lung cancer-operation - 1252777

steves
Posts:3

Dr. West,
I wrote to you on the 29th of nov.,2012. Diagnosed stage 4 nsclc with some sreading to some bone areas& lymph nodes. Did 2 different rounds of chemo. Had egfr marker & started tarceva. I did well for 1yr.& 9mos.
My tumor is where breathing tube & lung meet. Have struggled with bad cough yrs. before and after diagnosis. I had targeted radiation at that area, last scan 2 wks. ago showed no significant shrinkage. I still cough alot & very violently ,at times to the point of just about throwing up. My oncologist from the very beginning has said that an operation is out of the question because of being "stage 4" & also where the tumor is. Is it a steadfast rule to not operate on stage 4 patients? And also is it prohibitive because of where it is? I respect my doctor & all oncologists & the care they give. But I sometimes think some doctors become "pigeon-holed" in their thinking. My cough & shortness of breath have become intolerable.
Thank you,
steves

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Reply # - January 19, 2013, 11:46 AM

Dr West
Posts: 4735

I'm sorry that your cancer-related symptoms are so difficult. There aren't inviolable rules, and "unresectable is always in the eye of the beholder, but it sounds like it is probably in a location where surgery truly isn't feasible, and it would be particularly unwelcome to do a dangerous surgery that wouldn't be anticipated to provide meaningful benefit if the cancer is likely to progress in other places even before a person can recover from the surgery.

In these situations, we almost always favor radiation as the treatment of choice to shrink the cancer, as the best balance of reliable efficacy and minimal to modest side effects. I strongly doubt that surgery would be favored by any of the four thoracic surgeons I work closely with at my own center, even though I assure you that they all think highly of surgery as a concept and don't shy away from it when it's a sensible recommendation.

I'm not saying that you couldn't find someone to say yes if you seek enough opinions...that may be because they have poor judgment, they feel your desperation, or because they have a financial incentive to do surgery even when it's a poor choice. But I fear that surgery done under any of these situations wouldn't be a favor to you and would have a real chance of causing grave harm. I think it should be taken very seriously when a surgeon is disinclined to do surgery.

-Dr. West

Reply # - January 19, 2013, 02:18 PM

cards7up
Posts: 635

Steves, if you don't already have one, I'd ask for a palliative care doctor. They work with your onc to help relieve symptoms and side effects. Since you've already had radiation there, that may not be an option. But that is something only the rad onc can decide. Hope you get relief soon, as I know how aggravating a constant cough can be. I took care of my neighbor and she had a constant cough. They put her on prednisone (steroid) to help. Take care, Judy

Reply # - January 20, 2013, 06:21 AM

certain spring
Posts: 762

I'm really sorry to hear of everything you're going through - especially as your earlier post said the radiation had caused damage to the oesophagus, which sounds horrible. If the radiation was recent - and it sounds as if it was - it may yet help to shrink the tumour, as it "goes on cooking" for a while after the treatment is over.
The coughing can be hellish and I have had episodes where I was retching as you describe. (It sounds as if my tumour is roughly the same location as yours.) In terms of surgical procedures, I've had what they call an "interventional bronchoscopy" to clear out some of the tumour - but this is from the inside of the airway rather than the outside. Also, when my tumour was growing rapidly, they put in a stent to hold the airway open - that might be something to ask the oncologist or the surgeon about. It is only a delaying tactic but it does buy you time to find another treatment that might stabilise the cancer.
My best wishes to you.

Reply # - January 20, 2013, 09:41 AM

steves
Posts: 3

Dr. West,
Thank you for your thorough & thoughtful response.You are right that I feel desperation. I wanted an objective opinion & thats what you gave me. Would it be an appropriate course of treatment to have radiation again since the 18 treatments this last oct., nov. showed no significant shrinkage?
Thanks again,
steves

Reply # - January 20, 2013, 10:51 AM

Dr West
Posts: 4735

There may be room for more radiation, but a radiation oncologist directly reviewing your situation would need to provide that opinion. I certainly wouldn't discount the possibility out of hand.

-Dr. West

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