Father diagnosed with "Stage 2a-2b" N1, M0 - 1254489

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Father diagnosed with "Stage 2a-2b" N1, M0 - 1254489

Sorry if this is the wrong place for this...

My father had a pneumonectomy on Friday and is doing very well in his recovery and is on his way home now. The preliminary path report came back yesterday and the doctor told my mother that it is "2a-2b" and that he did not expect the final report to differ. This is based on the tumor being 5-7cm and them finding cancer in (I think) one secondary lymph node in the lung they removed. We were told that it has not metastisized to any organs. Before the surgery he had another lymph node outside the lung biopsied which was negative and there is no indication that t is in any other lymph nodes.

Here is what I don't understand and I am hoping someone can help me with. Since from what I have been able to gather from reading online it seems like pneumonectomies are not exactly common so I am not sure how a lot of what I just described means to his specific case. I know the size of the tumor is relevent but is it less relevant since they removed the entire lung? From what I have read it seems obvious that it is stage 2b. I am not sure why the doctor couldn't tell them that and I am not sure what that means in regards to his overall prognosis. Does the fact that they removed the lymph node that had the cancer and none of the other lymph nodes have shown signs of being cancerous improve his prognosis? Or once it is in the lymphatic system it doesn't matter and it is treated the same way? Does that mean that this is really no better than stage 3 and the pneumonectomy was done in vain?

I know these are questions for the doctor but he is just getting out of the hospital and I am not sure when his next appointment is or with who so I was hoping someone could help. Thanks in advance.


Reply To: Father diagnosed with "Stage 2a-2b" N1, M0

Hello Scott and welcome to Grace. Nothing you've said sounds odd at all even your questioning for there are always questions it seems. Pneumonectomies are a standard practice it just depends on the circumstances so I wouldn't assume your father has been over treated.
As you probably know staging is done by tumor (T) size, Node involvement (N), and metastases (M). Type of surgery and treatment doesn't change that. All these ingredients have a baring on what treatment is most likely to be the most beneficial. In your father's case I'd assume it's surgery followed by 4 to 6 cycles of a platinum doublet chemo within 6 to 10 weeks. Though the chemo heavily depends on his ability to withstand it.
I'm not sure what you mean about surgery being needless in stage 3. It's very possible to have a cure through surgery in stage 3.

I will add links to a following post that addresses some of your questions. Please check out our extensive library as well as our search engine (with the search feature you may need to log out first though it is very worth it).

It sounds like your dad is in a very good place. Most lung cancers are found after they've metastasized (another reason pneumonectomy aren't often done).
All hopes for an all clear on cancer,
forum moderator

Reply To: Father diagnosed with "Stage 2a-2b" N1, M0

This blog post discusses node involvement,

A discussion on over vs undertreating. Not specifically your dad's case but the idea is the same, i.e. I hope you don't spend a lot of time about what can't be changed at this point lobectomy vs. pneumonectomy. There are disagreements among the most talented players in the field of lung cancer. http://cancergrace.org/lung/2011/05/14/balancing-risks-of-undertreatment...

on adjuvant treatment, http://cancergrace.org/lung/2010/05/17/systemic-therapy-for-resected-nsc...
and much more (you may need to log off this is a search result, depending on your browser) http://cancergrace.org/lung/tag/adjuvant-therapy/

You may have read through these pieces but if not please do and post any follow up questions you have for our faculty.


Dr West
Reply To: Father diagnosed with "Stage 2a-2b" N1, M0

I'm sorry to hear of your father's recent diagnosis and need for a pneumonectomy.

Sometimes a pneumonectomy is required because of the size or location of the cancer, but the prognosis is guided by the stage, not by the surgery. In other words, stage IIA has a prognosis that is a bit better than that for stage IIB, but it isn't the same as stage III just because a pneumonectomy was done. And a pneumonectomy can still be a very appropriate treatment to recommend with curative intent in some people.

There is a gradually higher risk of recurrence and death from lung cancer as the cancer gets larger, and it doesn't really have any cut-off levels. Just as a continuous variable, the larger the tumor, the gradually greater the risk of recurrence and death from the cancer. For that matter, there is some evidence that the same is true for the number of lymph nodes involved: people with one of 20 lymph nodes involved have a better prognosis than people with 10 of 20 nodes involved. But the staging system only uses a somewhat simplified version of these variables.

Still, the key question in this setting is whether it makes sense to do adjuvant chemotherapy in someone who is able to consider it. Based on both the size of the cancer and the presence of lymph node involvement (which, for the purposes of recommending post-operative chemotherapy, is mostly a yes or no question, not one of degrees), his cancer would be well within the range for which just about all experts would favor pursuing a cisplatin-based doublet chemotherapy combination if feasible. Beyond that, of course we'd want it to be a smaller cancer with no or a small number of lymph nodes involved, but these are variables we can't change. We can only address the issues we can exert some control over, and his cancer would be well within the range at which the risk of recurrence would justify a recommendation for adjuvant chemotherapy.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education