Question regarding post thoractomy (spelling) - 1244927

dkm5859
Posts:89

If cancer is determined/discovered/confirmed during/post surgery and I'm sure it would depend on staging but how quickly would chemo and or radiation be started? How many and or how long do these first and hopefully last cycles be needed if in fact a type of cancer is confirmed? I can give further details if need be of my mother's case so far. She is scheduled this July23rd... Thank you very much & God Bless.

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Reply # - July 11, 2012, 10:59 AM

catdander
Posts:

dkm, I'm so sorry your mother is going through this process. I so hope it isn't cancer.

They should know whether or not your mother has cancer before the end of surgery though there may be details that won't be known until more testing is done.

What happens afterward would depend on what is found.

One clear option (edit to say possibility, one possibility) if it is cancer is that it will be taken out completely or as much as possible. After recovery of around 4 or so weeks (timing depends) there may be what is called adjuvant treatment.
This is a blog/post by Dr. Wakelee in which adjuvant therapy is discussed.
http://cancergrace.org/lung/2010/05/17/systemic-therapy-for-resected-ns…

I think this is at least a good starting point. Let us know of further questions.

Good luck,
Janine

Reply # - July 24, 2012, 06:35 PM

dkm5859
Posts: 89

Hello again. My mother had her procedures scheduled to be completed yesterday. The thoracic surgeon decided to not follow through with the actual removal of the lung nodule. It was detected by chance on a X-ray. The CT's, a PET/CT was performed and a broncosopy prior to the the PET/CT. Anyway... I am writing this directly from the medical/discharge report. They discharged my mother today and with a follow up MRI and meeting/appt. with an oncologist and follow up with the thoracic surgeon. The thoracic surgeon stated that the cancer type is adencarcinoma and the lymph nodes biopsied were/are on the same side as the lung nodule. The T. surgeon stated that no cancer was detected in the central nodes of the chest. He did not state anything about the nodes on the opposite side of the body but he my have but I was not present at the time. If none was detected in the central nodes would that liklely preclude any mets to the opposite side nodes? Also the report states the lymph nodes biopsied were the mediastinal nodes but the report also stated that final pathology of the lymph nodes is pending. Would this mean the final pathology of all nodes tested and or they likely tested some of the lymph nodes fully during the procedure and found cancer or cancer findings and are waiting for all pathologies on all nodes tested...but for what specific reason(s)?
The next appointment is not until Aug 2nd... Is this a normal time lapse given the diagnosis and timing of the procedure? I was looking at a TNM classification table and from my non-professional background/education it appears at this point she might be/ is stage IIIa T1 N2 M0? I need to know what we need to do, what we should do, and or not to do and to expect. I realize this is a lot but like many other people my mother means so very much to me and I'd like and want to do only the best for her so she hopefully becomes NED. I've read that it should/will be a tough time. What are the statistics on Aden, chemo, rad..thank

Reply # - July 24, 2012, 08:34 PM

dkm5859
Posts: 89

some more questions... If they are conducting further pathology tests on the lymph nodes are they likely testing for the best possible chemo and or radiology therapies/plans. I hate asking this but how effective is chemo and or radiology regimens in curing or at least getting to NED status? Also if the cancer gets beat backed and nore diagnostic tests are performed before achieving a NED status can surgery be performed to remove the nodule and or lymph nodes. Also I just remembered as I do not think I mentioned this in my most recent post or within this one... there is apparently thyroid involvement....what or how does this affect and or change possible plans/staging? Also how quickly CAN and or SHOULD chemo and or radiology be started? Can they be and or should they be administered concurrently? I believe I read some place that radiology should be saved as a last resort option but it can be administered at the beginning of any therapies but if administered later... then the effectiveness of the radiology is usually lessened? I fully realize I have many questions but I thank you all very much for any input in advance from the bottom of my heart. Thank you again!

Reply # - July 24, 2012, 09:28 PM

dkm5859
Posts: 89

One last one....my mother's first cause for concern was an x-ray on 05/04/2...we have tried to schedule all of her appointments, tests and procedures as quickly as possible... It is now and or will be early August until actual treatment will be starting and the first actual "firm" diagnosis was just givenon July 23rd...my question is...is this the typical timeline most people receive/should expect as normal ...or should we seek out a specialty cancer center or a very large hospital that specializes in cancer? Please help and again thank you very much!

Reply # - July 24, 2012, 11:45 PM

catdander
Posts:

dkm, Welcome to Grace, I'm so sorry your mom has been diagnosed with nsclc. It's a terrifying diagnosis and I know you and the rest of the family feel the same way too.

I absolutely understand you want to understand it all, now. You will but it will take a bit. Read the blogs/posts I've linked to. Use the Grace search feature. There is so much written. Any other questions you have we'll be happy to help with. Please take time to read the forum guidelines first, they explain the hows and whys of the forum and why we can't answer your post as is. http://cancergrace.org/grace-discussion-forums#guidelines

http://cancergrace.org/cancer-101/2011/11/13/an-insider’s-guide-to-the-second-opinion/
http://cancergrace.org/cancer-101/2011/08/28/hallmarks-of-cancer/
http://cancergrace.org/lung/2010/05/12/general-work-up-and-staging-of-l…
http://cancergrace.org/lung/2009/09/09/clinical-versus-pathologic-stagi…

The time line is ok, especially if your mom's not developing symptoms. I don't know if she had open surgery or VATS (using a scope instead of a opening the chest). But she needs to heal from that before starting treatment.

