newly diagnosed lung cancer

I don't see anyone's cancer as minor. Questions and fears are just as real for the stage 0 (Adenocarcinoma in situ) as a person like me stage 4b with an extremely poor prognosis. By staying engaged I believe not only do you help ease your fears you may help others feel they're not alone and what they're feeling is normal.

6 weeks is actually early. Follow up scan is recommended at the 8 to 12 week point. But earlier can help identify potential side effects like radiation induced pneumonitis (inflammation) that start a about 6 weeks post SBRT. It's just important to know that some side effects like Inflammation, edema, or fibrosis may mimic tumor progressio. This is called pseudoprogression. SBRT is usually very successful. I'm sure they told you that but it is true.

Definitely not a professional. I just don't want to enter a room or discussion without knowing what the topic may be and the possible answers beforehand. I read everything I can about my own condition And treatments . Keeps me feeling like I'm in charge.

hey db, how ya doing? Saw my thoracic surgeon yesterday and might not be able to have surgery due to the p-acne’s infection in my failed shoulder replacement. He never even heard of p-acne’s but he is not a replacement guy so that’s cool. They are just figuring out that it is the reason for most shoulder replacement failure. Loosens prosthetic and causes lots of pain lol. If I can it will be chemo, surgery,chemo, immunotherapy, but he wants to take the whole lung because of the nodule involvement. Kind of bummed about that! Know any people who have had a right pneumonectomy, and how they are doing or did? My mom never really felt good after hers, and I remember her saying don’t ever let them take out your whole lung, so that’s floating around my head this morning. No brain Mets so that good. Meet my oncologist and radiation oncologist next week, still waiting on genetic testing, should be. Soon. So that’s my story. Hope you have a great weekend. Batman

hey db, I’m with you on the superbowl lol! I have told every doctor throughout this entire process that I have an untreated c- infection, dont like the name change either, and not one of them knows what I’m talking about??? I know I will not be able to have that surgery without treatment for my shoulder, I’ve had terrible chronic pain for the last 10 plus years. I cant sleep on my left side period! I was surprised that a thoracic surgeon with 26 years of experience had never heard of this? I will definitely get a second opinion. I checked out his history and he is really good, but you would think he might have seen a similar thing in all his years. Most doctors don’t know about it though. He is speaking with an infectious disease doctor so we will see. Still waiting on the genetic testing. I already have a bunch of autoimmune diseases graves, vitiligo, another one I can’t remember lol, plus I still test positive for lyme. I also had ecoli in2010 and lost a testicle to it. I didn’t think I would get lung cancer as I have had every other weird thing lol. Meeting my oncologist and radiation oncologist next week so I will have some more input. I surely don’t want a pneumonectomy . My mom never really recovered from it, plus I would have to have my thyroid removed as it is already causing swallowing issues and with the shift of organs I might not be able to breathe eat Etc. He wants to do neoadjuvant chemo then surgery then chemo and immunotherapy so it is a nightmare lol, but I’ll keep plugging away at it. Thanks again for the advice. Batman

hey dive buddy. The infectious disease doctor says no way to the surgery with the infection. The reason I haven’t had it treated is I saw one of the best shoulder guys in the country a few years ago and he told me that there was not enough bone to put a third shoulder replacement in and I would only have a reverse shoulder replacement option. Reverse shoulder replacement is terrible and he would only recommend it to people in their late 70 s or eighties because it is useless. You can only lift 10 lbs for the rest of your life and you can dislocate it by wiping your but or scratching your back. They are really only for pain easement. Plus the procedure takes about a year . You get two months of I’ve antibiotics then they take out the old one and put in a biological spacer for 4 months, then if it is clear they put in the new replacement. Then you start pt for 6 months all really very painful lol. It would have left me in a worse position than I have been for the past few years. Now I can do stuff below the waist ie a little raking, shoveling, sweeping, Etc. With the reverse replacement I would have less use of my arm( long explanation) lol. So no surgery . I have EGFR exon 19 with TP53 so good and bad lol. She wants to do chemo/ radiation for a few months followed by immunotherapy ( Tagrisso) . I’m on board but doing research I can’t find any reason for the radiation at this stage. Most just do chemo then immunotherapy, so I will ask the radiation doctor tomorrow when I meet him.by the way my shoulder infection showed really big and bright on my pet scan and they saw a third nodule metastasis so I think I’m n2 with that. I really couldn’t get the surgery anyway with the bad shoulder it would have been a nightmare lol. So love to hear your advice and impressions. As long as the tp53 doesn’t inhibit the immunotherapy I could be around for a while. What do you think about the radiation at this point. I would think it would be something to hold in reserve in case it started growing or never stops. Thanks for listening db ttyl Batman

yeah. In the TNM staging system, the N category is based on location, not the number of affected lymph nodes.

