COPD and Lung Cancer - 1273053

hlw22
Posts:11

Are there any trials and/or strategies that can be used for lung cancer when the lungs damaged by COPD cannot tolerate standard treatments or even a needle biopsy of the lung.

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Reply # - February 24, 2016, 04:21 AM

JimC
Posts: 2753

Hi hlw22,

Welcome to GRACE. Without much background, your post raises a number of questions. First, if you can't tolerate a needle biopsy, is there a confirmed diagnosis of cancer? Only a biopsy can determine such a diagnosis for certain.

If you have an early stage lung cancer which would normally be treated with curative intent with surgery or radiation, I would want to be certain that those options truly are not feasible before discarding them. A second opinion, very preferably by a dedicated lung cancer surgeon (not one who performs a wide variety of surgeries and doesn't specialize) at a major cancer center affiliated with a top medical school. Such a surgeon would be best equipped to determine what can and can't be done in your particular situation.The same would be true with regard to the possibility of radiation.

If surgery or radiation is not possible, or if the cancer is advanced, your oncologist may suggest a targeted therapy (especially if there is an activating EGFR mutation or ALK rearrangement) or immunotherapy, each of which may be easier to tolerate than standard chemotherapy.

JimC
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Reply # - February 25, 2016, 06:05 AM

hlw22
Posts: 11

Dear JimC,

Thanks for your reply.

You are a voice in the wilderness of the web. I am getting another CT scan and then making an appointment at Sloan-Kettering (for a consultation at least) an under two hour train ride away. My present oncologist, a kind of circuit rider who visits different sites for PennMedicine, looked at my last CT, taken 3 months ago,and said the two nodules were slow growing, now 9.9mm & other 14.7mm (part ground glass, part solid with speculated edges) that it was in his mind cancer and that if I were his mother, he would want her to do nothing. There was not enough left of my COPD lungs to risk doing anything. I was told that at MSK, I would need to get a biopsy before I could see one of their oncologists. The first step, though, is to see one of their general surgeons before they decide which specialist I need to see. I will see the surgeon to see if he will pass me on to an oncologist and study without a biopsy. I doubt it.

I have spent hours on the web looking for relevant material. There is very little on survival of untreated Stage I and II non-small cell lung cancer which is what I assume I have. The only study I found was a small sample (39 people untreated with stage I&II NSCLC) from Dept. of Internal Med, U of North Dakota School of Medicine and published on PubMed. Results of Study:
Not much difference between the 2 stages. Mean survival was 11.9 months. (Authors: Chadha AS, Ganti AK, Sohi JS, Sahmoun AE, Mehdi SA. I am freaking out trying to adjust to that death sentence and getting my affairs in order. Not sure I can add a question here, but shall find out soon enough. What is more important in diagnosis of CT scan: SUV uptake or physical characteristics of nodules? Many, many thanks.
HelenW

Reply # - February 26, 2016, 12:43 PM

catdander
Posts:

Hello and welcome to Grace.

It's really not possible to know if you have cancer without looking at it under a microscope so a biopsy is needed. It wouldn't be hard to believe that the nodules you've described to be either malignant or benign. When there is minimal uptake in a PET the certainty is even lower. Uptake value or SUV describe how fast something is being metabolized, the higher the faster something is changing so you would expect a fast growing cancer to have a high uptake value. A low number suggest it's not growing fast. Inflammation and infection also cause nodules and SUV uptake.

Some cases of lung cancer prove be so slow growing that they never become a health risk and sometimes nothing is the best thing you can do. The only way you will know this is by waiting and watching. When someone has a comorbidity like copd there has to be a balance struck so the treatment doesn't become more harmful than the disease. Good doctors do this well but it takes understanding the whole person which is something our website isn't equipped to do.

As Jim suggested getting a second opinion gives you other options or at the very least gives a consensus and the comfort of knowing you're getting the best care.

I hope all goes well and the nodules just stay the way they are.

All best,
Janine

Reply # - February 26, 2016, 02:47 PM

hlw22
Posts: 11

Dear Janine,

I was so pleased to get an answer back to my second question. It helped answer an important confusion in information I had. It is also the first hopeful bit of news I have received in my searches. Let it be so! At the very least, these next few days will allow me to get done more easily some of the things I am in the process of doing in the event the prognosis is as grim as I have read it to be. This is a darn good site. Thank you. Helen W.

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