surgery in stage 3 -4 nsclc

[Guest dawn]

My mom was diagnosed in jan, after having a mild heart attack, with stage 3 nsclc. They found a tumor on her right lung and a very tiny spot in the mediastinum area.

My mom was told by one doctor that her best chance to beat this cancer was to go in and have the mid portion of the lung removed along with surrounding lymph nodes and also have the mediastinum cleaned out (there was a small spot there). The doctor said if we didnt do this that the tumor would come back.

The 2nd doctor told us that surgery was not an option since their was that small spot in the mediastinum area. And that if they went in to do surgery this would most likely cause the cancer to spread at a greater rate and show up in different areas. He also said the surgery was very dangerous and very painful and there was a long recovery time. During that recovery time she would not be able to have chemo as they have to allow time for healing.

I thought lung surgery was becoming a more common surgery. I would like anyones opinion on this subject. Thanks for your time.

Does anyone have an opinion,

[Karma1976]

Well how is the split and difference in opinions there. I would say...get a 3rd opinion. see what that dr. says.

[john]

Dawn,

maybe they can do both. Do the chemo/rad first and then the surgery. I think this is *supposed* to be the best. I'm sure it must be difficult getting conflicting opinions. Is the person pushing for surgery a surgeon by any chance

Here is a research article that says neo-adjunctive may be the best

The article is from 2001

Consensus development conference on the medical treatment of non-small cell lung cancer: treatment of the early stages.

Scagliotti G.

Department of Clinical and Biological Sciences, University of Torino, Azienda Ospedaliera S. Luigi, Torino, Orbassano, Italy

Surgery remains the mainstay of treatment for early non-small cell lung cancer (NSCLC) but more than 80% of recurrences occur within 2 years from radical surgery. The pattern of recurrence may differ by histology with more local recurrences seen for patients with squamous cell carcinoma and more distant metastases seen in patients with adenocarcinoma. A number of studies demonstrate that dissemination of cancer cells at levels much below those detected by any current available imaging techniques, including PET scanning also, affect prognosis of patients with clinical early-stage NSCLC. The current clinical evidence does not recommend adjuvant chemotherapy and/or radiotherapy in completely resected stage I-II-IIIA for N1. There are few randomised trials available for analysis of neo-adjuvant chemotherapy involving patients with resectable stage III disease; overall these trials suggest that induction chemotherapy (with or without radiation) improves survival, particularly in those patients who undergo significant downstaging. Heterogeneous study populations limit the ability to define the optimal patient population who would most benefit from this approach. There is no conclusive evidence that neo-adjuvant chemotherapy in early NSCLC is associated with an increased post surgical morbility and mortality. Additional trials are needed. More recently neo-adjuvant chemotherapy has been tested in resectable stage I-II NSCLC and proved to be feasible and better tolerated than adjuvant chemotherapy. Several randomised trials are currently ongoing. In the next future the role of targeted biological therapies as agents acting on minimal residual disease should be explored.

PMID: 12468140 [PubMed - in process]

--------------------------------------------------------------------------------

Summary Brief Abstract Citation ASN.1 MEDLINE XML UI List LinkOut Related Articles Domain Links 3D Domain Links Genome Links Nucleotide Links OMIM Links PMC Links Cited in PMC PopSet Links Protein Links SNP Links Structure Links Show: 5 10 20 50 100 200 500 Sort Author Journal Pub Date Text File Clipboard E-mail Order

Write to the Help Desk

NCBI | NLM | NIH

Department of Health & Human Services

Freedom of Information Act | Disclaimer

Apr 24 2003 12:56:45

[Guest dawn]

Is surgery itself a complicated and dangerous surgery?

[David A]

HI Dawn, Yes I think the surgery is a serious surgery as they have to go in to your chest cavity. I was stage 3a, I had chemo 1st, then surgery 6 weeks later, the about 6-8 weeks after that I had 30 rounds of radiation, this has all taken place in the last 11 months of my life, I'd be lying to you if I told you it was easy. I'm having complications from the surgery and radiation and numb toes from chemo, but it is much better then

the alternative. There is a lot of hope and seat of the pants advise here hope you find some peace here.

[Guest dawn]

i was wondering, if you dont mind me asking, are the complications from surgery ones you can overcome? Will the complications eventually go away after time?