N2 means the cancer has spread to ipsilateral (same side) mediastinal lymph nodes (located in the center of the chest, between the lungs) or subcarinal lymph nodes (just below the tracheal bifurcation). I posted a diagram from the 9th edition earlier.

N3 includes contralateral (opposite side) mediastinal or hilar lymph nodes and supraclavicular lymph nodes (above the collarbone, regardless of side).

Interesting note: In the previous (8th) edition, these were classified as distant metastases (M1a) and Stage IVA. However, survival data supported curative intent treatment, leading to their reclassification as Stage IIIC in the 9th edition.

Currently, the standard of care for patients with unresectable stage III or earlier non-small cell lung cancer (NSCLC) with EGFR mutations typically involves definitive concurrent chemoradiotherapy (CRT) followed by consolidation tyrosine kinase inhibitor (TKI) therapy.

Links first, as they sometimes don't work correctly here. Here are a few—there are literally thousands.

References:

🔗 https://pmc.ncbi.nlm.nih.gov/articles/pmid/31277121/

Hung MS, Wu YF, Chen YC. Efficacy of chemoradiotherapy versus radiation alone in patients with inoperable locally advanced non-small-cell lung cancer: A meta-analysis and systematic review. Medicine (Baltimore). 2019 Jul;98(27):e16167. PMID: 31277121; PMCID: PMC6635168.

🔗 https://www.nejm.org/doi/full/10.1056/NEJMoa2402614

Lu S, Kato T, Dong X, et al. Osimertinib after Chemoradiotherapy in Stage III EGFR-Mutated NSCLC. N Engl J Med. 2024 Aug 15;391(7):585-597.

🔗 https://doi.org/10.21037/tlcr-20-1081

Orlandi E, Przypisany R, Peeters S. Combining radiotherapy with targeted agents in non-small cell lung cancer: Mechanisms and clinical evidence. Transl Lung Cancer Res. 2021;10(5):2141–2157.

Lymph Node Staging

The number of lymph nodes does not change your N staging—only their location does.

N1 remains N1 whether 1 or 20 lymph nodes are involved, as long as they are within ipsilateral peribronchial, hilar, or intrapulmonary regions.

The associated stage depends on other TNM factors (tumor size, metastases, etc.).

Radiation was the easiest treatment I received. 5 days and done easy peasy. I experienced no side effects during the treatments.

hey db sorry to bother you but I have a quick question? The research I’m doing indicates a longer survival time with just radiation and tagrisso vs chemo radiation with tagrisso some saying the addition of the chemo. Will shorten my life especially in people with the tp53 mutation. Should I question my oncologists about this. Radiation is targeted where as the chemo kills everything. With my graves and Lyme and vitiligo and one other autoimmune I can’t remember at this moment. I would like your input and reason at why the chemo. I’m trying to find information on comparisons between the chemo radiation and tagrisso vs just radiation and tagrisso. Thanks

This proposal is for your radiation oncologist and infectious disease specialist. Because it involves a non-standard approach to treatment, it needs to be reviewed by the tumor board before it can be considered.

Proposal: Utilizing Incidental Radiation Therapy to Address Cutibacterium acnes Infection During Ongoing Cancer Treatment

Background:

In the early 20th century, low-dose radiation therapy (LDRT) was employed to treat various bacterial infections, including pneumonia, osteomyelitis, and gas gangrene. This approach leveraged radiation's anti-inflammatory properties and its capacity to disrupt bacterial replication, particularly in biofilm-associated infections. The practice declined with the advent of antibiotics in the 1940s, but historical data suggest that radiation could effectively reduce bacterial load and inflammation in deep-seated, antibiotic-resistant infections.

