Stage IV lung cancer - surgery???

My mother-in-lax was dx'd in 10/2005 with stage IV NSCLC with mets to her
brain, chest wall, vertabrae, lymph nodes. Her primary tumor was 6 x 7 x
6.5 cm. She had one course of chemo which shrank the primary to about 1/3
the size and seemed to knowck the other areas into remission (she had
sterotactic radio-surgery for her brain lesion). In late June the doc's
notice the primary getting larger again and put her on Tarceva (started in
August).

Initially the Tarceva seemed to work, but know they're saying that's it's
failed as the primary continues to grow. She's having a PET scan today and
if the primary is the only active site, they're considering removing that
lobe of the lung. If the PET is positive, than radiation would be her only
option.

My question is....Have any of you every heard of doing surgery on the
primary with late stage disease?

Mark

"Mark" <cirone@comcast.net> wrote in
news:t4adnZPi3tAD5hvYnZ2dnUVZ_ternZ2d@comcast.com:

> My mother-in-lax was dx'd in 10/2005 with stage IV NSCLC with mets to
> her brain, chest wall, vertabrae, lymph nodes. Her primary tumor was
> 6 x 7 x 6.5 cm. She had one course of chemo which shrank the primary
> to about 1/3 the size and seemed to knowck the other areas into
> remission (she had sterotactic radio-surgery for her brain lesion).
> In late June the doc's notice the primary getting larger again and put
> her on Tarceva (started in August).
>
> Initially the Tarceva seemed to work, but know they're saying that's
> it's failed as the primary continues to grow. She's having a PET scan
> today and if the primary is the only active site, they're considering
> removing that lobe of the lung. If the PET is positive, than
> radiation would be her only option.
>
> My question is....Have any of you every heard of doing surgery on the
> primary with late stage disease?
>
> Mark
>
>
>

Hi, Mark,

I am sorry to read about your M-I-L's cancer. Hopefully Steph, this
group's oncologist will reply. I only know from my late husband's
experience with Stage IV NSCLC & from all I have read here over the last
couple of years.

And, no, I have never heard of surgery to remove the primary when there
are distant metastaces - which she has. Is she having pain/suffering
from where the tumor is located, please? That is the only reason I can
think of for removing it, for her comfort or if it is encroaching on
another organ that could cause problems.

I also know that even when chemo shrank my husband's tumors to the point
where no cancer could be detected, the onc was careful to tell him he was
not in remission, not to give him false hope.

I would ask the oncologist some direct questions about what s/he hopes to
acheive before your M-I-L as subjected to surgery. She is fortunate to
have you looking after her interests.

Best,
Fig

"Mark" <cirone@comcast.net> wrote in message
news:t4adnZPi3tAD5hvYnZ2dnUVZ_ternZ2d@comcast.com. ..
> My mother-in-lax was dx'd in 10/2005 with stage IV NSCLC with mets to her
> brain, chest wall, vertabrae, lymph nodes. Her primary tumor was 6 x 7 x
> 6.5 cm. She had one course of chemo which shrank the primary to about 1/3
> the size and seemed to knowck the other areas into remission (she had
> sterotactic radio-surgery for her brain lesion). In late June the doc's
> notice the primary getting larger again and put her on Tarceva (started
> in August).
>
> Initially the Tarceva seemed to work, but know they're saying that's it's
> failed as the primary continues to grow. She's having a PET scan today
> and if the primary is the only active site, they're considering removing
> that lobe of the lung. If the PET is positive, than radiation would be
> her only option.
>
> My question is....Have any of you every heard of doing surgery on the
> primary with late stage disease?
>
> Mark
>

I've heard of it, but there is absolutely no good reason to do it.

Steph,

Is it possible that they're considering this option as it's the least
invasive treatment at this point? She's 67 yrs old and radiation would
probably make her sicker than a minimally invasive lobe resection.

Are you an oncologist as Figgertoes suggests?

