What next?

[2young]

My husband, Pat, had an upper right lobectomy one month ago. We were relieved to find out that his lymph nodes tested clean and his tumor was staged at 1A (even though it was about 3 cm?) The surgeon said that he is basically cured and there is no need for chemo. We'll meet with his primary doctor (the pulminary specialist) in a couple of weeks. He too had previously said that a stage 1A would not need any further treatment other than occaisonal xrays. Neither have suggested we meet with an oncologist. Something doesn't seem right. The more I read, the more I see cancers reoccuring. I will continue reading, researching and asking. I'm wondering what any of you think? Who out there has been fortunate to have been dx at this early stage and what did you do? I'll add that Pat is otherwise healthy, young and fit 43 year old father of three (and a wonderful husband.

[Debi]

I had surgery and also was pronounced "cured" by my surgeon and Pulmonary Specialist. Both of them, plus my general doctor advised follow up CTs/or xrays every 3 months for 3 years.

My Pulmononary Specialist would have been happy to do the follow ups for me and in fact told me I didn't need an Oncologist, but he was 4 hours away and I wanted to find someone closer. I found an Oncologist here in town who, on my first visit, started discussing putting a port in my chest and starting chemo for 6 months. There was a study done last May that suggested that adjuvent chemo after surgery improved the survival rate among lung cancer patients.

I thought about what I wanted to do and decided to stick with the doctors that I trusted, who advised AGAINST adjuvent chemo. Although there are mixed opinions about this, the more that I have researched, the more that it appears that adjuvent chemo does nothing for Stage 1A lung cancer. There was a later study done in Italy which clearly stated that while adjuvent chemo was beneficial for Stage 1B and higher cancers, there was no evidence of benefit for Stage 1A patients.

I guess adjuvent chemo is a matter of choice but people on here that are smarter than me told me to stick with the doctor's opinions that I trusted. That's what I ended up doing and I have no regrets.......

[Donna G]

There are doctors working on tests they would find micrometastasis. The current advise is to have chemo for about 40 % will have regrowth from the tumor in the first year. http://ats.ctsnetjournals.org/cgi/conte ... t/74/1/278

This means that you also have a 60 % chance of total cure but many don't want to take the risk when they know and opt for chemo. Donna G

[Nancy B]

Hi,

I was staged 1B (tumor was 6 cm). They removed my upper left lobe and two oncologists who are considered to be lung specialists recommended no chemo and no need to have an oncologist. I had no lymph node involvement. It is my understanding that 4 years ago that was the thinking but drs are leaning toward chemo now for early stage. I recently added an oncologist to my string of "ologists" just to make sure we are on top of everything. I am now getting an x-ray every 6 months and a ct scan once a year. I have definitely had second thoughts over the years but the further out I get I guess I made the right decision. Get several opinions and go with "gut feel".

Wishing you the best and keep in touch. My prayers are with you and your family.

Nancy B

[chloesmom]

Chemo after surgery for a Stage I is certainly a personal decision. I was a Stage IB and decided to go with the chemo. I have no regrets. Although the benefits are relatively small (about 5% more of a chance of no recurrence) I will take every little percent I can get.

The recommendations I had from my surgeon, my oncologist, and a second opinion from an oncologist said to do it, and I'm happy I did.

Maybe if I had been a IA I would have made a different decision. I don't know.

I do know that all the opinions that I got said do it and they based their opinion on the study that was published last May showing the benefit of chemo post surgery.

I had to feel like I was doing something, and now that that's all over, I take supplements and try to keep my immune system up by eating right and getting enough sleep and exercise. Have to say, I feel great.

By the way, chemo was not nearly as tough as I thought it would be. I missed very little work and didn't feel too bad at all most of the time.

Good luck with whatever your decision is.

[mayos]

I had an upper right lobectomy last September. My nodes were clean...no spread....but the tumor was 3.7 cm which made it a IB. I chose chemo for that itty bitty 5% so I could stick around at least a lttle longer. Chemo was sickening for me on some days...and not so bad to me on others. But I believe I made the right decision. I guess in the end... chemo is just a personal decision you make inside your head and your heart.

[Eileen]

Hi ---I had upper right lobectomy ---in 6/00 ---nodes all negative , margins all clear and tumor 1.5 cm----

My surgeon said I did not need chemo but recommended that I see an Oncologist for another opinion---I did and he said no chemo, it would hurt more than help----also I think the latest study said there is a benefit if the cancer was stage 1B, at 1A it did not make a difference

The Onc and the surgeon both said my chances of it not re-occuring was about 90%.

