Good afternoon all,
You have helped me SO MUCH in regards to my husband's cancer, but now I have a question about my step-mom. She was dx 11/30/12 with squamous lc stage lll. She underwent chem/rads and had a partial response.
This is my concern: she has had zero treatment since, and won't even get a scan until September. She knows next to nothing about her condition.
Is there a standard of care for squamous? I've seen where people were put on cisplatin with gemzar.
She is 74 years old, and as far as I know, her performance status is fine. She did have a stroke about six years ago but has recovered.
This just doesn't seem right to me. I know you can't comment on her specifically, but there must be a standard of care for stage lll squamous.
Thanks again,
Holly
Reply # - June 12, 2013, 11:20 AM
Reply To: Squamous Treatment
Hi Holly,
I understand that since your step-mom doesn't have much information you don't either. Whenever a patient has been treated with chest radiation, it can be very difficult to determine the response by looking at a scan due to the scarring caused by the radiation. Without knowing more about what "partial response" means in her situation, it's hard to know what's going on. If there is an area that was not radiated and did not respond to chemo, then I would think further treatment would be considered. If everything visible was radiated and something still shows up on a scan, that could either be cancer cells or scarring from radiation, so that might be why her doctor is waiting before re-scanning - her doctor might want to wait until the picture becomes clearer.
So although you're correct that no one here can suggest a course of action medically, if there is an opportunity to discuss her situation with her doctor, you might want to ask what they're seeing that qualifies her response as partial. And of course there is always the option of a second opinion, which is often valuable in stage III lung cancer, since the management of such patients is often not clear cut.
There is a discussion of stage III squamous management here: http://cancergrace.org/lung/files/2011/07/grace-cases-stage-iiia-n2-nsc…
JimC
Forum moderator
Reply # - June 12, 2013, 11:41 AM
Reply To: Squamous Treatment
Jim,
Thank you so much.
I will forward this link to her daughter who lives in her state. It would be impossible for me to be at any of her appointments. I live in AZ; she's in NY, and my husband isn't doing well.
Holly
Reply # - June 12, 2013, 12:12 PM
Reply To: Squamous Treatment
As Jim summarized, for stage III NSCLC (squamous or nonsquamous), we typically give 6-12 weeks of chemo, along with about 6-8 weeks of chest radiation, either concurrently or sometimes sequentially, then need to watch carefully. It's rare to have the cancer just melt away -- even when someone has a great response and no cancer emerge as viable/growing over the next few years or ever, we typically see only a partial response and just can't know whether the remaining findings are viable cancer or dead/dying cancer that will never cause a problem. It's possible to do a biopsy if we're really impatient, but there's some risk with that, and it's very possible to get an inaccurate result depending on the small area sample. The vast majority of the time, we follow with repeat scans over time and jump in to do a more extensive workup if we see something that appears to be growing. If stable or shrinking over longer follow-up, we're happy with that and favor continuing clinical and imaging surveillance.
Good luck.
-Dr. West