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Caregiver- New to Lung cancer but not to Cancer in General

Sara Riehle

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Hello. My Mom was diagnosed the week of Thanksgiving after some routine testing by her primary care physician. She was asymptomatic and was lucky this was caught when it was. Very quickly after finding out about her lung tumor, she had a VATS resection of her upper right lobe on the 15th of December. She had two tumors removed from her lung, a smaller one and a larger one. Although the hope was for a wedge resection, they ended up doing a lobectomy of the upper 1/3rd.

She spent 5 days after surgery in the hospital and had several complications during that time including a failed chest tube removal, emergency replacement of chest tube, a dumb nurse accidentally disconnecting her chest tube causing fluid to fill up in her lung, she went AFIB, and we found out she stops breathing in her sleep, likely sleep apnea.

Next week we will go for her (very delayed) post surgical follow-up where will will learn her stage based on whether her lymph nodes are positive or not. We do know there is no other visible cancer in her body though. 

This is not my first time as a caregiver for a cancer patient. My husband was diagnosed stage 4 colon cancer in June of 2020. He is thankfully NED now after several surgeries and specialized chemo. 

I am wondering if someone can guide me as to what standard of care is for chemo with lung cancer? Is it common for immunotherapy or targeted therapy to be added if possible based on genetic testing? Also, with lung cancer is there a tumor marker that is checked by blood work? (I am only familiar with a CEA test for colon cancer) 

Thank you!


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Welcome and Happy New Year; I wish we didn't need to share good cheer and discuss lung cancer concurrently. Perhaps someday we won't.

So a couple of things come to mind. First, has your Mom consulted with a medical oncologist? Thoracic surgeons are an important part of the lung cancer treatment team but the surgeon's work is done. You Mom will need an oncology (medical and perhaps radiation) and perhaps a pulmonology consultation. Certainly she have a sleep study or perhaps the hospital apnea record is enough to go straight to prescribing a CPAP machine. I've been using mine successfully since 1990.

The first thing your Mom should discuss when seeing the surgeon AND  medical oncologist is follow up chemotherapy. I'd rely more on the medical oncologist view of follow-on chemo than the surgeon's view. For some diagnosed at Stage 1 or perhaps 2A, post surgical chemotherapy can be waved off but most of us should really have it. I had presurgical chemo radiation after diagnosis, then surgery and a years worth of surgical complication. I was supposed to have post surgical chemo but the corrective surgery got in the way and cancer metastasized to my left and now only lung. This blog links a study that speaks to the dangerous nature of lung cancer: its frequency of recurrence after supposedly curative treatment. Post surgical chemo adds a margin of safety for recurrence.

I think it is pretty common that biopsy tissue be sent to a laboratory after a Pathologist's histology examination. This second biopsy is to screen for suitability for treatment by Targeted Therapy and Immunotherapy. These therapies are game changers in survival and so press hard for the laboratory analysis. Yes it is common to add targeted therapy and immunotherapy as treatments alone or in combination with conventional chemotherapy. Blood test tumor markers for lung cancer are not commonly used. The scientific community is working on a diagnostic grade blood test biopsy but it is not yet a standard of care. So only tissue biopsies are used with our disease.

Standard of care for lung cancer gets complicated. It is dependent on Stage and Type. I assume your mom is Stage 2A or 2B. Once these 2 conditions are known, a medical oncologist will walk you through the National Standard of Care the stage and type of lung cancer that your Mom has.

Stay the course.



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