It certainly is a personal decision---but I do think you should perhaps get 2 more opinions with Oncologists, then do your own research and decide from there

Also -- Donna can you please let me know where you are getting the stats that you sometimes quote ---that 40% of early stages reoccur in the first year---I read some of the summary of the articles on your link, but did not download the whole thing as I needed a password----can you please cut and paste and post here the 40% stats in the article? I would appreciate it---since that goes against the almost 85-90% survival stats for stage 1A patients that I read in other articles---it is hard to believe who is correct with articles saying contrary things

Thanks Donna

2young please keep us posted of your husband's decision about the chemo---and hoping for the best for your husband no matter what you decide

regards and good luck with your decision

[john]

http://www.lungcancerclaims.com/stage%2 ... wpage1.htm

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=12645726

Identifying patients at risk of early postoperative recurrence of lung cancer: a new use of the old CEA test.

Buccheri G, Ferrigno D.

Cuneo Lung Cancer Study Group, Divisione di Pneumologia, Ospedale S. Croce e Carle, Cuneo, Italy. buccheri@culcasg.org

BACKGROUND: In the current study, we report the carcinoembryonic antigen (CEA) capability to predict early tumor relapses after a pulmonary resection for nonsmall cell lung cancer (NSCLC). METHODS: We studied 118 consecutive NSCLC patients who were clinically judged operable and were eventually operated upon. Anthropometric, clinical, and CEA data along with the results of both preoperative and postoperative stage classifications were recorded. All patients were followed up for at least 1 year after surgery and the time to the first clinical recurrence recorded. Receiver-operating characteristic (ROC) curves and diagnostic formulas were used for data analysis. RESULTS: In this series the CEA test was among the most accurate methods to predict an early postoperative recurrence (ROC area: 0.72, 95% confidence interval [CI]: 0.60 to 0.85, p = 0.001; accuracy rate for CEA at the threshold of 10 ng/mL: 83%, CI: 76% to 90%). Also predictive was the postoperative pathologic stage of disease (ROC area: 0.68, CI: 0.56 to 0.80, p = 0.007). In tumors pathologically classified in stage Ia to IIb, a preoperative CEA level higher than 10 ng/mL was associated with a 67% probability of tumor relapse. In the same stages of disease, a CEA level less than 10 ng/mL increased the baseline probability of no recurrence from 80% to 88%. CONCLUSIONS: In operable patients with NSCLC the frequency of abnormal serum concentrations of CEA is low (17% in our series). However, it is important to identify such a small group of high-risk patients as many of them (in our study, 55% and 70% of those with a CEA value in excess of, respectively, 5 and 10 ng/mL) will develop an early postoperative recurrence. Such patients should be investigated preoperatively by mediastinoscopy or positron emission tomography in even in the absence of suspicious symptoms and signs. Then after an apparently successful operation, they should be carefully followed up. These patients could represent a suitable target for neoadjuvant clinical trials of selected high-risk groups.

Getting more info about the tumor can help. Find out the grade and actually type (adeno, squamous and there are others large cell neuroendocrine, typical carcinoid, etc.)

You should be able to find out the mitotic rate and possibly other markers such as a p53 mutation, CEA, etc.

Based on how aggressive the cancer is or not aggressive will help you make a decision.

Also there are a few trials on chemoprevention and early stage cancers that are testing drugs to prevent recurrence (Selenium, COX-2 inhibitors)

The trials are randomized, phase IIb studies designed to evaluate the effects of R115777, a farnesyltransferase inhibitor (STOP-FTI)

and Iressa.

These studies are very early and experimental, but it might be something you may want to look into. Also there are is a proteomic study (it tries to determine the proteins) in your body that are different than in a person without cancer in order to find markers and potential therapies.

This study won't help you now but may help in the future

I think it is wise to push for CT scans versus x-rays. X-rays usually won't find anything smaller than 2cm or so. There is a device called "rapid screen 2000" by deus technologies that will take an x-ray and digitize it and the results are as good as a ct scan

[mhutch1366]

I would think of it as similar to taking out insurance......

