Tumor blocking the airways - treatment options - 1258710

Wed, 08/21/2013 - 07:38

My father, diagnosed with stage 3b squamous lung cancer in May 2012, relapsed after 6 months of being NED. He had had chemo (cisplatin and gemzar) and 30 rounds of radiation and now he is having the same chemo protocol. His doctor is not very optimistic about his health and says he is going to detoriate very fast. His tumor is almost blocking his trachea and as a result of this he has shortness of breath and gets tired very easily. Recently his face and lymph nodes in his necks have swollen. The CT showed that his tumor is pressing a vein and both the tumor and his lymph nodes are enlarged. What would you suggest in this emergency situation? Even if he gets a palliative treatment to relieve his symptoms, do you think his prognosis is poor because of the location of the tumor? What other treatments (chemotherapy wise) would you recommend? Please tell me and I will share it with his doctor.

Thanks,

Dilay

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catdander

Dilay, Welcome to Grace. I'm so sorry your father has a recurrence. I will ask a doctor to comment on the information you've provided but please understand we can't say what you should do or even what he or she would do in your father situation. As I'm sure you've learned lung cancer (cancer in general) is one of the most challenging cancers to treat. Cancer will do anything. So it's impossible to generate a plan from a forum discussion. However we can provide you with knowledge that can help make informed decisions.

There are treatments and procedures that are done to open airways that are being blocked by tumors, again everyone is different, circumstances are different so individual attention is given in every situation. Your father's oncologist or team will need to make the determination about that. Before I contact a doctor to comment on your post I want to say that being such a difficult situation a second opinion may be in order. One in which the second opinion doctor who specializes in these situations.

Treatment for anyone with incurable nsclc is treated with 2 goals always in mind, to increase longevity and increase quality of life. I hope he is able to get stabilized and breathe easier soon.
Janine
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Dr West

As Janine said, our role here isn't to provide medical advice to people we don't know, as the treatment decisions need to come from the people directly involved with a person's care. In general, when a cancer is causing local symptoms from compression, we do radiation when feasible, or sometimes a bronchoscopy can be done to remove tumor from within the airway. However, options can be very limited when a cancer progresses after receiving a full dose of radiation administered previously. Sometimes radiation can be tried in the same area, but that gets into a riskier place, as there is not much experience with re-irradiating a previously irradiated tumor that is growing again.

Chemotherapy, such as with Taxotere or possibly another chemo might be tried, but results tend to be worse, not better, than the results with a first line regimen like cisplatin and gemcitabine. Unfortunately, it sounds as if options are indeed very limited. If it would provide some peace of mind to get a second opinion to determine whether any options might be overlooked where you are now, you should feel free to seek that opinion.

Good luck.

-Dr. West

drramchandran

Dear Dilay,
My apologies for my delay in response. As Dr. West and Janine mentioned, we cannot give direct advice about your father's situation. However a few points

1. If the radiation is to a different area than originally radiated then it might be helpful in relieving symptoms and possibly providing longevity
2. If the tumor was chemotherapy sensitive, additional lines of chemotherapy can be helpful, as discussed by Dr. West
3. A 2nd opinion is a thoughtful approach if your father can handle additional visits, tests, etc

I do hope that he derives some benefit in his symptoms, and hopefully gets some additional time.

Warmly,
Dr. Ramchandran