Relevance to Current Case:

The patient is currently receiving conventional radiation therapy for cancer and concurrently suffers from a Cutibacterium acnes infection linked to a failed shoulder replacement. Given that the shoulder joint is non-functional, traditional concerns about radiation-induced joint damage are less pertinent. This unique scenario presents an opportunity to potentially mitigate the infection by extending the existing radiation field to encompass the affected shoulder area, thereby avoiding additional invasive procedures.

Rationale for Consideration:

1. Challenges of Prolonged Cutibacterium acnes Infections:

- Cutibacterium acnes is known for forming resilient biofilms on implants, rendering infections difficult to eradicate with antibiotics alone.

- Chronic infections can lead to severe complications such as persistent pain, osteomyelitis, and the development of fistulas.

- Standard treatments often involve surgical intervention and extended antibiotic regimens, which carry significant morbidity and may not guarantee resolution.

2. Potential Benefits of Radiation Therapy:

- Biofilm Disruption: Radiation may weaken the protective biofilm of Cutibacterium acnes, enhancing the efficacy of antibiotics.

- Anti-inflammatory Effects: Radiation can reduce inflammatory responses, potentially alleviating pain and improving tissue health.

- Synergistic Potential: Combining radiation with antibiotic therapy might lower bacterial load more effectively than antibiotics alone.

- Minimal Additional Risk: Given the existing non-functionality of the joint and the current radiation treatment, expanding the radiation field could pose minimal additional risk.

3. Risk Assessment:

- Soft Tissue Fibrosis: While radiation can cause scarring, this is less concerning in an already non-functional joint.

- Local Toxicity: Potential risks include skin irritation or delayed wound healing.

- Fistula Formation: There is a rare possibility of creating abnormal connections if the infection is not fully resolved.

Conclusion:

This proposal suggests considering the expansion of the current radiation treatment field to include the infected shoulder area as an adjunct to ongoing antibiotic therapy. Given the patient's unique circumstances, this approach may offer a viable method to address the persistent Cutibacterium acnes infection with potentially minimal additional risk. We welcome your expert evaluation of this proposal and any insights into its feasibility based on current clinical practices.

Citations:

1. Calabrese EJ, Dhawan G. How radiotherapy was historically used to treat pneumonia: Could it be useful today? Yale J Biol Med. 2013;86(4):555-570. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848110/

2. Oppenheimer A. Roentgen therapy of infections. Milbank Mem Fund Q. 1943;21(1):13-27. Available from: https://www.jstor.org/stable/3348013

3. Prekumar K, et al. Biofilm formation by Cutibacterium acnes: Pathogenesis and clinical implications. Infection and Immunity. 2020;88(10):e00753-20. Available from: https://journals.asm.org/doi/10.1128/iai.00753-20

4. Dhawan G, Kapoor R, et al. Radiotherapy for non-malignant disorders: Current concepts and clinical results. Antimicrobial Resistance & Infection Control. 2020;9:75. Available from: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-020-00775-w

Hello jojo1965,

I’m really sorry you’re going through this. A cancer diagnosis is overwhelming, and a stage 4 diagnosis can be absolutely terrifying. I completely understand the fear and uncertainty that come with it. But I want you to know you are not alone. Many of us here have walked this road, and some of us were given grim prognoses but are still here years later.

When I was diagnosed, I was told things didn’t look good. My lung cancer had spread to my liver, neck, brain, and eventually my skin. At one point, I was told I might have only 30 days left and was admitted to the ICU for emergency chemotherapy and a craniotomy. Well, I’m now years past what anyone expected. I’m still here, still living, and still enjoying my life.

There’s always hope. Hope for more time, for good days, and for treatments that can work. Medicine is constantly evolving, and many people with stage 4 lung cancer live far longer than they were first told, especially with newer treatments like immunotherapy and targeted therapies.

As for faith in healing, I think it’s different for everyone. For me, it helped to stay active in my care, keep asking questions, and never assume I was out of options. It also helped to focus on today, not the statistics. Just taking things one step at a time. Prognoses are used to guide treatments, not to predict the future for an individual.

And about fear, I get it. I’ve had those moments too. But you don’t have to go through this alone. There’s a whole community of people here who understand, who will listen, and who will help however they can.

You’re not just a statistic. You are YOU, and that matters. You’re still here, and that means there’s still time to live.

Sending you strength,
eDiveBuddy