Need Help, Confused

[Mouse424]

On 6/18/04 had right upper lobectomy due to a 1.4cm nodule. When patholgy came back I was staged 1a small cell lung cancer. When in the hospital I thought all Dr.'s were on the same page with treatment. Yesterday I went for my two week checkup with surgeon and he is against chemo. Oncologists I am seeing on Monday want me to do it. I am the fourth person in my family to get cancer. My Brother died at 37 after an extremely brave fight. I know I am extrememly lucky for my cancer to have been found so early. I also have extensive emphysema. This slowed down the sealing of lung after lobectomey. I was in hospital for 13 days and had the chest tube in for 12 of them. I was all set to start chemo and now I don't know what to do. My husband and I are going to get two more professional opinions but were wondering if anyone had any thoughts. I am a 42 year old Mom with two wonderful kids and an amazing husband. Does anybody know where I can find some information on this. If it will improve my odds, I will gladly take the chemo, but if it is just me being a guinea pig, I think I will pass. I have seen what chemo can do and can't do. If anyone can be of any help, I would greatly appreciate it.

Cathy

[Remembering Dave]

Cathy, I have been told that Small Cell is not much effected through surgury but does respond very well to chemo. I do not see where you ae from in your signature but I think you should go to a cancer center for a 2nd opinion. Like I said Small cell eacts very well to chemo and even though you have had surgury there could still be cells floating around. Please keep us informed how you are doing. My prayers are with you.

David C

[Rachel]

Hi Cindy,

Good thing you found us here. There are many very knowlegable, Kind & helpful people on this board. I had SCLC also. No surgery as what Dave said is true. NSCL seems to react with surger & SCLC reacts very well to chemo.

I really didn't feel to bad on chemo. Radiation was a little tougher but Hey, anything to scare the beast away is worth some discomfort for me.

Only you can make the desion that is best for you,but, in your limited stag I would go for chemo again. All my best to you & your family. Please let us know with a post hoe your doing. Rachel

[Elaine]

I am kind of surprised they did surgery on your small cell or maybe they didn't know what kind it was before they went in? Pls check with your onc as to the type of lc you have and listen to what he has to say about chemo.

It's all kind of stressful and confusing, but knowledge is power.

love to you

elaine

[Donna G]

I am confused also. You say you had Small Cell but say you were Stage 1A. Small cell is either limited or extensive. I have never heard it "stage" the way NSCLC is staged. With either I believe the latest studies recommend Chemo. Donna G

[Remembering Dave]

Yes, everyone here is making good points. Small cell is never staged by numbers, just by limited (just in the lung) or extensive (has spread outside the lung). Also, surgery is almost never done for small cell unless it was caught VERY early and they're SURE it is very isolated. Small cell, especially if caught early, responds very well to chemo and radiation. very well. so if it is small cell you want the chemo. it is a very fast growing cancer so you won't the chemo to hunt down any stray cancer cells that's in your bloodstream.

I'm just repeating what everyone said.

I would get a copy of everything in your file at the doctor's office and look it over AND take it to a major cancer center like Dave said for a second opinion. and come back here and give us more information. I'm really curious about this.

Take care and hang in there.

Karen C.

[daggiesmom]

In my case, i was limited sclc and the recommended treatment is chemo/radiation done concurrently. No operation. I am now 27 months out of diagnosis and feel quite well. Please get a second opinion.

Joanie

[Cindy RN]

Second opinion!! sclc is staged either limited or extensive so if they said stage 1A then I would question whether it was sclc OR nsclc. Get your files and see another DR before you make a decision. Chemo works well against sclc. I am now 3 1/2 yrs from diagnosis.

Cindy

[john]

I think Katie is right. Surgery is done sometimes for limited SCLC.

That is good, since you were Stage IA it is T1N0M0. No mediastinal mets and no metastasis and the tumor is under 3cm.

I would find out about some type of adjuvant therapy. Whether it is chemo or something else. With chemo the 5-year survival for resected SCLC stage I is 60% or more. one article said 60 the one below said 71%!

http://jtcs.ctsnetjournals.org/cgi/cont ... t/88/4/495

http://ats.ctsnetjournals.org/cgi/conte ... /70/5/1615

Sometimes doctors will use the TNM staging for SCLC - It gives a more detailed stage than just limited or extensive

[qoute]

Staging Small Cell Lung Cancer

Staging for small cell lung cancer can also use the TNM system. However, small cell lung cancer is generally classified into only two stages.

Limited small cell cancer is confined to one lung and to its neighboring lymph nodes. This corresponds to TNM Stages I through IIIA.

