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Can any one answer

Posts: 1
Joined: Sep 2006

Last June my 78 year old father was diagnosing with NSC Lung cancer his Oncologist said it was stage 4. From what I have read stage 4 means that the cancer has spread to other parts of the body. My dad’s cancer has remained confined to left lung. The cancer is on the lining of lung. I guess it is large cell. If it is confined to one lung shouldn’t that be stage 1?? Is it because of his age? Doctor also says cancers inoperable. I cant get answer from doctor.

reinstones1's picture
Posts: 92
Joined: Feb 2006

Hi there. Was your dad diagnosed in 2005 or 2006?

My mother has Stage 3B or Stage 4 non-small cell lung cancer (different doctors stage it differently). My mothers cancer was initially limited to her right lung, but had already spread to the lining (pleurae) by the time she was diagnosed.

I think the information you need is this:

The two (2) pleurae (called the visceral and parietal pleurae), are the inner and outer linings that surround the lung. The pleurae are considered a site of spread, so if you have cancer of the lining of the lung, it's already "spread" outside the lung. Think of the pleurae almost like an "organ" of their own.

Once the cancer has spread to the pleurae, cancer cells can come in contact with the chest wall.
Generally, in cases where the pleurae are involved, surgery is not performed, because the surgeon wouldn't be able to guarantee the patient a clear margin (meaning, they can't get all the cancer out).

My mother was also told that she was inoperable/incurable.

I hope this helps you. My mother was diagnosed on 12/7/05, and today marks the 9 month mark for her! She is doing pretty well, and is in the middle of her 2nd round of chemo.

Plymouthean's picture
Posts: 264
Joined: Jan 2004

Based on my experience, and perhaps to oversimplify, the stage is the size of the tumor, - such as stage 1, 2, 3, 4, etc. I was diagnosed with stage 3a, the "a" meaning that the tumor had spread. (The tumor was about 4 x 5 x 7 cm in size.) The higher the letter, - b, c, etc., the more metastasis, or spread. Stage 4 is a large tumor, but with no letter following the 4, I would think that there is no metastasis. Double check with your Dad's oncologist, to be sure that you understand exactly what the stage is. Sometimes, especially at first, we tend to miss some of what the doctors tell us. That's natural. Keep asking questions until you are satisfied that you understand the situation. If you are not satisfied that the doctor is forthcoming with the answers that you need, seek a second opinion.
Also, I was diagnosed as inoperable/incurable -- five years ago! I'm cancer free now. Inoperable, in my case, meant "as presented" or when first found. The thoracic surgeon told the medical and radiation oncologists what needed to be done (shrink the tumor) to make me a candidate for surgery. They were successful in shrinking the tumor by 75%, and the tumor was removed. My point is that it is often difficult, but important to know exactly what the situation is. Again, if the doctor can't make it clear to you, get another opinion. Best wishes and prayers to you both. Please keep us posted.

Posts: 156
Joined: Aug 2006

To add to the explanations, my understanding of the staging of the cancer is how far the cancer has spread from its original site - whether it is localized (i.e. within the same region) or to other areas (e.g., organs or bone).

My mother is diagnosed with stage 4 because the cancer spread to the bone in her pelvis. If the cancer remained around the lungs, I think she might have been staged as 3. As for stage 1 or 2, I believe it may be based on the size of the tumor. Anything bigger than 3 cm is considered large and definitely not small. I think that is the limit for surgical removal. (Not exactly sure about the operable limit but I was told tumors less than 3 cm are considered to be small.)

Reinstones1 gave a detailed well-informed description of what the state is when cancer occurs in the lining.

You should be able to discuss all your concerns and questions with your dad's oncologist. If he's not forthcoming, I would think that is an indication of his level of compassion (or lack thereof) and patient manners. Don't feel you are stuck with any one oncologist. If you don't have confidence in him or her, you can get a second opinion or change oncologist.

Don't worry too much that the tumor isn't operable. Chemotherapy is a systemic attack of rogue cancer cells. Radiation annihilate tumors in specific sites. My mother isn't undergoing radiation but I've read that radiation equipment is so sophisticated and precise these days that it can contain the radiation to the tumor and not the adjacent healthy cells. It used to be where the radiation would damage surrounding healthy cells as well. Yeah, chemotherapy can't distinguish between healthy and cancerous growing cells either, but generally speaking if the oncologist is competent, s/he should be able to determine the dosage tolerable to the patient (with the caveat that everyone reacts differently).

Anyway, best wishes on your dad's recovery.

Posts: 156
Joined: Aug 2006

Sorry for the earlier misstatement by me.

The difference between stage 1 and stage 2 is not the size of the tumor, but whether the cancerous cells have spread beyond one half of the lung and the extent of the involvement of the lymph nodes.

This webpage describes the staging with greater detail than I. It is also a site I would recommend in staying informed of the latest effective treatments and cancer research.


Nevertheless, don't get too bogged down with the late staging. Ideally, an early stage is better (even better is not having cancer period!), but as you can read on this site, many people do survive advanced stages of lung cancer.

Maintain a relationship with an oncologist you trust and feel comfortable in asking ANY questions. S/he can match the most effective therapy for you. Focus on the treatment and getting well.

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