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New Here and would like opinions!


CynthiaW

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Hi all. I just found out about three weeks ago I have lung cancer after just ending breast cancer treatment. Please help me with your insight. I thought I was going to surgeon today to schedule my surgery to remove lower left lobe. I don’t know my stage but I have squamous cell nsclc. The tumor is under 3cm. The lymph node right next to the tumor is in the path report with question mark. So not sure yet if that lymph node is involved. My tumor is protruding into my bronchus and has it severely narrowed. The doc today said he could do surgery now but because of the tumor being so close to bronchus he would not have any room to get clear margins and would damage that bronchus so he would have to remove the whole left lung. He is concerned with the chance for more complications after removing whole lung. He suggests that I do chemo for a few rounds and see if they can get it to shrink enough to where he could possibly only have to take lower lobe. He is conferring with my oncologist to see if I can even do chemo again so soon after my breast cancer chemo and will call me back. If i can’t do chemo then he would plan to go ahead and take whole lung as this would be for cure but of course no guarantees. One of my concerns is what if the cancer spreads in the length of time it takes for chemo? My guess that would mean no possibility of surgery. Also, i am allergic to those nulasta shots. I barely made it through my last chemo on those. Did end up in Er on last one. I was so praying i would just schedule surgery and get it over with. Now I don’t know what to do! Thanks in advance for any advice and positive vibes. I am happy with this surgeon as he seems very knowledgeable in what needs to be done. Also has anyone here done chemo then surgery with good results?

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Hi, Cynthia, and welcome.

Man, you just can't seem to catch a break, can you?  I know one of our members here, PaulaC, JUST had surgery after undergoing chemo to shrink the tumor.  

Is radiation maybe an option?  Did your surgeon mention that as a possibility?  Sometimes location precludes radiation, too, but that would be another way to potentially shrink the tumor.

One of our other members, Tom, had squamous cell cancer and he might have some thoughts, too.  He's a long-time survivor.

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The surgeon said no radiation before surgery because it tends to cause to much scar tissue. I’m just so scared if I wait, it might spread then surgery would probably be out. Just don’t know what to do. 

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Hi Cynthia, 

How horrible to just end one battle and have to start another. I am so sorry. I am not very familiar with squamous cell, my mom has non-small cell.  Its not all that uncommon for people to have chemo before surgery. Some people need to have their tumor shrunken a bit before surgery is possible. 

My mom originally had her right, upper lobe removed. Docs told her that all the lung function tests in the world could not predict how she would do with decreased lung capacity. She had to wait for surgery to let her RA meds get out of her system. We had the same concern as you - will the cancer spread while I am waiting for treatment? But in the end, it all turned out okay and did t spread.

If you do not like the answers or the proposed treatment plan you are getting from your docs, don't be afraid to get a second opinion. 

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Hi Cynthia and welcome,

Wish I had some answers for you, but I don't. I like Steff's suggestion of a second opinion. Here's my experience with second opinions : Prior to my lung cancer (Stage 1a, lobectomy) I had an unrelated cancer that was advanced and aggressive, also a rare type. I wasn't sure about the my medical oncologist made for chemo. A tumor board had considered my case and one doctor had  suggested  some additional chemo. I decided I wanted  a second  and independent opinion. My insurance wouldn't pay for an opinion outside or my HMO medical group. i went to a specialist at Oregon Health Sciences University, our local teaching hospital, and paid for it myself. She recommended some specific additional chemo.  I couldn't afford to go out of my HMO for treatment. I took the recommendation back to my original med onc and she agreed to follow it. Glad I did! Today, 7 years later, I'm NED on that cancer. I think medicine is an art as well as a science, and doctors have differing opinions on how to go about things. 

Bridget O

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Thanks. It sure is a gamble either way to me. He said if I can have chemo again so soon after, that they would do two and then rescan. If no change then they will operate immediately. If it does show that it has shrunk then he would like me to have a third one. It really does make sense and I will probably go this route and pray it doesn’t spread in that time.  I don’t think mine is as aggressive as other types. I don’t really want to loose my whole lung unless it can’t be avoided.

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I'm not quite sure why you think it would spread in the time it takes to have surgery, when you are having the chemo during that time.  The surgery--even removal of the entire lung--isn't guaranteed to prevent it from spreading.  Just because the doctors aren't seeing any signs of metastasis right now doesn't mean it hasn't already begun.  I'm not trying to scare you, just point out that cancer can be stopped in various ways--surgery is one, chemo another, radiation another.  Chemo would not only attack the tumor you see, but any cancer cells that might be out there that you don't know about.  

Unfortunately ALL cancer treatment is a "gamble" to some extent.  You hope that the alternative chosen is as good as or better than the road not taken.  Sometimes any of them will have a good result; sometimes nothing works.  That's just the nature of the beast.  Every person, and cancer, is unique.  And none of us (nor our doctors) has a crystal ball.

A second opinion never hurts.  Where in Texas are you?  There are some notable cancer treatment centers there.

 

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Yes i understand that it doesn’t mean it won’t show back up. I’m going to MD Anderson in Houston so I feel pretty good about there opinions. Certainly more than the Veterans Hospital where I had my breast cancer treatment and they completely missed the lung cancer. They never did any scans though I tried to get them to. 

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Cynthia,

We share many characteristics. I have Squamous cell NSCLC. My tumor intruded into the bronchus. My surgeon’s first determination was no surgery unless chemo and radiation shrunk the tumor. I had both chemo and radiation and the tumor did indeed get much smaller. My surgeon had to remove my right lung to get clear margins. But radiation did complicate healing which led to two more surgeries, and four additional thoracic procedures. That is why presurgical conventional radiation is rarely used these days before surgery. 

Chemo can shrink tumors but Squamous cell is notorious for resisting chemo. Your allergy to Neulasta complicates the type and strength of chemo you might receive. Precision radiation may be a solution but it will likely rule out surgery. 

I’d have a consultation with a radiation oncologist to check if a form of precision radiation can be administered in place of surgery. Precision radiation goes by many names: SBRT (stereotactic body radiation therapy); IMRT (image modulated radiation therapy); and proton beam radiation. This last type may be suitable because it is very precise and can be used with great accuracy and in delicate tissue structures like the trachea. 

Thankfully, these days Squamous cell has been successfully treated with immunotherapy. This depends on your a tumor marker called PD-L1. Ask your oncologist if your tumor biopsy was sent to a lab to check for PD-L1. 

I’d normally be able to link to articles about immunotherapy and precision radiation contained at LUNGevity.org, Lung Cancer 101. But, I’m on a cruise ship and can’t link on my cell phone. Go read about these topics and post if you have further questions. 

Most important, if I can live, so can you.

Stay the course.

Tom

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