Mom is now stage 4 - question on tumor location - 1250016

Hello Carrie
I've pasted your bio to the bottom of this post to give the doctors a look at it. Please add it to your signature so it shows up on your posts for future reference. Click on your user name to access the "forum profile" to add bio to signature.

As far as managing side effects your mom should carefully follow the doctor and nurses orders. It helps to have someone at home to help also. And make sure the team at the cancer center is aware of all new problems as to stay ahead and on top of them. Lastly once she starts treatment I think she will feel better about it.

I'll contact a doctor for input on your questions about tumor position.

As for other ideas to mitagate side effects check out our cancer info links at the top of the page.

Much luck to your mom and I hope you get your permissions to speak with the team in place soon.

Mom 61 yr old w. systemic lupus;42 yr smoker; 2x breast cancer survivor 25yrs (treated with rad both times); Spot found too small to biopsy 5/2010. Follow up scan confirms growth; Biopsy 2/8/2010 confirms Aednocarcinoma w. N1 involvement. Surgery 3/8 & 3/14, rt. upper lobectomy, then 4cm more of middle lobe due to N2 involvement. Stages IIIA. Chemo not recommended due to health issues-Rad not possible due to previous Rad tx. Monitoring only. 10/12: spot on chest x-ray discovered. Follow up PET shows spot and additional location in "throat"; Bioposy scheduled 10/31 and results due 11/2.

So if this is metastatic lung cancer, the treatments like gamma knife and cryosurgery really aren't used the way local treatments would be done for a primary cancer in the neck (one that starts there and hasn't spread elsewhere). The general treatment approach for metastatic lung cancer is still primarily systemic therapy like chemotherapy, or a targeted therapy often as a first treatment strategy if the person has a "driver mutation" like an EGFR mutation or an ALK rearrangement.

There are many broad recommendations, really too many to cover here, but primarily we say to stay focused on more bland comfort foods to minimize potential for nausea or development of conditioned taste aversions (an association of a certain food with nausea that a person experiences at the time). Some chemo leads to taste changes that make some foods taste metallic, and some say that lemon drops help with that. If someone has mouth sores or other reason for tenderness in the mouth or throat (such as from radiation in the area), softer foods are certainly easier to swallow. Otherwise, we want people to ensure they're drinking enough, which is a higher priority than eating a lot every single day -- a body can go without a lot of food transiently, but we can't go for long without drinking.

We want a person to have a thermometer and to call the doctor any time someone on chemo has a fever. Because it can possibly be life threatening if a person with low blood counts has a fever (because they can't defend themselves against a bacterial infection), we typically urge that a patient call us with any fever, whether it's day or night, weekdays or weekend.

-Dr. West

Hi Carrie. I think it's fair to say that anything that might obstruct someone's airway is harder to deal with than something that's deep within the lung. It presents more immediate problems - as your mother is already finding when she's coughing up blood. And obviously it makes it harder to breathe. (I have a tumour that threatens my airway - not in the throat but at the entrance to the lung.)
On that subject, the coughing up of blood (haemoptysis is the technical term): although it is frightening and distressing, and should always be reported to her doctor, it isn't life-threatening. I cough up blood routinely, even though I am physically well. I coughed it up when the cancer was growing and I cough it up now I am stable. It is definitely something one can learn to deal with. It helps to be reassured that nothing terrible is happening.
It's great news that your mother has been tested for mutations, and I hope that yields some useful information. If she is frightened about the location of the new tumour, it might be worth asking whether her doctors would consider local radiation if it becomes a problem. I see she has already had radiation, but it might be possible - I had radiation to the whole lung and then, six months later, targeted radiation to the tumour. It's only a short-term measure but it can ease any discomfort.
Best to you and your mother.

Just to clarify, there are varying degrees of hemoptysis, the symptom of coughing up blood, and in some patients it can be a high enough volume that it can even be life threatening or fatal. That's far less common than coughing up just a small amount of blood. Radiation is often the best treatment for that, and radiation can also typically do a good job of shrinking a bulky cancer that is narrowing an airway.

-Dr. West

Thank you for the clarification, Dr West. I did make the point that it should always be reported to a doctor. However I know from my own experience and from people on GRACE that coughing up blood causes a lot of worry, some of which may be needless. One can cough up dead tumour cells, for example.

My mention of it is pretty picayune, just to say that it's possible for it to be life threatening, but you're absolutely right that coughing up a small amount of blood is both common and typically not particularly dangerous.

-Dr. West

Carrie, I think if you search this site, use our search function (you may need to log out first), use the Cancer Info links in the green column at the top of the page, and our FAQ you will find as much info as there is to have on lung cancer.

I understand you compare other experiences with what may be your mom's so read my husband's history at the bottom of this post. He is doing well after a very rocky start 3 years ago. It can turn around.

Just to get you started, there's an FAQ about how response to treatment is assessed:
http://cancergrace.org/cancer-101/2010/09/16/cancer-101-faq-assessment-…
Do you know what chemotherapy is being proposed for your mother? I think you will feel easier in your mind when you know the results of the mutation testing.
If you're a "doer", I can understand that this situation must be very uncomfortable for you. Family members on GRACE often feel desperately frustrated at being so powerless, and compensate by trying to learn everything there is to know. Learning to manage your stress levels is important.
As to not knowing what to say: in a way there's nothing you can say - your mother is a cancer veteran and must be fully aware of what this all means. Perhaps she isn't ready to talk about it yet. But you will help her without even trying - just by virtue of being her daughter and showing that you love her.

Thank you certain spring for you help. It, like you, is invaluable.

A typical cycle of chemo is 3 weeks, sometimes 4 weeks, depending on the combination, and we typically check a repeat scan after 2-3 cycles. You're unlikely to get a clear signal of the direction of things in less than about 6 weeks, and beyond about 8-9 weeks, you run a risk of continuing an ineffective therapy for too long without knowing it.

Good luck.

-Dr. West