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Decisions to Be Made

suebanj
Posts: 16
Joined: Jul 2009

I just had my upper left lobe of lung removed on July 7th. Came home on Friday and have a follow up appt with my thorasic surgeon on Thursday to go over things. I've been told that all pathology tests show that the cancer did not spread at all and that they got all out. I've been reading alot of different boards and sites and am wondering. Should I still be having some kind of treatment to increase my chances of survival?? Should I be seeing an oncologist??? If anyone has gone through this and can assist me with any questions I should be asking on Thursday I'd really appreciate it!

catcon49's picture
catcon49
Posts: 398
Joined: Aug 2008

I am sorry to hear about your dx. I was dx in 9/08. Stage 1a Lung cancer after undergoing VATS surgery. My surgeon did not feel that I needed Chemo. I spoke to an oncologist and she said she would go as high as 95% 5 year survival rate. Some people on this site have had the chemo with an early stage cancer. I'm not sure there is just one answer to your question of getting chemo or not. Listen to the doctors get an opinion. Get a second opinion. Good luck and you will be in my prayers

soccerfreaks's picture
soccerfreaks
Posts: 2801
Joined: Sep 2006

On your successful surgery and being on the road to recovery.

When your doctor(s) advised you there was no edidence of further pathology, if they had been completely honest they might have added that, of course, when cancer is very small, it is virtually undectable. Doctors often have to wait for months to determine whether there is cancer.

Both times I had cancer, for what it is worth, I received additional treatment. The first time, surgery to remove tongue and neck cancer, was followed by radiation and chemotherapy. The second, to remove a small node in the lowest lobe of my right lung (a lobectomy) was followed by chemotherapy. Both times, my team included an oncologist from the very beginning and both times the additional treatment was considered to be a sort of additional security measure: an opportune time to catch any strays.

As catcon indicates, each person's case is a tad bit different. But you might ask about the possibility of, need for, chemotherapy and, in any event, about seeking the advice of an oncologist. You should almosts certainly be anticipating regular and frequent checkups at first, including CAT/PET scans (maybe every three monthst?), to verify the success of the surgery.

Best wishes, and again, congratulations!

Take care,

Joe

ljrn1963
Posts: 7
Joined: Jul 2009

I was diagnosed with Stage 1a nonsmall cell carcinoma in my right middle lobe in July 2007. I too, had the VATS done, removal of my right middle lobe. My surgeon said there was no need for chemo. I made an appt anyway with an oncologist. She also said there was no need for chemo. Exactly one year later when it was time for my annual CT/PET scans, I got a big surprise. The cancer had metastasized to my lymph nodes, bones, and other parts of my lungs. I've been doing chemo and radiation ever since. My oncologist suggested palliative care last week since the Tarceva isn't working. Insist on chemo after surgery. I'll be 46 next week. Way too young to be checking out.

cabbott
Posts: 1048
Joined: Aug 2006

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

suebanj
Posts: 16
Joined: Jul 2009

Well, had my appt today with the medical oncologist. I did have stage 1 adenocarcinom and he feels that they got all with the surgery. He is having me see a radiation oncologist next week for him to review my file. He said that at my age of 56, they sometimes do a few radiations to better the chances that nothing was missed through surgery. My medical oncologist also has a board that reviews files and make sure nothing is missed.
So, I'm feeling pretty postitive at this point and he said I was one very lucky woman. I will have to have scans done every three months the first year.
I guess my mental state will improve more after seeing the radiation oncologist and then the appt with my medical oncologist after the board reviews my file. Now, at a little over two weeks after my surgery, I just wish I would not still feel so tired, but then again, I did have major surgery.
thank you all for your support and information.
Sue

suebanj
Posts: 16
Joined: Jul 2009

Just got back from Radiation Oncologist. After reviewing my file, he feels that I do not need any radiation therapy. He said I was one very lucky woman...Next week I go to the medical oncologist to set up schedule for follow up scans, etc....
Now, just need to get my energy back but I do realize this was major surgery and it will take time...Hey, it's only been three weeks...

soccerfreaks's picture
soccerfreaks
Posts: 2801
Joined: Sep 2006

That is fantastic news!

Take care,

Joe

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