Extensive small cell cancer has spread to both lungs, more outlying lymph nodes, or other organs. This corresponds to TNM Stages IIIB (primarily when it involves the lung lining or fluid) and IV.

[/qoute]

http://www.bccancer.bc.ca/HPI/CancerMan ... edSCLC.htm

Treating Super-Limited Small-Cell Lung Cancer?

Question

A 67-year-old male smoker presented with pneumonia and was found to have a 5-cm peripheral RUL mass. CT-guided biopsy was inconclusive. He underwent RUL/RML lobectomies. Pathology revealed small-cell carcinoma morphology with a large-cell component (synaptophysin positive). All initial staging studies were negative; the mediastinum was not evaluated. Should the tumor be treated as a small-cell or as a non-small-cell carcinoma? Is there a role for chemotherapy?

Response from Corey J. Langer, MD

Associate Professor, Temple University, Philadelphia, Pennsylvania; Medical Director, Thoracic Oncology, FCCC Oncology Department, Temple University, Philadelphia, Pennsylvania

Fewer than 3% of patients with small-cell lung cancer (SCLC) present with super-limited, resectable disease. The prognosis in this group, stage for stage, matches that of non-small-cell lung cancer (NSCLC). Nevertheless, the small-cell morphology, despite admixtures of large-cell histology, merits a "small-cell approach." Given this, it makes sense to treat the tumor as SCLC.

Surgery has been shown to have a real, but limited role in SCLC[1,2] and in isolated thoracic relapse.[3] In a phase 2 trial, Japanese researchers assessed the role of adjuvant therapy with etoposide and cisplatin (EP) in patients who underwent resection for SCLC.[1] Over a 5-year period, 62 patients from 17 different medical centers with stage I-IIIA SCLC underwent surgery; all but 3 underwent lobectomy. Four cycles of conventional EP were planned and 69% of patients completed adjuvant EP. The 5-year survival for the 36 patients with stage I SCLC was 71%; for the 25 patients with diagnosed stage II and IIIA SCLC, it was 38%.

This trial substantiated the role of surgery in super-limited SCLC, and also established a reasonable paradigm for adjuvant treatment in this relatively rare group of patients. However, since it required years to accrue to this effort, the number of patients who present this way would most likely be insufficient to mount a formal phase 3 trial.

Unfortunately, the final stage in this case is not available. More seriously, this case is complicated by the absence of formal mediastinal evaluation, which, in my mind, would be tantamount to the absence of axillary node sampling or dissection in breast cancer. If viable mediastinal nodes persist, then the addition of local mediastinal radiation therapy would be advisable. It is disingenuous to believe that chemotherapy alone can control residual mediastinal involvement, if present.

Under these circumstances, there are several options:

Empiric therapy with concurrent chemotherapy and radiation to the mediastinum;

Positron emission tomography (PET) scanning to evaluate for residual mediastinal disease (if negative, consider chemotherapy alone);

Mediastinoscopy (if negative, defer radiation)

We would strongly consider both invasive and noninvasive evaluation of the mediastinum and, if both PET and mediastinoscopy proved negative, then adjuvant chemotherapy alone would be warranted.

Posted 07/24/2002

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

References

Suzuki K, Tsuchiya R, Ichinose Y, et al. Phase II trial of postoperative adjuvant cisplatin/etoposide (PE) in patients with completely resected stage I-IIIA small cell lung cancer (SCLC):The Japan Clinical Oncology Lung Cancer Study Group Trial (JCOG9101). Proc Am Soc Clin Oncol. 2000;19:492a. Abstract 1925.

Shields TW, Higgins GA Jr, Matthews MJ, et al. Surgical resection in the management of small cell carcinoma of the lung. J Thorac Cardiovasc Surg. 1982;84:481-488.

Shepherd FA, Ginsberg R, Patterson GA, et al. Is there ever a role for salvage operations in limited small-cell lung cancer? J Thorac Cardiovasc Surg. 1991;101:196-200.

[Guest bean_si (Not Active)]

From my research, staging is sometimes done for SCLC. Surgery is also done for very limited, small SCLC. Chemo is usually a follow up option, most especially with SCLC. I'd get a second opinon on the the chemo if you can.

Cat

[Elaine]

You are right: surgery is sometimes done and so is staging. I still think she should check to be sure.

elaine

[john]

1) Make sure you get a 2nd opinion on the pathology report. Sometimes it is difficult to distinguish SCLC from other neuroendocrine tumors

2) You might want to ask about PCI also

prophylatic cranial radiation.