Mark


"Steph" <steph@vancouvers.island> wrote in message
news4zhh.494944$1T2.80231@pd7urf2no...
>
> "Mark" <cirone@comcast.net> wrote in message
> news:t4adnZPi3tAD5hvYnZ2dnUVZ_ternZ2d@comcast.com. ..
>> My mother-in-lax was dx'd in 10/2005 with stage IV NSCLC with mets to her
>> brain, chest wall, vertabrae, lymph nodes. Her primary tumor was 6 x 7 x
>> 6.5 cm. She had one course of chemo which shrank the primary to about
>> 1/3 the size and seemed to knowck the other areas into remission (she had
>> sterotactic radio-surgery for her brain lesion). In late June the doc's
>> notice the primary getting larger again and put her on Tarceva (started
>> in August).
>>
>> Initially the Tarceva seemed to work, but know they're saying that's it's
>> failed as the primary continues to grow. She's having a PET scan today
>> and if the primary is the only active site, they're considering removing
>> that lobe of the lung. If the PET is positive, than radiation would be
>> her only option.
>>
>> My question is....Have any of you every heard of doing surgery on the
>> primary with late stage disease?
>>
>> Mark
>>
>
> I've heard of it, but there is absolutely no good reason to do it.
>

"Mark" <cirone@comcast.net> wrote in message
news:aqCdnUeIeqt4HxfYnZ2dnUVZ_rOqnZ2d@comcast.com. ..
> Steph,
>
> Is it possible that they're considering this option as it's the least
> invasive treatment at this point? She's 67 yrs old and radiation would
> probably make her sicker than a minimally invasive lobe resection.
>

Surgery is much more invasive than RT. Palliative treatment to the lung
woudl have few or no side-effects.
What are you hoping will be achieved? A cure?

> Are you an oncologist as Figgertoes suggests?
>

Yes

> Mark
>
>
> "Steph" <steph@vancouvers.island> wrote in message
> news4zhh.494944$1T2.80231@pd7urf2no...
>>
>> "Mark" <cirone@comcast.net> wrote in message
>> news:t4adnZPi3tAD5hvYnZ2dnUVZ_ternZ2d@comcast.com. ..
>>> My mother-in-lax was dx'd in 10/2005 with stage IV NSCLC with mets to
>>> her brain, chest wall, vertabrae, lymph nodes. Her primary tumor was 6
>>> x 7 x 6.5 cm. She had one course of chemo which shrank the primary to
>>> about 1/3 the size and seemed to knowck the other areas into remission
>>> (she had sterotactic radio-surgery for her brain lesion). In late June
>>> the doc's notice the primary getting larger again and put her on Tarceva
>>> (started in August).
>>>
>>> Initially the Tarceva seemed to work, but know they're saying that's
>>> it's failed as the primary continues to grow. She's having a PET scan
>>> today and if the primary is the only active site, they're considering
>>> removing that lobe of the lung. If the PET is positive, than radiation
>>> would be her only option.
>>>
>>> My question is....Have any of you every heard of doing surgery on the
>>> primary with late stage disease?
>>>
>>> Mark
>>>
>>
>> I've heard of it, but there is absolutely no good reason to do it.
>>
>
>

Steph,

I'm not hopeful for a cure. I know where she stands and I'm unfortunately,
quite familiar with the process. My wife (her daughter) just celebrated her
5 yr anniversary as a stage IV BC patient (multiple mets to her brain and
lung in 2001 - WBR, SBR and a neurosurgery later on - four yrs on
Herceptin/navelbine/femara and now on Xeloda).

I just had a friend the same age as Sharon's mom have a lobe re-sected for
recurrent renal cancer and he told me it was no big deal.

>> Is it possible that they're considering this option as it's the least
>> invasive treatment at this point?

I asked the above question b/c I know, first hand, what radiation sickness
is like. I was also curious if the protocol may have been a new study and
if you may hav heard about it. I haven't had time over the last week .

Here are the balance of the details...

She had a PET scan this past Monday with results and decisions due today.
The Dr.'s have told them that if they didn't see any disease elsewhere (this
flies in the face to what I know about cancer treatment), they would try to
re-sect the afflicted lobe with the caveat that if the neighboring lobe was
involved (determined during surgery) they would stop and use RT as the
treatment.

What is your specialty and where do you practice oncology?

