Decisions to Be Made

Chemo or no chemo
What a rough decision we have to make when we are at Stage 1-A cancer! There are no sure answers. Chemo has side effects, no doubt about that. Some of those side effects are temporary. Some are permanent. Sometimes it is a life-saver. Other times the cancer doesn't seem to respond at all to it. The genetic research is woefully thin even though it is yards better than it was a decade ago. The medical research pathologists are slowly beginning to be able to tell which kinds of cancer are more aggressive than others. Sometimes they have a pretty good idea. Sometimes they don't and we have to guess what to do. The little bit of research I'm able to understand suggests that cancer is aggressive or non-aggressive from the beginning. Think of puppies and their temperaments. Some dogs are yappy from the beginning and will jump around and make noise from puppyhood on up. Others are laid back and mellow. You can train those yappy ones to be a bit better, but yappy little cocker spaniels and slow moving saint bernards don't have the same temperament from the beginning and no amount of training is going to make them act just the same at adulthood. They actually inherit those temperaments. (oh, I had a cocker as an adolescent that was from a mellow strain, so I know they exist. The owner told my dad that there were two strains of cockers and that ours came from a calm line. Dear little Lady was so mellow that she didn't even bark at strangers, much to my parents' distress. She was just like her parents, also mellow. My neighbor's cocker, who came from the yappy strain, yapped and ran in circles every time she heard a noise! So even within the same breed, differences that are inherited can be passed on). So just imagine how different various tumors can be from the start. Tumors also have a temperament. Some are aggessive and some aren't. Different kinds of messed up cells act differently and sometimes cells that look about the same act differently too. Those stage 1 cancers that are an agggressive type (the kind that grows and spreads quickly) should be hit with chemo as soon after surgery as possible no matter how small they are. Some cancers appear to be much more laid back. Those that are slower growing don't respond as well to chemo (I've heard it said that chemo tends to be absorbed more by fast-growing cancers and therefore is more effective with the more aggressive cancers anyhow). If you have a slow growing cancer,you get all the side effects from the chemo but not as much benefit. It is worth a year of my life on chemo to gain another two years. I wonder if I would do it if I knew that it would only help me gain an extra month. Doctors are not so sophisticated that they can predict for sure what benefit chemo will give. They review their research every year and come up with probabilities that they use to determine the current gold standard for cancer treatment. Some facitilities can do genetic testing to help determine just how aggressive a stage one A tumor is so that you get the aggressive treatment if you have an aggressive tumor. Some facilities don't have such testing. Getting into a clinical trial might be one way of getting tested and at the least helping them make better decisions in the future. Maybe some research on the internet might pin-point whom you could consult to help you make the best decision for you. If not, it may be just a 50-50 guess that you and your doctor make together based on whatever the local pathologist is able to tell you. I know if I had oat cell or small cell lung cancer I would go for chemo even if the tumor was small. I have an adnocarcinoma with BAC tendencies. It is a very slow growing kind and chemo was not advised. I started for the first two years with CAT scan screenings every 3 months. So far I'm down to screening twice a year with an Xray at the end of this month and a CAT scan next January providing the xray is clean this time. The doc warns me that it may take 8 years or more before my cancer rears its ugly head. Or I may be cured. So my screening will go on for a long time. My diagnosis was back in 2006. So far no chemo. If it comes back, it may be in the other lung and maybe we will catch it again at stage 1 A. Or maybe not. And then I will have to decide again: chemo or no chemo. Good luck with your decision!

C. Abbott