3) Also ask about topotecan

http://www.docguide.com/news/content.ns ... AD00722E5A

http://www.guideline.gov/summary/summar ... oc_id=3651

Treatment of Limited-Stage SCLC

Patients with limited-stage SCLC should be referred to a radiation oncologist and a medical oncologist for chemotherapy and radiation therapy. Level of evidence, good; benefit, substantial; grade of recommendation, A

I am not a doctor, but keep on researching and keep on asking the doctor questions. If you feel the doctor is not being helpful or can't work with her/him then find another one

[Larry]

Hi Cathy and sorry your found with sclc but i must chime in with every one else and that is sclc respond's very well with chemo.Example my wife was DXed stage 4 sclc in april with met to liver and 3.5 cm lung tumor.after 3 rd's and new cat scan's done in june the tumor was almost impossible to spot and the liver was clear,and now she just had another exam with good result's ,so please get that second opinion and take Chemo if your health will permit,and it all depend's on the onocologist whether they stage sclc.

Larry

[Mouse424]

Hi Everyone! I can't thank you enough for all your support. I went to my oncologist with my husband yesterday armed with many questions. Unfortunately he was very defensive. There were many things he had wrong in my case. First was that he had my father as deceased second was diagnosis. I have Stage 1A Non small cell carcinoma poorly differenciated. the Tumor was 1.3 . Also the Chemo he had suggested I can't take because due to prior GERD surgery I am unable to throw up. He now suggests carboplatin and taxol. I am awaiting information from my insurance company for receiving second opinion. I will be going to Sloan Kettering for Second opinion. The oncologist states that because my cancer was found so early my stage has been in no trials and that there is no proof it will do anything because there are no studies on 1A. Needless to say my confidence in his opinion isn't high. I just wanted to keep everyone updated and give a great big thank you to everyone. You are all in my thoughts and prayers.

Cathy

[Donna G]

There have been studies showing that people with diagnosis originally as Stage I may benefit from chemo.

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

[Donna G]

There have been studies showing that people with diagnosis originally as Stage I may benefit from chemo.

There are doctors working on tests that 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

[Andrewsmom]

I would suggest a second opinion. Everything I've read says that recent studies are indicating chemotherapy as a follow-up to surgery should become protocol. I recommended this to a friend. She went to Johns Hopkins to discuss it and they absolutely recommended it based on recent studies. I would think this is especially important for SCLC since it is more sensitive to chemotherapy than surgery.

[Hebbie]

I would concur that a second opinion is in order. All research over the past year has indicated that surgery, followed up by Chemo for Stage I is beneficial.

Here is just one of the many articles on the subject:

Postop combination chemo prolongs survival in early NSCLC

Megan Rauscher

Reuters Health

Posting Date: June 9, 2004

Last Updated: 2004-06-09 10:28:49 -0400 (Reuters Health)

NEW ORLEANS (Reuters Health) - For the first time, a large, prospective, randomized trial has shown that adjuvant combination chemotherapy significantly prolongs survival of patients with completely resected early-stage non-small cell lung cancer (NSCLC).

In the study of 482 stage I or II NSCLC patients, mean survival was 94 months for those receiving 16 weeks of vinorelbine and cisplatin in combination after surgery compared with 73 months for those receiving no adjuvant chemotherapy after surgery, the current standard of care. Recurrence-free survival was also significantly longer in the vinorelbine/cisplatin group.

Sixty-nine percent of the vinorelbine/cisplatin group survived at least 5 years compared with 54% of the surgery only group. Patients tolerated the vinorelbine/cisplatin well after surgery.

"This study should solidify opinion in favor of changing the standard of care for these patients," Dr. Timothy L. Winton of the National Cancer Institute of Canada said in a statement from the American Society of Clinical Oncology (ASCO), where he presented the study.

"A 15% overall survival benefit 5 years after surgery and prolonged disease-free survival in this population are major advances," he added.

In other NSCLC news at ASCO, researchers reported that second and third-line treatment with the EGFR tyrosine kinase inhibitor erlotinib (Tarceva; OSI Pharmaceuticals) improves survival by 40% in patients with advanced or metastatic NSCLC who have failed standard therapy.

"This is a new, well-tolerated oral treatment for patients who previously had very few options," said Dr. Francis A. Shepherd of the Princess Margaret Hospital in Toronto, Canada. "Patients treated with erlotinib in our trial not only lived longer, but they also had better quality of life."

Dr. Bruce E. Johnson from Dana-Farber Cancer Institute in Boston and moderator of an ASCO press briefing on lung cancer said these studies provide "important new information" that could change the practice of lung cancer.