Mark


"Steph" <steph@vancouvers.island> wrote in message
news:w8yih.509046$5R2.90879@pd7urf3no...
>
> "Mark" <cirone@comcast.net> wrote in message
> news:aqCdnUeIeqt4HxfYnZ2dnUVZ_rOqnZ2d@comcast.com. ..
>> Steph,
>>
>> Is it possible that they're considering this option as it's the least
>> invasive treatment at this point? She's 67 yrs old and radiation would
>> probably make her sicker than a minimally invasive lobe resection.
>>
>
> Surgery is much more invasive than RT. Palliative treatment to the lung
> woudl have few or no side-effects.
> What are you hoping will be achieved? A cure?
>
>> Are you an oncologist as Figgertoes suggests?
>>
>
> Yes
>
>> Mark
>>
>>
>> "Steph" <steph@vancouvers.island> wrote in message
>> news4zhh.494944$1T2.80231@pd7urf2no...
>>>
>>> "Mark" <cirone@comcast.net> wrote in message
>>> news:t4adnZPi3tAD5hvYnZ2dnUVZ_ternZ2d@comcast.com. ..
>>>> My mother-in-lax was dx'd in 10/2005 with stage IV NSCLC with mets to
>>>> her brain, chest wall, vertabrae, lymph nodes. Her primary tumor was 6
>>>> x 7 x 6.5 cm. She had one course of chemo which shrank the primary to
>>>> about 1/3 the size and seemed to knock the other areas into remission
>>>> (she had sterotactic radio-surgery for her brain lesion). In late June
>>>> the doc's notice the primary getting larger again and put her on
>>>> Tarceva (started in August).
>>>>
>>>> Initially the Tarceva seemed to work, but know they're saying that's
>>>> it's failed as the primary continues to grow. She's having a PET scan
>>>> today and if the primary is the only active site, they're considering
>>>> removing that lobe of the lung. If the PET is positive, than radiation
>>>> would be her only option.
>>>>
>>>> My question is....Have any of you every heard of doing surgery on the
>>>> primary with late stage disease?
>>>>
>>>> Mark
>>>>
>>>
>>> I've heard of it, but there is absolutely no good reason to do it.
>>>
>>
>>
>
>

"Mark" <cirone@comcast.net> wrote in message
news:A56dnf10BIS_IhbYnZ2dnUVZ_vGinZ2d@comcast.com. ..
> Steph,
>
> I'm not hopeful for a cure. I know where she stands and I'm
> unfortunately, quite familiar with the process. My wife (her daughter)
> just celebrated her 5 yr anniversary as a stage IV BC patient (multiple
> mets to her brain and lung in 2001 - WBR, SBR and a neurosurgery later
> on - four yrs on Herceptin/navelbine/femara and now on Xeloda).
>
> I just had a friend the same age as Sharon's mom have a lobe re-sected for
> recurrent renal cancer and he told me it was no big deal.
>
>>> Is it possible that they're considering this option as it's the least
>>> invasive treatment at this point?
>
> I asked the above question b/c I know, first hand, what radiation sickness
> is like. I was also curious if the protocol may have been a new study and
> if you may hav heard about it. I haven't had time over the last week .

"Radiation sickness"? Radiation to the lung, especially in palliative doses,
would have no - NO - appreciable side-effects.

>
> Here are the balance of the details...
>
> She had a PET scan this past Monday with results and decisions due today.
> The Dr.'s have told them that if they didn't see any disease elsewhere
> (this flies in the face to what I know about cancer treatment), they would
> try to re-sect the afflicted lobe with the caveat that if the neighboring
> lobe was involved (determined during surgery) they would stop and use RT
> as the treatment.
>
> What is your specialty and where do you practice oncology?
>
> Mark
>
>


I think you should ask them what reason there could be to do invasive
surgery on someone with widely metatastatic disease.

Thanks for your input Steph. I missed your answer to my question as to
your specialty and local of practice.

