My father is 65, was diagnosed in November. 3CM in the lower left lobe of the lung. They thought it was stage 1 at the time, and resected in January. They got clean margins in all directions, but found that the tumor was actually on the outside of the lung, not the inside. And they also found cells outside of the Tumor, including 1 cell just .25" from the Ribs in the Chest Wall. But, 100% clean margins. Because we thought it was Stage 1 and knew that that meant a really strong prognosis we were happy.
Today, we found out that because it had spread to the chest wall it became a T3 and technically Stage IIB. Despite the small size and that it had barely spread at all.
Surgery went pretty well and his recovery has gone well though slow. Doctor today recommended Olimta and another paired drug for a course of chemo that is preventative. This is the protocol for Stage IIB.
My questions:
-What about the spreading into the Chest Wall makes this go from a Stage I to IIB? Why not IIA?
-The doctor has referred to a 5% change in prognosis due to this course. Chance of recurrence I guess is right around 50% and having the chemo would reduce that to 45%. What is this based on? This type of cancer in this place with this type of spreading? Or all IIB's?
-Are there differences between this type of IIB and others? If so, what are they?
-Any clinical trials that might be worth looking into for this type of preventative treatment?
-Finally, the doctor has asked that my father start Chemo right away (next week which would be Week 6). He has a strong sense of urgency about it. Why is this so important? If there's only a small chance that cancer broke off and started to multiply, wouldn't it be slow-growing? Why is 6 weeks so important? My father could use a few more weeks to get stronger before such a step, which is why I ask.
Thanks so much!
JT
Reply # - February 12, 2013, 10:02 PM
Reply To: Chemo after Surgery to remove T3NOMO Adenocarcinoma of
JT, I hope your dad does well. Adjuvant chemo (chemo given after surgery for curative intent) needs to be given as soon after surgery as possible. It will help his chances of a cure. The difference in the stage would be because the tumor entered the chest wall making it more likely to spread.
Dr. West has just released a video that may describe just what you're asking. I've not watched it yet. Note the other links that follow the video, http://cancergrace.org/lung/2013/02/11/cip-adjuvant-chemo-for-smaller-h…
This is the link following focused cancer info/lung cancer/stage I and II, http://cancergrace.org/lung/category/lung-cancer/non-small-cell-lung-ca…
I hope this helps answer your questions,
Janine
forum moderator
Reply # - February 13, 2013, 08:29 PM
Reply To: Chemo after Surgery to remove T3NOMO Adenocarcinoma of
The staging is based on a detailed assessment of the tumor characteristics, presence and location of any lymph nodes involved, and any distant spread. However, we can't provide details of what the staging should be without seeing all of the details of the pathology report (and we also can't review that here, so please don't upload it).
The prognosis is based on the stage, and patients with a particular combination of characteristics are grouped together because they all share a similar prognosis: that's really how the staging system is refined over time. Experts look at how different people did, tracking back to figure out the right combinations of patients that all seem to share a similar probability of survival over time. Because of that, there aren't significant differences in survival within the same stage, though those with a higher T stage and lower N stage are less likely to have distant spread.
As I indicated in my video, there is some judgment in whether to recommend chemotherapy or not, but if a patient is felt to have a high enough risk of recurrence, chemo would have a meaningful chance of reducing that risk in most cases.
One of the larger clinical trials is ECOG 1505, which randomizes patients to standard chemo with or without a year of the anti-angiogenic agent Avastin (bevacizumab). There are some other trials out there in the world, really scattered here and there, and too many to mention every possibility, but ECOG 1505 is among the most important being done right now in North America.
-Dr. West
Reply # - February 13, 2013, 08:31 PM
Reply To: Chemo after Surgery to remove T3NOMO Adenocarcinoma of
One more thing. About the timing, post-operative chemo is typically started in the range of 5-7 weeks after chemotherapy. Though there isn't anything magical about the 6 or 7 week point, the longer someone goes, the more risk there is that micrometastatic disease might grow. Patients are typically still recovering but over the hardest part of the post-operative process by then, and the clinical trials proving a value of chemo all focus on starting the chemo within 6-7 weeks after surgery.
Good luck.
-Dr. West
Reply # - February 14, 2013, 07:04 PM
Reply To: Chemo after Surgery to remove T3NOMO Adenocarcinoma of
Dear Dr. West,
Please explain your comment: "Those with a higher T stage and a lower N stage are less likely to have distant spread." I have never heard that before. So a T4 N0 M0 is not as lethal?
Thanks again,
Holly
Reply # - February 14, 2013, 08:12 PM
Reply To: Chemo after Surgery to remove T3NOMO Adenocarcinoma of
Staging groupings all share a comparable prognosis, so it's not that it's more or less lethal, but that it tends to grow by local spread more than distant spread. The problem is that a cancer growing into the trachea or heart is just as bad as a cancer with distant spread to the liver, adrenals, etc.
-Dr. West