I hope for the best for you mom,

Janine
forum moderator

Reply # - July 25, 2012, 10:28 AM

dkm5859
Posts: 89

She had the VATS & also apparenrtly a scope from the neck also as she has a large incsion. I do not have the report in front of me curently. If I offended anyone with my posts I apologize. I was just looking for information and input. Does adencarcinoma have subtypes of cancer also depending on different factors that may have led to its development like radon and such?
How treatable, NED or 'curable' if ever cureable is a stage III adencarcinoma patitent?
Are lymph nodes not affected at the time get affected very quickly with adencarcinoma? I guess how agressive or again is there subtypes with differring degrees of 'agressiveness'.
Is it true that radiology is 'normally' given after a first round of chemo or even a second round for patients with aden? Since radiology loses it efectiveness if given at the onset?
Are non sectable patients with adencarcinoma normally have worse outcomes with regards to survival rate?
They stated they would be testing the node samples further...are they profiling it / staging it to determine what specific plan of attack they should commence with or just staging it and the oncologist determines with other information after our visit with him/her? I just would like to know if they are likely already working on a specific plan of attack or will only be working on an actual plan after the office appointment?
I did read the posting guidelines and I tried to be more general but maybe I failed again. If I did I apologize.
God bless and take care. It appears you do wonderful work here from the limited time I've spent here and I'm sure you all have busy complex lives. Thanks for any input and information.

Reply # - July 25, 2012, 01:14 PM

catdander
Posts:

You've not offended anyone so no apologies needed. Everyone here understands where you are and it's bewildering at best.

We provide information through faculty written blog posts that cover everything from basic cancer work up and treatment to up to the minute findings on mutation targeted drugs and what the specialist are doing. The forum is here to help you fill in the gaps so you can construct a personal picture of your mother's case. The doctors who answer the questions have a full practices they attend to each day many do research in their specialty. Hence they have a very full schedule. Each one has agreed to answer questions upon request and in return we ask that your post contain 1 or 2 questions. As a moderator I try to see that the forum post fit that rule. I'm the one who will apologize for not being able to provide you with all the info you're seeking.

Stage III nsclc is curable even without surgical removal. Chemo alone won't cure cancer however it will enhance the possibility of a cure when given with radiation or surgery. I think the link below will help a great deal. It contains several blogs that discuss Stage III locally advanced nsclc. Some are about surgery which may not be as helpful as the ones that address unresectable locally advanced. At least that is what I understand you to say your mom has? http://cancergrace.org/lung/category/lung-cancer/core-concepts/locally-…

I think this will help,
Janine

Reply # - July 25, 2012, 08:01 PM

Dr West
Posts: 4735

I'm sorry I haven't had the opportunity to chime in here, but at this point, you've got a very large number of questions floating -- really too many to hope to tackle here -- but you've also been pointed in the direction of some very good resources for obtaining the answers to many of these questions.

I'd be happy to try to address one or two remaining high priority questions that you might have after reviewing the materials available here. We can't cover a long list of them, but if you can distill it down to the most pressing questions that remain unanswered by the content already here, feel free to ask, and I, one of the other faculty members, or another knowledgeable person in this online community will do what we can to help.

-Dr. West

Reply # - July 25, 2012, 08:40 PM

dkm5859
Posts: 89

I want to thank so very much again. The below are the questions I think are the most important currently.
She had the VATS & also apparenrtly a scope from the neck as she has a large incision. I do not have the report in front of me .
Does adencarcinoma have subtypes? Possibly depending on different factors that may have led to its development like radon and such?
How treatable, NED or ‘curable’ if ever cureable.... is a stage III adencarcinoma patitent?
Are lymph nodes not affected at the time get affected very quickly with adencarcinoma? I guess how agressive or again is there subtypes with differring degrees of ‘ If possible please let me know and thank you.

Reply # - July 26, 2012, 01:09 PM

Dr West
Posts: 4735

There are a few different subtypes of adenocarcinomas, but they are all treated essentially the same way, except perhaps for bronchioloalveolar carcinoma (BAC), which is a non-invasive form of adenocarcinoma that can follow a more indolent pace of progression. There isn't really enough known about the subtypes to assign different causes to one vs. another, except that BAC is less well associated with tobacco exposure than other forms.

Stage III NSCLC is cured about 20-25% of the time. Stage IIIA NSCLC is more on the higher end there, and stage IIIB is more in the lower part of that range.

Adenocarcinoma tends to have a greater tendency to spread distantly than squamous NSCLC, but I can't really answer your last question except to say that the hope is that treatment is associated with no progression of disease beyond where it starts, and only regression of the existing cancer.

Good luck.

-Dr. West

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