Mark


"Steph" <steph@vancouvers.island> wrote in message
news:aqTih.507889$1T2.380387@pd7urf2no...
>
> "Mark" <cirone@comcast.net> wrote in message
> news:A56dnf10BIS_IhbYnZ2dnUVZ_vGinZ2d@comcast.com. ..
>> Steph,
>>
>> I'm not hopeful for a cure. I know where she stands and I'm
>> unfortunately, quite familiar with the process. My wife (her daughter)
>> just celebrated her 5 yr anniversary as a stage IV BC patient (multiple
>> mets to her brain and lung in 2001 - WBR, SBR and a neurosurgery later
>> on - four yrs on Herceptin/navelbine/femara and now on Xeloda).
>>
>> I just had a friend the same age as Sharon's mom have a lobe re-sected
>> for recurrent renal cancer and he told me it was no big deal.
>>
>>>> Is it possible that they're considering this option as it's the least
>>>> invasive treatment at this point?
>>
>> I asked the above question b/c I know, first hand, what radiation
>> sickness is like. I was also curious if the protocol may have been a new
>> study and if you may hav heard about it. I haven't had time over the
>> last week .
>
> "Radiation sickness"? Radiation to the lung, especially in palliative
> doses, would have no - NO - appreciable side-effects.
>
>>
>> Here are the balance of the details...
>>
>> She had a PET scan this past Monday with results and decisions due today.
>> The Dr.'s have told them that if they didn't see any disease elsewhere
>> (this flies in the face to what I know about cancer treatment), they
>> would try to re-sect the afflicted lobe with the caveat that if the
>> neighboring lobe was involved (determined during surgery) they would stop
>> and use RT as the treatment.
>>
>> What is your specialty and where do you practice oncology?
>>
>> Mark
>>
>>
>
>
> I think you should ask them what reason there could be to do invasive
> surgery on someone with widely metatastatic disease.
>

"Mark" <cirone@comcast.net> wrote in message
news:nZmdnaxsBqNpMRHYnZ2dnUVZ_sGqnZ2d@comcast.com. ..
> Thanks for your input Steph. I missed your answer to my question as to
> your specialty and local of practice.
>
> Mark
>
>


I didn't answer.........
I'm a radiation oncologist with the BC cancer agency

HI Mark

Canadian Healthcare is different than US Healthcare. I am not trying to
debate the differences, but American Doctors often treatment options to
patients that Canadians are not offered.

Some could argue that Americans are overtreated for cancer. For
example many countries would not have offered the treatments you
mentioned for advanced breast cancer, I have found every health care
provider has their own agenda ( at least in the US), when I see a
surgeon they will offer a surgical option to an illness but surgeons
have always told me they have a bias towards surgery.
When you see an oncologist they offer you chemo which they have a bias
towards If you see a radition oncologist +(which is a different
specialtiy here in the US) they will provide you with Radiation
options. A good primary care doc could help you sort out your options.

Best of luck sorting this all out..... Could you ask for a meeting will
all providers at the table?
That maybe helpful.

HI Mark

Canadian Healthcare is different than US Healthcare. I am not trying to
debate the differences, but American Doctors often treatment options to
patients that Canadians are not offered.

Some could argue that Americans are overtreated for cancer. For
example many countries would not have offered the treatments you
mentioned for advanced breast cancer, I have found every health care
provider has their own agenda ( at least in the US), when I see a
surgeon they will offer a surgical option to an illness but surgeons
have always told me they have a bias towards surgery.
When you see an oncologist they offer you chemo which they have a bias
towards If you see a radition oncologist +(which is a different
specialtiy here in the US) they will provide you with Radiation
options. A good primary care doc could help you sort out your options.

Best of luck sorting this all out..... Could you ask for a meeting will
all providers at the table?
That maybe helpful.

Thanks Alex, I understand what you're saying but our experience has been
different. My wife is treated at the MGH BC Center and their approach in
much more clinical. As a teaching/research hospital, we've always had the
expertise of our medical oncologist as our point man and he in turn directs
her treatment with neuro-oncology and radiation oncology as needed.

As far as my mother-in-law, her PET results were not good. Seems like the
disease has spread to her femur and hip and there's some discussion about it
morphing from NSCLC to SCLC. Her options will be chemo and/or radiation.
Not the news anyone was hoping for, but she was dx'd 14 months ago as Stage
IV with mets to her brain, chest wall, lymph system and vertabrae, so it's
not too surprising given what I know about the disease. I'm going to make
plans to fly down there and be present for the next onccology meeting as I'm
getting some mixed information.

She's being treated at a major Cancer Center in FLA. I guess I'll hop on
the internet over the next week and see if there are any advanced trials for
her current condition.

Merry Christmas to all...

