinkage and no more cancer in the lymph nodes, one may go on to surgery for a possible cure.

Your husband’s doc probably considers the tumor inoperable because of cancer in the lymph nodes, which makes it a system wide problem that has to be treated systemically. Surgery is for local treatment. If your husband had the lung cut out now with the tumor, the cancer would still be in his body.

It is always a good idea to get a second opinion. I would ask for both a diagnosis and treatment recommendation although, I suspect the diagnosis would be the same, especially after the PET scan results are in. You might as well wait for the PET scan results if you are going to go ask for a second opinion.

Don M

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You didn't mention whether he has a pleural effusion (fluid outside the lung, in the space between the lung and the chest wall, aka the pleural space). If so, and if the fluid is determined to be malignant (by finding cancer cells in the fluid or identifying other characteristics that point to the cancer as the source of the fluid), then the cancer is staged IIIB, which is considered inoperable. It's assumed that there are cancer cells in the bloodstream and that even if the lung tumor could be safely removed, the horse is out of the barn so to speak and the condition must be treated systemically (chemo). That's my situation (see below). If he doesn't/didn't have a pleural effusion, that simplifies things somewhat and you can disregard this entire first paragraph!

You should ask specifically WHY his condition is considered inoperable. Here's an article on the current TNM (primary Tumor, regional lymph Node involvement, Metastatic involvement) staging system for NSCLC which you might find helpful:

http://www.emedicine.com/radio/topic807 ... nm_staging

Looking forward to your updates. Aloha,


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