XOXOX

MaryAnn

[Eileen]

Dear MaryAnn---I guess I would have felt that way if my tumor was larger or I was stage 1B or if I knew that chemo would make sure it did not come back---

but chemo does not really kill anything if there are cells that are resistant--and it is not guaranteed---as we see here from the people that have chemo, the cancer still comes back---

chemo is toxic to the body --and sometimes the cure is worse than the illness-and while I believe in insurance, I would not take out a million dollar home owner's policy if my house was only worth $300,000

although I was not offered it at the time, If I went back in time, I still would not have it---(unless my surgeon and onc recommended it) but again it is a personal decision and hopefully everyone makes the choice that is/was right for them

best wishes

[Gyongy]

I was told that the chemo is not necessary for stage IA tumors. I am not sure this is the best for everyone but for me this is what I chose to do.

If I remeber correctly, the Japanese study that looked at this daae was looking at tumors classified in stage IA to IIB, so the differences could be attributed not only to the variety and agressive nature of cancer cells but the stage the person is in.

[Mark67]

Great news on the successful surgery, But some times you have to take things in your own hands don't always trust the doctors go get a second opinion it can't hurt. But from what they are saying it sounds accurate because the main reason you get cancer or the main reason it re-occurs is from a weak immune system and radiation and chemo actually poison your body in order to kill the cancer, the bad cells along with some good cells. So the best advice for your husband would probably be to live life and try to forget about the cancer he once had because more then likely it won't return, but eat a lot of Tomatoes they are suppose to prevent lung cancer from forming.

Mark

[jamie]

My outlook on this is that even if it only helps a minimal amount... its better than nothing. If the chemo can help a little, I would just do it. Anything to keep this monster at bay. Im no doctor, just my opinion...best of luck!

Jamie

[dave s]

Dear Friends,

I resisted the urge to respond to this post when it first appeared (quite some time ago). I am generally reluctant to inflict my opinions on others about controversial issues, BUT....

I see an attitude being expressed here which I feel is potentially very dangerous. The attitude is summed up best in Jamie's most recent post. I'm not picking on you Jamie so please don't think that. But it's important to consider the downside of treatment along with the potential gain.

Both chemo and radiation are toxic. They are designed to inflict the maximum possible damage to the targeted cells DNA. Their mission is to damage the DNA of the cancer cells so severely that they can no longer reproduce. They can't kill the cancer cells directly but they can and do cause so much DNA damage that they can't reproduce at all.

Now think about this in the context of the worst possible environmental exposure possible. Which do you think is more destructive, 50 pack years of smoking or a course of chemotherapy? Which one is more likely to cause additional future cancers?

My point is that both chemo and radiation are extremely high risk therapies. They are given rather freely in cases where they are percieved as the lesser of two evils. It is a mistake to overlook the fact that they leave behind their own permanent legacy of damaged DNA (and future cancers).

I'm sorry to be blunt here, but I cringe when I think people may be making treatment decisions about possible radiation or chemo as "it can't hurt".

It can and it does "hurt". It's a calculated risk and must be balanced carefully against the possible reward of stifling cancer growth.

Best Wishes,

Dave S

[EileenM]

I had an upper right lobectomy July 23, 2003. Lymph nodes were clean and tumor was quite small 1.3 x 1.5. I was also told being Stage 1A that no further treatment other than having Catscans with Contrast and CEA blood tests every 4 months for one year and then once every 6 months for 1 or 2 years and then once a year until I kick the bucket was all that was needed.

So far I have had good Catscans and CEA results. I also was told by my arrogant , egotistical surgeon not to go to an Oncologist because it wasn't needed and he would tell me what I needed to know. But I went to one anyway. The Oncologist(at same hospital) concurred with the surgeon about the treatment. Went to the Surgeon for one more follow up and when he didn't tell me about the 2 lesions on my liver I knew it was time to move on. The lesions have remained small with no change and are being followed along with the Catscans of the chest. My new Oncologist(closer to home) is knowledgeable and open to any and all questions.

I will admit I was concerned about not having additional treatment - not that I wanted to go through Chemo or Radiation treatments - but worried that maybe the Cancer would reappear. But with each Catscan and CEA blood test, I feel the right decision was made. When it's time for the next Catscan, I do get anxious. Used to have a lot of sleepness nights starting the month before but now I lose sleep only about a week before having it done.

Did Pat have VATS surgery? That is what I had.

I think if you can get a second or even a third opinion about treatment you will feel better about your decision on what to do.

Wishing you the best and a speedy recovery as possible.

EileenM