Mark



"Alex" <usenetgirl@gmail.com> wrote in message
news:1166877132.549779.16870@f1g2000cwa.googlegrou ps.com...
> HI Mark
>
> Canadian Healthcare is different than US Healthcare. I am not trying to
> debate the differences, but American Doctors often treatment options to
> patients that Canadians are not offered.
>
> Some could argue that Americans are overtreated for cancer. For
> example many countries would not have offered the treatments you
> mentioned for advanced breast cancer, I have found every health care
> provider has their own agenda ( at least in the US), when I see a
> surgeon they will offer a surgical option to an illness but surgeons
> have always told me they have a bias towards surgery.
> When you see an oncologist they offer you chemo which they have a bias
> towards If you see a radition oncologist +(which is a different
> specialtiy here in the US) they will provide you with Radiation
> options. A good primary care doc could help you sort out your options.
>
> Best of luck sorting this all out..... Could you ask for a meeting will
> all providers at the table?
> That maybe helpful.
>

Mark wrote:

> As far as my mother-in-law, her PET results were not good. Seems like the
> disease has spread to her femur and hip and there's some discussion about it
> morphing from NSCLC to SCLC. Her options will be chemo and/or radiation.
> Not the news anyone was hoping for, but she was dx'd 14 months ago as Stage
> IV with mets to her brain, chest wall, lymph system and vertabrae, so it's
> not too surprising given what I know about the disease. I'm going to make
> plans to fly down there and be present for the next onccology meeting as I'm
> getting some mixed information.

And stabilization of her femur (to keep her mobile as long as possible)?
Or is she wheel-chair bound due to other reasons.
J

Being from the Boston Area myself, we have so many choices, MGH, BWH,
BUMC, Tufts all great places, I have heard the quality of care in
Florida is mixed.
Great idea going down to Florida and it's not a bad time of year to
get away from Boston.

Alex

Being from the Boston Area myself, we have so many choices, MGH, BWH,
BUMC, Tufts all great places, I have heard the quality of care in
Florida is mixed.
Great idea going down to Florida and it's not a bad time of year to
get away from Boston.

Alex

In article <1166905739.333737.29780@80g2000cwy.googlegroups.c om>,
"Alex" <usenetgirl@gmail.com> wrote:

> Being from the Boston Area myself, we have so many choices, MGH, BWH,
> BUMC, Tufts all great places, I have heard the quality of care in
> Florida is mixed.
> Great idea going down to Florida and it's not a bad time of year to
> get away from Boston.
>
> Alex

Are you replying to a post, or just sharing a paragraph from your blog?

If you are replying to a post it is customary to include a short quote
so we know what you are talking about.

--
Dear Santa,
All I want for Chriatmas is your list of naughty girls

Bobert

Alex,

She's being treated at the Moffit center in Tampa. Coincidentaly, we were
visiting them in FLA at the time of her dx and I was able to be with them
when they got the initial PET scan results that confirmed the cancer dx.
Her oncologist studied under one of my wife's Dr's at MGH and seems to be on
the ball. When this thing first surfaced in Oct 2005, I checked with all
the people I knew at MGH for opinions and they all thought her recieving
treatment near her home was better than coming to Boston. I'm sure their
reasoning had to do with the advanced stage of her diesease and her
prognosis. She has done quite well considering the size and spread of her
cancer.

I know, all too well, there are no guarentees in life. I was just hopeful
the Tarceva would have worked....

I initially posted b/c the options they were considering flew in the face of
what I knew about advanced lung cancer treatment.

Mark

"Alex" <usenetgirl@gmail.com> wrote in message
news:1166905739.333737.29780@80g2000cwy.googlegrou ps.com...
> Being from the Boston Area myself, we have so many choices, MGH, BWH,
> BUMC, Tufts all great places, I have heard the quality of care in
> Florida is mixed.
> Great idea going down to Florida and it's not a bad time of year to
> get away from Boston.
>
> Alex
>

Mark wrote:

> She's being treated at the Moffit center in Tampa. Coincidentaly, we were
> visiting them in FLA at the time of her dx and I was able to be with them
> when they got the initial PET scan results that confirmed the cancer dx.
> Her oncologist studied under one of my wife's Dr's at MGH and seems to be on
> the ball. When this thing first surfaced in Oct 2005, I checked with all
> the people I knew at MGH for opinions and they all thought her recieving
> treatment near her home was better than coming to Boston.

I would agree with that and it's usually easier on the caregiver /family as
well.

