Possible strange issue(s)..?? - 1246852

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dkm5859
Possible strange issue(s)..?? - 1246852

I did search this site for "cough" and post operative thoro...and did read it. It was helpful but not competely fitting to this situation?.
My Mother who has been diagnosed with Stage IIIA aden had an attempted thoractomony on July 23rd and also a procedure where they cut the skin at her throat...sorry I can't believe I can not remember the name at this time) but she has primary lung with an original 1.9cm lung nodule, two meditasinal node involvement which are contiguous near the aorta no other involvement in the other nodes so far, had a contrast & non-contrast MRI to the brain and no metases were detected. She is scheduled to begin chem and radiology on 8/28/12 & planning on having surgery approx. (6) weeks after the chemo and radiology. She was 'mapped' for radiology and her port put in last week. She will be 70 on 10/18. Now...the issue.. at least five to seven days after her attempted thoractomony on 7/23/12 she has developed at times a chronic mainly hacking, normally non-productive cough. At times it had been productive with clear sputum. She is also hoarse at times also. Over a two period after 7/23/12 she was running a low grade fever...what could this be? I realize it could be the cancer affecting/causing this but she did not have any coughing as described above for awhile(meaning months) before the procedure and certainly not just within two weeks of the procedure... her PET scan had indicated a high uptake value could this cancer really be advancing this quickly god forbid where it is starting to invade other places in her lungs already like her bronchial tubes and such..god forbid??!!
...is a month a normal/customary time frame for starting chemo and radiology? Why so long?
Also is having radiology once a day for seven weeks along with chemo given during the same exact time frame with these same weeks too agressive or normal?
How often is surgery normally performed on 70 year old people after having chemo and radiolgy?
Thank you very much.

catdander
Reply To: Possible strange issue(s)..??

It isn't uncommon that people develop coughs after such surgery because of the irritation it causes. So that is very possibly what happened with your mom.

A fever is something you should let her team know about asap. That is found in many discussions with a search using the term "fever".

I'm not quite sure about your 3rd question about the PET. I think you were saying that PET showed high uptake before surgery? and you wondered if because of it, the cough, and fever her cancer is growing. If so, yes it could be but is probably is due to irritation from surgery.

Your mom needs to recover from her surgery before beginning treatment. A thoracotomy is one of the most demanding surgeries a person can withstand. In reality she'll be recovering for another several months.

This is a blog/post about balancing treatment risks and benefits, http://cancergrace.org/lung/2011/05/14/balancing-risks-of-undertreatment...

Your question about concurrent chemo and radiation has been the topic contained in a webinar linked to below. Also I've pasted a slide from the wedinar containing info about concurrent chemo and radiation.

http://cancergrace.org/lung/2011/10/03/lilenbaum-on-lc-in-elderly/
http://cancergrace.org/lung/files/2011/10/dr-lilenbaum-on-treating-lung-...

Final Conclusions – Locally Advanced
• Elderly patients have similar survival rates as younger patients
• Additionally, “fit”elderly patients appeared to benefit from the
more aggressive regimens (concurrent rather than sequential
therapy or RT alone)
• Elderly patients experienced more myelosuppression
• Elderly patients also experienced greater non-hematologic
toxicity: pneumonitis and esophagitis
• Future research should focus on decreasing treatment toxicity
especially in the elderly
• Elderly-specific trials may help delineate better treatment
approaches for these patients

I hope you post your last question separately.

catdander
Reply To: Possible strange issue(s)..??

dmk, please check your email for suggestions on future posts.
I hope your mom is doing alright.

Dr West
Reply To: Possible strange issue(s)..??

I'm sorry I can't say why she's coughing more. Sometimes the procedures themselves can lead to an increased cough, though that will usually be transient.

We'd generally want chemo and radiation to start as soon as possible, but it often takes several weeks, and even a month or longer, to go from the initial detection of the cancer to completing all of the staging, referrals, and then planning for chemo and radiation.

Chemo and radiation given together over 6-7 weeks is considered an optimal approach for people who aren't candidates for surgery, while about 5 weeks of chemo or chemo and radiation followed by surgery is often done for people who have cancer that is early stage enough to pursue surgery. There is a great deal of variability in how we approach stage III NSCLC, especially in older patients, and we essentially always need to do individualize the best treatment plan using some general principles. Here's some summary information about locally advanced (stage III) NSCLC:

http://cancergrace.org/lung/2010/04/23/stage-iiia-n2-nsclc-summary-ref-lib/

http://cancergrace.org/lung/2010/08/22/introduction-to-locally-advanced-...

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

catdander
Reply To: Possible strange issue(s)..??

Also I think if you go back through some of your other posts you may be able to glean something from a second reading.
Janine