The 2010 "General Work-up and Staging of Lung Cancer: What Do You Need to Know?" page on GRACE states that in stage 3 "Occasionally, surgery is offered for this stage of disease, but this is uncommon." Is it possible to know how often or under what circumstances surgery is recommended for 3B NSCLC patients?
In the archived 2010 forum thread titled "NSCLC 3b--is surgery an option?" I read of an example of someone's friend who had chemo/surgery/chemo + 6 months of Tarceva.
On another 2010 thread (this time about 3A: http://cancergrace.org/lung/2010/04/23/stage-iiia-n2-nsclc-summary-ref-…) I read Perry's comment describing surgery for his wife's recurrence 5 years after presenting with 3B.
3B I understand to be the same as N3 meaning lymph nodes are involved. Is surgery ever advised when lymph glands are impacted? Is it possible that after the agreed standard effective concurrent chemo/radiation is complete the lymph nodes can be clear even if a (smaller) mass is still present? I could understand taking a 3A approach at that point. In 2015 are there different reasons in I have not imagined to recommend the uncommon surgery for stage 3B? Are there any voices arguing these distinctions or is it an agreed upon non issue that continues to be rarely applied?
Reply # - November 2, 2015, 07:45 AM
Hi Amy,
Hi Amy,
What it really comes down to is whether it is anticipated that the possible benefit of surgery outweighs its quite significant risks, as well as the time needed to recover from it before receiving additional anti-cancer treatment. This recovery period is especially relevant if after surgery the cancer appears elsewhere in the body, but the patient cannot yet withstand the rigors of systemic therapy such as chemo.
Dr. Pinder discusses the differences in treatment between Stage IIIa and IIIb here.
I wish I had a more clear-cut answer for you, but it really is a decision that is made on a case-by-case basis.
JimC
Forum moderator
Reply # - November 2, 2015, 06:49 PM
Thanks JimC, as I keep
Thanks JimC, as I keep reading my confusion shifts from not understanding to understanding that it is not known and that the nodal piece generally makes things too murky for surgery to be worth it or a sure thing.
I did read the Dr Pinder's post as well as several from Dr West such as
http://cancergrace.org/lung/2015/07/20/many-faces-of-stage-iii/
http://cancergrace.org/lung/files/2014/04/Core-Principles-of-Managing-L…
http://cancergrace.org/lung/2015/09/09/gcvl_lu-e02_locally_advanced_nsc…
as well as the 2010 post mentioned in my opening post, but was still hoping to find some discussion of distinguishing factors leading to surgery or even Dr's who said they recommended it once at this stage.
Case by case it is. And thankfully there are many more options these days.
My dad I think "wants it out" and so scheduled a 2nd opinion visit with a surgeon. He is an active patient who wants to understand each choice made in his care. I'm hoping the Dr will have enough time to do that and if not I have some reading for him. :)
Reply # - November 3, 2015, 05:17 PM
I'm pasting an excellent blog
I'm pasting an excellent blog post on 2nd opinions, there's so much info in it I know you and your dad will want to read it. http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
I think if you read up on reasons for differing treatment options for stage III nsclc ask lots of questions (write them down and make notes, better yet record conversation) of your dad's 2nd opinion and onc you'll be able to pin down how best to approach treatment decisions. It sounds daunting but very doable.
Janine