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kelly24h

Small Cell, curable? Stage IV?

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My mom was diagnosed with small cell lung cancer after several months of mystery symptoms (weight loss, headaches, hallucinations). She has a tumor on her lung that is inoperable due to its proximity to the heart and possible mets on her spine and bladder (a small spot on each). The doctor initially thought it was non-small cell but after biopsy confirmed that it is small cell lung cancer. In general, I'm just very confused about what the prognosis is. The oncologist that did the biopsy and the nurse that administered the first chemo said that it was curable. Yes, curable. Exactly what they said. Not manageable or treatable. My mom's own oncologist (different from the one that did the biopsy) is also very optimistic. But on the prescriptions (written by her oncologist), stage is listed as IV and small cell. And I know that small cell is staged as limited and extensive, which is why this is all the more confusing. 

I'm concerned that a doctor would use the word curable when talking about such an aggressive cancer. Someone help?! 

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Kelly,

Use of the word "curable" as an outcome for any form of lung cancer is hard to fathom. About 10 years ago, my oncologist introduced me to the term no evidence of disease (NED) and said that was the outcome the oncology community was aiming for.

From your post, I glean your mom is diagnosed with extensive-stage small cell lung cancer with a primary in the lung and two mets. Any stage of small cell lung cancer is difficult to manage or treat. Often small cell responds positively to chemotherapy but quickly develops resistance to drugs and spreads rapidly. I've read about clinical trials of combining conventional chemotherapy with immunotherapy and these are showing promising results. While she completes here current therapy, you might want to investigate your mother's eligibility for an immunotherapy clinical trail. Here is a resource you might use. I'd also ask her treatment team about trial eligibility. 

Here is a member's experience of treating small cell with combination chemotherapy (Carboplatin & Etoposide, and the immunotherapy drug Tecentriq) after a recurrence after successful first-line treatment. And, note the emerging immunotherapy treatment options after recurrence for small cell lung cancer here. Note the FDA has approved three immunotherapy drugs for treatment of extensive-stage small cell lung cancer (read Treatment Options for small cell lung cancer and scroll all the way down to see the Immunotherapy section).

So, while I wouldn't use the word curable, I would use the words no evidence of disease. Immunotherapy is having a huge impact on both non small cell and small cell cancer treatment. So there may be two paths forward for your mom, even with extensive stage: a clinical trial or second line treatment with immunotherapy. There might even be a third to combine with the aforementioned: stereotactic radiation (SBRT) of the spine and bladder mets.

Welcome here.

Stay the course.

Tom

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