[Eileen]

Hi Dawn it is hard for people here to tellyou---all dpends on the Dr, where the cancer is, the age, the helath, etc.

I had no problems---it was no picnic, but I was mobile when I came home from the hospital and was driving in one week and only rarely used pain killers--- -but others on here have had a really hard time with surgery and have felt pain for months---

Rgerads and I agree, I would get a second opinion as well as other tests (e.g. bone, head) ----you usually have them before surgery---

regards Eileen

[john]

I agree with Eileen. Probably depends on a large number of things. In my mom's case it was relatively easy. She went back to work a few weeks after surgery

[David A]

Hi Again Dawn , I have severe shortness of breath, much worse then before, still fight fatique somewhat, and pain often in my chest area.Best of luck

[AdaW]

Dear Dawn,

I was always told I could not have surgery but after 1 1/2 years of treatment, I became a candidate for surgery. I was thrilled because I vowed early on that I would do everything possible to get well.

I had the surgery on January 10, 2003. I had complications. I had to have 4 blood transfusions during the surgery and I was in Intensive Care for 5 days and in the hospital for a total of 11 days. I believe the reason I had complications was the location of my tumor which was very close to the vena cava. This major blood vessel was knicked during the surgery. I also always keep in mind that I endured a lot of chemo and radiation treatments prior to the surgery.

It's a painful recovery, especially when you have to cough constantly to clear your lungs. When I went home, I was on oxygen and had visiting nurses for about a month.

I have been on the mend since January. I just got off oxygen a week ago because I had a bad bout of bronchitis since the surgery. I feel better every day and my life is slowly returning to normal. Right now I can do everything I did before but I just have to pace myself.

Eventhough this surgery was a huge challenge, I am very strong. At 54, frankly I am amazed that I am as resiliant as I am. As soon as they told me that they thought they could operate, I did everything I could to make that happen. I was not afraid of the surgery one bit. I wanted every chance I could get to get well. I would go through all of this again if I knew that it would help me get better.

Questions you should be asking--what are the credentials of the surgeons you are talking to? What are their experiences? Have they performed operations on people with similar problems? Are they thoracic surgeons who specialize in operating on people with lung cancer?

Everyone is an individual case. I wish you and your Mom the best of luck in making this decision.

Ada

[Ry]

Your mom's situation is very similar to my husbands. The problem with the surgery is due to the tumor in the mediastinum. It is hard to get in there and take a tumor out and get a "clean field" around it. There are many nerves and vessels in that area that make it difficult to operate. If they cannot get a clean field they run the risk of it getting into her system and spreading. Also, in my husbands case it is on a major blood vessel. With him, they did chemo and radiation, stopped to evaluate whether surgery was possible (it wasn't) and then continued on with treatment. I beleve most protocols call for chemo to see if the tumor shrinks enogh for removal. I was also very surprised with everything they do now that they could not operate in that area.

[Guest]

I realize there are different options for a number of good sound medical reasons, but just wanted to share my story briefly. Just received another clean bill of health at my six month checkup....I'm out 5 years from surgery after being diagnosed as IIIB NSCLC. After many scans, endoscopy, etc., surgery was decided to remove right lower lobe. Thankfully my WONDERFUL thoracic surgeon while I was on the table, conferred with the pulmonologist and oncologist after finding 3 lymph nodes in the medistinum which of course were cancerous, but not seen as they were directly behind esophagus and argued for removal. Six weeks after surgery, started the rounds of 6 chemos and 34 radiation treatmetns. Statistically it doesn't appear the odds are better with this course, but I'm glad the surgeon went forward. Good luck to you!

[Guest KerryToo]

Just wanted to give you a different perspective. My Mom was diagnosed NSCLC IIIB with mediastinal involvement and tumor with 3 “satellites” in left lung. She decided against surgery because she is a widow now and didn’t think that she could handle the after effects while living alone. (She has family and support, but lives alone.)

She decided to go with just Chemo and Radiation combination. She had 6 cycles of Taxol combined with aprox. 30 radiation treatments. She has “no signs of cancer” and has had clean scans for 6 months. I pray she has 100 years of clean scans!

There are other options available – so be sure to consider all the factors. My best to you and your Mom.

