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poppling

Recent Lung Cancer / Chemotherapy questions

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Hi all,

My father was recently diagnosed with lung cancer stage 1. Tumour was 1.7cm (17mm) in his upper left lobe. Lobectomy was performed and successful. He is pain free and breathing is relatively good. He is currently coming up on 6 weeks out of surgery.

The results of the surgery showed it had spead to one of his lymph nodes that were removed from his body.

We understand it is a normal course of treatment to have chemotherapy when this happens however we have been told he cannot have the "regular course" of chemo that they would normally offer due to a slight history of clotting and side effects that it may cause clotting.

A course they have said we can go with is Paclitaxel & Carboplatin. 

The doctor said we would have added about 4% to his overall chance of a "cure" had we been able to go with it however since we cannot the doctor stated the Paclitaxel & Carboplatin chemo option would add about 2% to our overall chance of a "cure".

He has said it is a decision that is up to us to make and he is nether for or against whether we should get it since it is only a 2% increase (in his words).

Has anybody got any experience with this kind of situation or can they give any guidance? Any experiece or information at all about the chemo, the situation, anything at all... would be great.

Thanks a lot.

Disclaimer: I am not asking for medical advice here.

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After VATS surgery, February 2018, I was seen as "no evidence of disease".  Since 2 of the 4 lympth nodes with cancer that were removed were in my esophagus, it was seen as cancer on the move. The thinking there could be unseen cancer and chemo and radiation were recommended.  It was not a fun experience, but I chose to fight as hard as I could. I was taking no chances.  After one year snd 3 scans, I remain "no evidence of disease".

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2 hours ago, Laurel said:

After VATS surgery, February 2018, I was seen as "no evidence of disease".  Since 2 of the 4 lympth nodes with cancer that were removed were in my esophagus, it was seen as cancer on the move. The thinking there could be unseen cancer and chemo and radiation were recommended.  It was not a fun experience, but I chose to fight as hard as I could. I was taking no chances.  After one year snd 3 scans, I remain "no evidence of disease".

Thanks for the reply.

That's great to hear that you're in the all clear!

Were you stage 1 when you were initially diagnosed?

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Yes....in November, 2017, I was stage 1b.  I was told it was slow growing.  After surgery, February, 2018, it was stage 3a.....not slow growing.  Thank God my sister and a friend pushed me to connect with a patient advocate at M D Anderson who found out my files from my local oncologist had been lost...twice.  The patient advocate pushed for an appointment.

 

 

 

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Poppling,

I had a lung removed to address a very large tumor that blocked the main stem bronchus of my right lung. Before surgery, both my surgeon and medical oncologist recommended a post surgical chemotherapy routine of the then standard of care drugs, Taxol and Carboplatin (much like Paclitaxel & Carboplatin). I recall the same type of projection of survivability being made with and without chemo treatment but I can't recall the percentages. It was 15 years ago.

The purpose of this course (called adjuvant chemotherapy) is to sweep the blood and lymphatic systems of cancer cells that may be dislodged or generated as a result of the trauma of surgery.  Unfortunately for me, surgical complications precluded my adjuvant therapy and about 6 months after recovering from a years worth of surgery, I had a scan that showed 3 tumors in my left lung. They were quite small at discovery so my oncologist believed they were blood-born metastasis from the large tumor in my resected lung.

Statistical methods of predicting survival from lung cancer are problematic.  This explains, in part, why. Rather that trying to rely on statistical rationale, focus on the reason for adjuvant therapy -- sweeping cancer cells from blood and lymphatic systems and that reason makes a great deal of sense to me. I won't pretend to give medical advice but if it were me, I'd want every chance available to preclude a recurrence.  I've had 4 in total and they are not fun.

If Irish methods parallel those in the states, adjuvant therapy may be a lower dose variety. That is because it is not designed to kill tumors or masses but individual cells. Your dad may not even experience any side effects from the adjuvant therapy. I know many who didn't even lose hair! 

Welcome here. It sound like your dad is down the recovery road and doing well. OBTW as to being "cured", we don't use that term in lung cancer because of its penchant for recurrence after supposedly successful treatment. We use the term no evidence of disease (NED) and I do hope your dad achieves that state. More questions -- fire away!

Stay the course.

Tom 

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Poppling,

Lung cancer is persistent.  Several active members on this forum have had at least 1 recurrence of lung cancer.  Some after surgery, others after other traditional treatments.  My mom is one of those who had a recurrence after surgery and chemo + radiation.  We just never know where and when lung cancer will pop up again.  Statistics can sometimes skew our idea of whether or not a certain type of treatment/procedure is worthwhile, especially when that treatment/procedure can have some nasty side effects.  Lung cancer is being treated differently now that there are different treatment options besides just radiation and chemo.  In many cases, it is being treated more like a chronic condition rather than a death sentence.  But rest assured, if nothing is done to halt the lung cancer, it is 100% fatal - it is that persistent.  

My mom's surgical case is similar to your dad's.  She had a lobectomy to remove a couple of cancerous nodules.  During the surgery, docs found several lymphnodes were involved as well (surprise!).  However, unlike your dad, they were unable to be removed, so she had to have follow-up chemo and radiation.  She was given the "all clear" after treatment and began her 3 month follow-up scans.  The shortened version of this story is that the lung cancer popped up again, less than 1 year after treatment was complete.   It was the same type of lung cancer she had previously and the mass was just outside the original radiation area.  We will never know if these cancer cells were there all along and were not killed off by the chemo and began to grow again once treatment had stopped or if this was a true recurrence.  None of that matters at this point, either way, this is an example of how persistent lung cancer can be.  But her docs treated it as a recurrence and she was prescribed a different treatment than before (immunotherapy + chemo).  Immunotherapy was relatively new to the lung cancer world when my mom was diagnosed with her recurrence.  We were scared of the unknown and asked why she couldn't have radiation and chemo again.  My mom's radiologist reassured us that the immunotherapy and chemo (different that what she was prescribed for her initial diagnosis) were her best options because the radiation and chemo did not work the first time.

I know this is a long example, but let me get to my point...the first treatment did NOT get rid of the cancer.  We learned that through trial and error, there is no test that is widely available to tell us if a type of treatment will work or not.  Since it was the same lung cancer, docs figured that the original treatment would probably not work again either.  Your dad's follow-up chemo may not only help increase his No Evidence of Disease (NED) possibility, but it may help with future recurrences (if they happen) - If your dad's cancer were to come back in a short period of time, docs might feel comfortable in saying that the original chemo did not fix the problem, so they need to throw something new at it.  This would be better than finding out at a later date that the current treatment will not work and allow the cancer to spread even more.  I hope this makes sense!

So, yes chemo has side effects.  Some are affected worse than others.  Like Tom said, a lesser dose will likely result in less intense side effects, or none at all.  Can there be long lasting side effects? -Yes.  Are most of these long lasting side effects manageable? -Yes.  Is it worth the risk and decreased quality of life during the treatment? -Only your dad can answer that.

I hope this helps a bit and makes sense,

Take care,

Steff

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