Hi. I just learned this week that my mother (71) was biopsied, then we learned the cancer was malignant. They did surgery on Thursday and removed her right lung--the cancer was worse than they had expected. Although seemingly limited to the right lung, it had metasasized within the lung. They say they think they got everything. Yet, she is still 3a. I guess the staging is because with metasases they think it probably has spread, even though the PET scan came back clear. Is that correct?
Is there anyone out there who has survived for more than five years after a 3a diagnosis with metasases and lung surgery?
I am so heartbroken. My mom and I have always talked on the phone everyday.
I am not really sure how to embark on this journey.
Thanks for listening.
Reply # - April 14, 2013, 12:55 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
Hello and welcome to GRACE. I'm sorry to hear of your mother's diagnosis. I'm also sorry that the surgeons found more cancer than they expected, but it is an important distinction that the spread was confined to the lung, which means it is potentially curable with the combination of the surgery she's already had as well as radiation (if necessary) and chemotherapy. Note I used the word "spread" rather than "metastasized", which is used to describe spread outside the organ in which the cancer originated. That does not appear to be the case in your mother's situation, and that is why she is stage IIIa (denoting the existence of local spread) vs. stage IV (which would indicate spread to a distant organ).
So the answer to your question, if you drop the word "metastasize" and insert "local spread" is yes, there are patients who are cured of stage IIIa lung cancer. Statistics in any stage of lung cancer are not good, and they are worse for IIIa than earlier stages, but patients are individuals and have varying results, and some are cured.
You may want to read Dr. Weiss' excellent "Introduction to Lung Cancer" at http://cancergrace.org/lung/2010/04/05/an-introduction-to-lung-cancer/ and then return with more questions.
Good luck with your mother's further treatment.
JimC
Forum moderator
Reply # - April 14, 2013, 01:05 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
Thank you so much Jim. It is not so much that I insist she have a cure, you know--I just want to know what is possible, how to lean my energy, if that makes sense. What you say about the local spreading rather than mets makes sense; though the surgeon uses the word mets, which is confusing.
I am so sorry about your wife's passing, about your loss. Thank you for using that experience to help others.
Heidi
Reply # - April 14, 2013, 01:07 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
Your comments also really help because I have been eaten up by the fact that they "took" her lung--that her quality of life will be impaired somewhat. If no cure is possible, this seemed so radical and potentially the wrong choice. But maybe the medical team is hoping for a cure. If the docs can hope, I guess I can too!
Best,
Heidi
Reply # - April 14, 2013, 02:36 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
Thank you for your condolences; I greatly appreciate them. You will find that the GRACE community is very supportive as well as knowledgeable.
And that is the general principle of cancer care: if all of the cancer can't be removed by surgery, then a risky, debilitating surgery is not favored. But in your mother's case, it is possible that all of her cancer has been removed, or that the small amount that may remain will be taken care of with post-surgery ("adjuvant") chemo. There is a GRACE FAQ on the subject here: http://cancergrace.org/cancer-101/2011/01/01/cancer-101-faq-i-have-meta…
How to approach the future with cancer is always difficult. Dr. West likes to say "prepare for the worst but hope for the best".
Hoping for the best for your mother,
JimC
Forum moderator
Reply # - April 14, 2013, 03:51 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
With the situation you described -- spread of the cancer to more than one location in the same lung -- it's really a tough call. As you noted, the consequences of a pneumonectomy -- removing the entire lung -- are significant, and it makes sense to do this only if there is a realistic possibility of cure. While saying "they got it all" implies that possibility, it's also too often a surgeon's reflexive battle cry, and it's not uncommon to see lung cancer surgeries undertaken that are somewhere in the range between ambitious and foolhardy.
To be honest, without having all of the information from films and pathology it's not possible to say whether her surgery was something that many of the best surgeons would agree is worth doing or whether it's something many or most would have been disinclined to do. But as Jim notes, there is at least more ambiguity (and therefore possibility for cure) if the spread is within the same lung than if it were spread more distantly to another site in the body.
Good luck.
-Dr. West
Reply # - April 14, 2013, 04:50 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
Thank you both so much for your thoughtful and prompt replies. I really so much appreciate them. The doctor is Dr. Eric L. Sandwith at Fort Walton Beach, FL Hospital. I don't know if we can discuss particular doctors, but if so and if we know anything about him...
