limited small cell now calling it extensive small cel - 1248304

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limited small cell now calling it extensive small cel - 1248304

My 54 year old husband just finished his 6th round of sisplatin/etoposide. He also had double session radiation for 3 weeks. We had a brain MRI and lung scan last week and all was clear. Our next step was to to be PCI and to come back in 3 months. 2 days later he woke up with sever leg pain from his groin down his leg. The next night it came back so i called oncologist and he told us to go get MRI. MRI showed tiny lesions in pelvis and lumbar spine. Was called back from ER next day because when it was read they thought that it actually may be a fracture with swelling and so we went back for CT. Results of CT were they thought it was cancer. Saw Oncologist next day. Told us our limited was not extensive and my husband had between 7 months t0 2 years. We had a choice between taxol or a clinical. The did a pet scan and it took 36 hours for the radiologists at Dana Farber along with all his previous scans to finally come to the conclusion that it is the cancer. I was told that it was microscopic and that the rest of his pet scan was clean. We are wondering why we can't try to eradicate these microscopic legions. It seems to us that we should be able to be more aggressive. My husband is in excellent and handled the 6 rounds of chemo incredibly well. They are going to have us meet with the radiologist team for some palliative care for the occasional pain in his legs however due to the fact that the lesions are so small I really feel he may just have sciatica. We also don't understand why they can't radiate the lesions to try to get rid of them and why they can't continue with the PCI? Any input would be truly appreciated.

Dr West
Reply To: limited small cell now calling it extensive small cel


I'm sorry to hear about his recent progression/recurrence. If the cancer can be seen on scans, it's not microscopic. Unfortunately, if someone has metastatic cancer, the risk isn't just from the cancer you can see, but also from the cancer you can't see, because it must be traveling in the blood stream if it reached from where the cancer started to the place to which it spread. This means that it's like picking dandelions from a lawn: you're still going to get more, because there are other invisible seeds -- picking just what you can see doesn't solve the problem. Here's a post about this issue:

With extensive stage SCLC, it isn't realistically possible to cure it once it has spread and become extensive/metastatic (it may happen more often than never, but unfortunately it's extraordinarily unlikely). The fact that the metastatic disease has appeared just after completing 6 cycles of first line chemo also indicates that this cancer is resistant to the chemo that was just given, which means that it is typically harder to treat effectively. In general, the longer it takes for the cancer to recur after first line treatment, the greater the probability that it will respond to more treatment.

Radiation to the bone lesions may still be appropriate to treat pain related to the lesions and reduce the risk of a fracture. In contrast, PCI generally wouldn't be recommended if there is evidence of a more immediate issue of visible disease elsewhere that is resistant to recent chemo. In general, we don't worry about PCI unless there's no evidence of any disease elsewhere that would be a higher priority.

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