> I'm sure their
> reasoning had to do with the advanced stage of her diesease and her
> prognosis. She has done quite well considering the size and spread of her
> cancer.
>
> I know, all too well, there are no guarentees in life. I was just hopeful
> the Tarceva would have worked....

It's in her bones, Mark.
There's no "Herceptin" for lung cancer, AFAIK.
Hope you're not comparing one to the other.
Tarceva Phase III trial of patients with second- and third-line advanced NSCLC
included 731 patients.
improvement in median survival (6.7 versus 4.7 months) - unless it happens to
help some (small subset of) people during certain phases of more aggressive
growth. J- no expert.
I can't see it doing anything for a lung cancer patient when it's in the bones
J

I'm familiar with the mechanism for Herceptin use and know that Tarceva is
not the same. I was just hopeful as I've heard about some LC patients that
are 2+ yrs out on Tarceva.

Mark


"J" <ercent@anon.inv> wrote in message
news:45911265.33E08562@execulink.com...
> Mark wrote:
>
>> She's being treated at the Moffit center in Tampa. Coincidentaly, we were
>> visiting them in FLA at the time of her dx and I was able to be with them
>> when they got the initial PET scan results that confirmed the cancer dx.
>> Her oncologist studied under one of my wife's Dr's at MGH and seems to be
>> on
>> the ball. When this thing first surfaced in Oct 2005, I checked with all
>> the people I knew at MGH for opinions and they all thought her recieving
>> treatment near her home was better than coming to Boston.
>
> I would agree with that and it's usually easier on the caregiver /family
> as
> well.
>
>> I'm sure their
>> reasoning had to do with the advanced stage of her diesease and her
>> prognosis. She has done quite well considering the size and spread of
>> her
>> cancer.
>>
>> I know, all too well, there are no guarentees in life. I was just
>> hopeful
>> the Tarceva would have worked....
>
> It's in her bones, Mark.
> There's no "Herceptin" for lung cancer, AFAIK.
> Hope you're not comparing one to the other.
> Tarceva Phase III trial of patients with second- and third-line advanced
> NSCLC
> included 731 patients.
> improvement in median survival (6.7 versus 4.7 months) - unless it happens
> to
> help some (small subset of) people during certain phases of more
> aggressive
> growth. J- no expert.
> I can't see it doing anything for a lung cancer patient when it's in the
> bones
> J
>

Mark wrote:

> I'm familiar with the mechanism for Herceptin use and know that Tarceva is
> not the same. I was just hopeful as I've heard about some LC patients that
> are 2+ yrs out on Tarceva.
>
> Mark

Hello Mark,
Some websites give the 5-year survival rate (by type of lung cancer) and some
clinical trial results give the median survival rate but don't distinguish the
type of lung cancer. So it's difficult to compare one person to another.
Most websites distinguish lung cancers as mentioned here
http://www.bccancer.bc.ca/PPI/Typeso...ng/default.htm
but I was reading lchelp website yesterday and I think there was a longer
survivor (bone involvement) of adeno- w/BAC bronchioloalveolar involvement,
which I don't think is on the above but is on ACOR mail lists, (but they don't
distinguish between each type of NSCLC)
http://www.acor.org/mailing.html?l=l Those are mail lists; one subscribes by
clicking on the group(s) and a moderator emails you as to when you can start
reading and sending messages.

http://lchelp.org/ has a forum. It's divided in sections. I noticed that many
(maybe not all) have signatures showing their (or their loved ones) history -
dates, surgeries, treatments, when mets appeared etc.
There's also other forums for cancer patients, all over the place, but those may
be best places to find others.
The problem with the latter is, for example, I was reading the lady's "history"
under "Complementary" but she may have updated her history and posted a message
somewhere else. So what I'm saying is there is no way (for me) to follow along
with one individual patient, as I can sometimes do here, if the person stays and
keeps us updated.

But since there's more posters (than here) at those 2 locations, I would be
remiss in not pointing them out to you.
If the latter, you may wish to also have a "signature" prepared and lurk a bit
and see if you can find a section, or post in the intro part and ask if they
know of someone else with the mixed type. My thinking (and I could be wrong) is
that all poeple there try to watch for new people or the moderators may remember
one person or another. and which section they might be in.

I don't know if this helps; could sure keep you busy.
Not sending you away- just want you to know there's other resources.
Best wishes,
J