Need help, confused

cabbott said:

Wow, what a lot of questions! I will try to tackle what I can though I am just a patient and not a medical specialist. You also might want to look at some of the medical websites including the cancer information on this website for explanations by doctors and nurses who are experts in the field. (Stay away from non-medical websites that try to sell you the latest crackpot "cure" for cancer. There are a lot of snakeoil salesmen on the net!)

If you are at Stage 0 or 1, surgery can remove the primary tumor in the lung and maybe even take care of the entire cancer problem. Cancer is considered curable at those early stages. Usually the doctor removes the entire lobe containing the cancer. You have 3 lobes on the right, 2 on the left. If the cancer is confined to the lung at Stage 2 where the tumor is bigger, sometimes they will remove the entire lung. But once the cancer is growing into more distant areas, especially when the areas are far from the lung as it is in stage 4 cancer, surgery doesn't provide a cure. The bad effects of surgery aren't counterbalanced by the possible great effects of a cure, so the doctors usually don't operate. Chemo and radiation can be used to shrink the primary tumor and the mets. If it shrinks to the point that it looks like surgery could benefit the patient again, then surgery might happen. If the tumor totally disappears,celebrate bigtime! This is called NED (No Evidence of Disease). It is a great place to be. However, living with a tumor that isn't causing any problems and isn't growing is just about as good as far as survival and well-being are concerned. The surgeon will set up periodic CAT scans or x-rays to monitor tumor growth and shrinkage. The oncologist will get the reports and vary the chemo based on how things are working. The radiation oncologist will work with both to keep the cancer controlled as much as possible. Cancer can be treated at any stage. It is not considered curable once the cancer progresses into a form where it is setting up camp outside the lung--ie. stage 4 cancer mets. Let me say that again. It may not be curable but it is still treatable. You probably know folks with diabetes. Their disease is not curable but it is treatable. They have to be careful what they eat, take their meds as prescribed, and see the doctor a lot to monitor their medical problem and make changes in their plan as needed. They have the disease, but with effect they can live a relatively normal life with less of the bad effects of their disease if they have a good treatment plan and follow it. Stage 4 disease is like that for many,many survivors. Younger, stronger, healthier folks can deal with the side effects of cancer treatment better. More aggressive cancers need more aggressive treatments to stay controlled. Sometimes what we need hasn't been invented yet, so please don't blame patients or doctors when they can't keep cancer from progressing. And sometimes the side effects of aggressive cancer treatment become so bad and the benefits so few that patients have to stop that kind of treatment. There are still ways to make life better for the patient even when treatment to stop the cancer from progressing ends. If your sister's mets are very small and her health is good, they will want to use chemo to limit the growth of cancer as much as possible. Radiation will kill cells in a limited target area, so it may be part of the plan if a tumor met is growing in an area where either chemo can't reach or where it is causing problems like pain or seizures. If she is a smoker, they will also want a plan for her to quit smoking to maximize her lung capacity and improve her general health. Chemo is tough enough on the body without the added stress of smoking even though quitting is difficult to do. Ask more questions any time you need to. Hopefully more folks will be able to correct anything I've left out, especially since I'm at stage 1 and don't know much more than I've read about the other stages.

jagged said:

First, mets stands for matastases. Lung cancer matastasis to the bone and brain makes this stage IV. Treatment for the tumors will depend on the goal of treatment, the tumor location, and its size. The goal of treatment may be to get rid of the cancer (cure or remission), to shrink a tumor for further treatment, or shrink a tumor as part of pallative care (treatment to help the quality of life until death).

Surgery gets rid of a tumor and is generally followed with radiation to the surgery area.

Radiation is a localized treatment. It is used to insure that any residual tumor cells in a specific location are killed / burned (following surgery). And it is used to shrink / dissolve a specific tumor.

Chemotherapy treats the whole body. It is often used to shrink / dissolve tumors and kill any residual cancer cells possibly roaming through the body.

Treatment can use one or all of the above methods in any combination.