Thanks so much again.
Heidi
Reply # - April 14, 2013, 05:53 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
Hi. I want to thank you both again.
I have read the articles on metastatic disease and must admit some disappointment and dismay that my mother now sits less able to face fighting a systemic disease.
Maybe the doctor had reason to think the metastases was precocious (if I understand that properly)? During surgery, all of the lymph nodes came back clear (though we're waiting to hear from the pathology post-op that was sent out of house). Her PET scan showed no evidence of disease elsewhere in the body.
She had a 2.5 centimeter tumor and then a metastatic mass about which I know only that it was between the second and third lobes, so to offer any possibility of a cure, the whole lung had to be removed.
Apparently, the doctor had not foreseen this possibility and so had not discussed the possibility with my mother. I worry that he was reaching for the cure he had suggested but that did not turn out to be possible. That said, he did tell my brother, who signed off on "taking the lung" that if the cancer had appeared anywhere outside of the lung, he would have just "sewn her up"...
Is it actually possible that the second tumor, the metastases, is limited to her lung? Dr. West have you EVER seen that happen?
Thanks again.
Heidi
Reply # - April 14, 2013, 07:28 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
As Dr. West stated, only your mother's doctors, with access to all of her medical records,would be able to answer most of your questions. But we can infer from their statement that "the cancer was all contained within the lung" and their staging as IIIa, that this is local spread within the same lung and not metastatic lung cancer. This is not unusual - at diagnosis my wife had a large tumor and multiple smaller nodules throughout all 3 lobes of her right lung (she was staged at what is now stage IVa only as a result of a pleural effusion, otherwise her cancer would not have been metastatic).
It's also good to remember that at the time of the surgical decision, it was believed that there was less cancer than what eventually was found, making the decision a bit simpler. It would have been ideal if you had known the extent of the cancer before your brother signed off on surgery, but often that is not possible.
JimC
Forum moderator
Reply # - April 14, 2013, 08:21 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
Thanks so much Jim. It has all been very confusing. I have asked why she was staged at iiia if the disease was only local to the lung and was told the staging was because it was metastatic--Language perhaps is slippery around these issues. My understanding is the metastasis is what gives her the staging, the bad prognosis compared with stage 2--so if a cure is possible because it is simply a "spreading" rather than a metastasis, why is she staged at iiia where the prognosis is so grim? Does the staging perhaps not account for "spreading" as distinct from metastasis? Does localized spreading really occur? The articles on metastasis suggest this is very rare. That actually it's likely spread at a microscopic level already. Another question: does the PET scan cover the brain?
My brother and my mother's best friend have access to the doctors; I am eight hours away and have been asked not to call, to receive my information through my brother and my mother's best friend for efficiency's sake. Also, it seems my mother does not want me to have full access to her medical status. She didn't tell me about the testing until this Sunday. She received the diagnosis Monday and had surgery Thursday. She's trying to protect me I guess. I'm not sure yet if she is right in this. I'm pretty obsessed by her situation--wanting to help yet helpless. And well, I guess fighting the point certainly wouldn't help her.
Again, I am so sorry about your wife. I cannot imagine what you have been through. I appreciate you taking the time to describe her diagnosis.
Heidi
Reply # - April 14, 2013, 09:19 PM
Reply To: Mother, Adenocarcinoma Stage 3a; right lung removed
The staging system is designed to cluster people with a similar prognosis over the next few years, but it doesn't really address the mechanism and semantics of metastatic spread, nor the possibility of cure. It's really not possible for us to get that into the weeds about details if staging in patients we don't know. I will say that while the risk is quite high for recurrence, it's possible for a cancer to be cured with surgery even if it appears to have spread to other lobes of the same lung. This is a situation in which chemotherapy would typically be recommended to reduce the risk of recurrence and improve the possibility of long-term survival.
A PET scan doesn't cover the brain well, because the brain takes up so much sugar just in normal operation. An MRI or CT scan of the brain (MRI preferred and offering more detail) are generally done as part of the staging process for people with higher than a stage I NSCLC (and is recommended for everyone with SCLC).
-Dr. West