[Hebbie]

Thought I would ad in my two cents -- I was originally thought to be a Stage 1, it wasn't until during surgery when the mediastinal nodes were removed and sent through pathology that I was correctly staged as a IIIA. My surgeon has assured me "he got it all" (typical surgeon!) My oncologists have started 6 weeks of radiation and 7 weekly chemo treatments. I too had heard that chemo/radiation BEFORE surgery was the "best" way to go, however, my medical oncologist told me during my last visit that there has never been a clinical trial/study done to track the results of chemo/radiation AFTER surgery. A clinical trial will be underway next month for Stage IIIA with surgery, followed up by chemo/radiation to have some official numbers on the outcome of this method. I am not a part of this trial since it is not underway yet, but the two chemo drugs they prescribed are the idential drugs they will be using in the trial. I thought that was kind of interesting!

[cathy]

Hi Dawn..You must be so confused right now... I wish I had done a little more research on lung cancer before they did my dads surgery....We never had to deal with cancer in our family,so naturally we trusted everything the onc. was telling us at the time of my dads diagnosis, and never even thought of a second opinion... The one big problem my dad has is not getting well enough for chemo after the surgery....He kept having complication after complication, never regaining enough strength to proceed with chemo..Now it looks as if he will never get chemo... I am still not sure to this day if the right decisions were made, we were never told of any other options, unlike you,you have heard from two different doctors with two different opinions... If my dad had the chance to do it all over I am not so sure he would have had the surgery first, but then again if everything had gone according to how it should have I know we would be saying the opposite....I'm not sure if I helped or not..I think its good that you know you have options..I really just saying I wish we would have known all our options......cathy

[Guest katsmum]

Hi there

My dad was diagnosed with stage 3 LC in December 2001 and immediately started chemotherapy which was followed by 10 weeks of radiation. The size of the tumour meant that he was not a candidate for surgery but he was put on a special intense radiation therapy - sorry I don't know what it's called but it is not widely available. He responded well to the treatments and in October 2002 was offered surgery to remove what was left of the tumour. He decided to go for it and had his entire right lung removed - it was supposed to be a partial but during surgery they had to remove all the lung because the tissue was so fried from all the radiation. Unfortunately he developed a complication of the surgery - he had developed an air hole in the stump and had further surgery only 5 weeks later. He was in intensive care for a few weeks (even spent a whole week sedated in an effort to heal the wound) and "mini" ICU for several weeks. In all, he spent more than 2 months in the hospital but he is home now and has been since January. His recovery is slow and he has daily home care as he has a thoracic window (a hole in his chest) which needs to be re-dressed everyday. He is doing pretty good, he started driving again soon after coming home and he is slowly getting his life back. He still gets shortness of breath and pain in his chest but it's managed ok with pain killers. We hope that one day the thoracic window will be closed - it is now 30% smaller than it was a few months ago so we are hopeful and he goes for his 6 month cancer check this week, so fingers crossed there too.

What was left of the tumour was apparently dead cells, but there really wasn't any way of knowing for sure and my dad felt very lucky to have been given the chance of surgery since it was originally not an option. I don't think he regrets having the surgery but it was very hard for him initially, since he was very fit and feeling well all through chemo and radiation.

Good luck and best wishes

[Guest dawn]

Well my mom had her 3rd chemo treatment monday and we talked to the surgeon. He still says surgery is not an option. They say a total of 6-8 rounds of chemo and then at that time they will do another pet scan and we can go from there. But he said to have the surgery we would have to really twist his arm and we dont want to force him to do something if it is not the right thing to do. He said the tumor is really responding to the chemo and has shrunk over half and the spot in her mediastinum is now all but disappeared. He also told us that remission only lasts at best about 2 years and then we would see the cancer pop up somewhere else and have to start this chemo process all over again. This whole process seems to go on forever. You beat it once only to have it come back in another area. I hate this cancer. My mom has alot of faith and alot of family support but you wonder how long that faith will take her. They always say god doesnt give a person more than they can handle. I hope that is true.

I guess we just keep going forward with the chemo. She is just so tired and he says there really isnt anything we can give her for that as her wbc count is good(5400). Thanks for all your responses. I pray everyday they can come up with some cure for this. In all these years you think something better would have come along by now. But we can always hope for tomorrow.