Your sister's cancer is stage IV. Cancer cells are not in one location, but roaming throughout her body. This is why the mets. Chemotherapy is the likely treatment choice to affect all tumors and mets. Depending upon the location and impact of a specific tumor, they may also suggest radiation.

Doctor's monitor health during treatment and can do some ajusting to accommodate health issues. But, health and a person's tolerance to chemotherapy, is definately a factor, as there are some unpleasent side affects.

As someone who obviously loves and cares about your sister, periodically, send her a note and/or give her a call. This is to let her know you are there and care. If you know there is something you can help her with, don't ask, just do it. Any next move is hers. If she does shut you out, please, don't take it personally. Keep in mind, she is likely in shock and handling things the best she can. Just follow up with a card.

jagged said:

Stardust1,

I am sorry my answer caused pain for you. This is just not an easy subject to get through.

I too have cancer stage IV, so my answers are based only on my experience-based guess.

Brain surgery would depend on where in the brain the mets are. With four mets, the odds are unlikely that treatment would include brain surgery. This is only a guess.

Chemotherapy can shrink / dissolve the mets and that may be enough with on-going monitoring, no surgery. The same can be said with radiation. The goal would be to take pressure off the brain and to extend her life.

--jag

cabbott said:

Fatigue is very common with chemotherapy. Some kinds are more wearing than others, and individuals respond differently to the same medications. When your blood counts go down after chemo, you often feel wiped out. Sometimes you need medical assistance to get those counts back up, so have her talk to her doctor if she is really feeling bad. Naps, early bedtimes, and lots of support helps. Your calls and letters help too. She is lucky to have a sister like you. If the chemo stops the mets in her brain from growing or causing problems, surgery would not usually be done. Sometimes the spot of cancer dies and gradually disappears. Sometimes it stays around (maybe as scar tissue?), but as long as it isn't causing problems it is good. There is a special kind of radiation called "gamma knife radiation" that can kill off brain tumors if they are localized, but it is not the answer for everyone and it is not available in all communities. There are other radiation treatment plans that kill off cells in the area of a tumor (either the original spot in the lung or at one of the spots where it has traveled to and set up camp.) It is good that doctors have these high powered medicines and treatment plans to deal with cancer. Another thing my sister did for me when I was diagnosed was come visit. I didn't need her to drop everything and come right away, but it certainly has been nice seeing her every couple of months. I really didn't feel much like company after my operation, but cancer has been a wake-up call for my whole family that we don't live here forever and we ought to make the most of what time we have. This year I'm well enough that I'm planning to drive down (7 1/2 hours) and see her in a few weeks and go tubing. I can't wait! So if there is something special you were hoping to do with your sister "someday", take the advice my sister gave me and "do it now!. The same goes for things you want to say to her. That doesn't mean she is terminal or anything and you certainly don't want to sound like you are totally out of character and overly gushy. It's just that living with cancer teaches you that life is unpredictable and we should make the most of every day. Thanks for being there for your sister!

C. Abbott

Diane03 said:

I too have stage iv. I was diagnosed in May of this year. It's extremely difficult going through the therapies thinking it will noy be cured, but we have to be thankful for everyday we awake and see the sun. I had 2 weeks of radiation along with my first Chemo treatment. I found applying Aloe Vera gel without alcohol to the radiation areas, protected my skin a little. The burns were managable. I didn't get the side effects of the burning until the 12th day. I found Boost to be my best friend. I was having radiaiton to the lung which burns the esophogus.
It is a lot to digest, but thanks to family members, such as yourself, it makes everyday a little easier.
I wish you and your sister well.
Diane

hansie said:

hi im a newbe here,but ive ben doing a lot of reserch on this,as my 42 yr old wife has lung cancer.From what i gather "small cell "cancers are not treated with any kind of operation,and "non small cell" cancers are.My wife has small cell cancer,which has now spread to her neck after a brief remission,and again they are treating it with only chemo and radiation.