I am a returning customer. 3.5 years ago my dad was diganosis with NSCLC adeno T1N2 M0. I was reading this website and forum in the middle of night for months during treatment. My dad had 4 cycles of chemo, operation of remove left upper lobe and followed by 6 weeks radiation. Now 3 years he has been clear with CT scan. Knowing this websit and forum is a big part of our journey. I don't know how much i appreciate these.
Now one of my friend's dad got SCLC. He had operation and removed left bottom lobe. through the surgery, they said it was SCLC. There was no PET scan done so far.
I don't know much about SCLC, as my previous knowledge is about NSCLC.
My questions is 1. Is PET scan necessiry now to know whether it has spread?
2. Should chemo therapy followed the surgery for SCLC?
3. Is target therapy or immu therapy work for SCLC?
Thanks so much for the support of cancer grace.
Wed, 01/15/2020 - 14:05
It's so great to hear your dad's scans are clear! I know how exciting that is, my husband is lucky enough to have that distinction too!
I'm sorry to know about your friend's father. You're right that a pet scan is the best way to stage the cancer (see if it's spread beyond the primary tumor) and is the standard. But knowing whether or not this person has distant metastases won't change his treatment options...not to mention the stress of knowing could easily outweigh not knowing (Denial can be an excellent coping mechanism). The reasoning behind not doing a PET scan can only be explained by the treatment team. For instance, it's possible that surgery was the only way to get a tissue sample to get a diagnosis, though that's unusual. Again, this is what happened to my husband; his biopsies were undiagnosable. Sometimes cancer can't be diagnosed through conventional ways (see pp tests to diagnose lung cancer) and surgery could make sense to get a diagnosis. If that's the case then chemotherapy would be considered.
At this point, your friend's dad may consider chemotherapy much like stage I and II nsclc, sometimes it makes sense to add chemo to surgery or radiation especially since SCLC is treated more aggressively than nsclc. There is a time limit at which chemo can add value, I think it's somewhere around 6 and 12 weeks post-surgery to start chemo. It's also a very personal choice whether or not to add chemo to an already very invasive surgery. The added benefit may or may not outweigh the possible side effects.
I hope this is helpful,
Wed, 01/15/2020 - 14:32
From uptodate, "Brain radiation — The brain is a common site of tumor spread (termed metastasis) in people with small cell lung cancer. In patients with limited-stage disease who have normal brain scans after initial treatment (chemotherapy or chemotherapy plus radiation), preventive radiation treatment to the brain can substantially reduce the chance of developing brain metastases and prolong survival. This type of radiation therapy is called prophylactic cranial irradiation, or PCI. PCI is often recommended for people if the cancer in the rest of the body has partially or completely responded to the initial course of chemotherapy or chemoradiotherapy."
As for immunotherapy, there still are no standards the using immunotherapy in limited stage sclc. However there are clinical trials.