Stage IVa, after three period of GP, Is it necessary to do a surgical operation? - 1247367

Good morning Sefier. I'm sorry to hear about your father. The doctors will try and answer your questions if you can help us with a couple of points.
1) It would be helpful to understand what you mean by "GP". Is this radiation? Chemotherapy?
2) Also we need to understand better your reference to "stage IVa" and surgery. At Stage IV, the cancer has spread beyond the lungs, and that usually means that it is too late for surgery. I'm not sure there is such a thing as Stage IVa, although the earlier stages are divided into a and b: for example Stage I a and b, Stage II a and b, Stage III a and b. Could you check your father's diagnosis for us? And is his cancer in both lungs, or one (you said "the other side of the lung" and then mentioned "two original cancers")?
3) Just to confirm, your father has tested negative both for EGFR and for ALK? That would be normal as these mostly occur in people with adenocarcinomas. What are his doctors recommending?
Best wishes to you and your father.

sefier, I hoped you would respond to certain springs post so we could have more info before I invited a doctor to join the conversation.
I wonder if GP is the chemo used.

from http://www.cancerstaging.org/staging/posters/lung8.5x11.pdf
Distant Metastasis (M)
M0 No distant metastasis
M1 Distant metastasis
M1a Separate tumor nodule(s) in a contralateral lobe, tumor with pleural nodules or malignant pleural (or pericardial) effusion2
M1b Distant metastasis (in extrathoracic organs)

Usually stage IV isn't curable but your dad's doctors may feel there is a possibility of cure becasue the cancer hasn't extended past the thoracic region, therefore they feel surgery would be an option.

Janine
forum moderator

let me add this link http://cancergrace.org/cancer-101/2012/04/06/broadening-precocious-met/
and this that I think you already know http://cancergrace.org/cancer-101/2011/01/01/cancer-101-faq-i-have-meta…

I presume GP is gemcitabine and platinum, likely cisplatin. This is a very fine chemotherapy for squamous NSCLC.

The division of stage IV into IVa and IVb is based on whether there is evidence of disease outside of the chest or not. However, stage IV really means that it is metastatic and we cannot realistically expect it to be curable. There are some rare exceptions, and sometimes when there is just a single area of cancer on the other side, it represents a second cancer rather than metastatic disease. If that's the case, it means that it can possibly be treated with curative intent, such as with surgery. However, in that case, it should really be considered stage __ (maybe II) on one side and stage __ (maybe I) on the other. If that's the case, then surgery would still be recommended if it is really felt that it can potentially be treated with curative intent. If it's stage IV, however, I don't think cure would be very likely, so it would be very appropriate to question whether surgery should be done.

Good luck.

-Dr. West

Dr. West, is the only reason to distinguish between IVa and b the placing of the met? and why the distinction?

sefier, My previous post was to try to guess why the doctor wants to do surgery. Sorry for any confusion on my part. I should have said the reasons for surgery include cure or because it's near or invading other structures like the heart.

Please let us know if the information has been helpful. There is another current thread about surgery you may find helpful. http://cancergrace.org/topic/facing-thoracotomy-need-help-please

Yes, the difference is whether spread is within the chest or outside of it. Why the distinction? Because staging is in large part designed to provide prognostic information, and the prognosis tends to be modestly more favorable, by a couple of months, for people who just have lung nodules and/or a pleural effusion. Many of these patients have a bronchioloalveolar carcinoma (BAC) pattern, which tends to be more indolent.

-Dr. West