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First they say SC extensive, now they say NSC - any similar situations?

kimbee1218
Posts: 29
Joined: Jun 2010

When my Dad had his biopsy the pulmonary Dr came out and told us he was sure that it was small cell and it didn't look good. Now we go to the onocologists and they say pathology report says squamus cell not small cell. They are rushing into treatment and we have a 2nd opinion appt on 7/20. If they start the treatment around 7/8 then he will not be able to travel out of town for the 2nd opinion. What should we do - who do you believe. I cannot believe that the pulmonary Dr would tell us this before the biopsy came back, unless he was sure of what he was seeing. Is it that obvious when you see SC? Any input would be appreciated.

stayingcalm's picture
stayingcalm
Posts: 654
Joined: Feb 2007

Kimbee,

I can only tell you what I would do if it were me, and I would go with the oncologist, who is trained in cancer treatment. You can certainly ask him to show you the pathology report and explain it, and you can call your pulmonary Doc and ask him why he was so sure about it being small cell, and then make your decision.

Good luck :)

Deb

kimbee1218
Posts: 29
Joined: Jun 2010

Deb,
Thanks for your input. Now the dilema is starting the treatment. If we start on 7/8 - we will not be able to make the 2nd opinion on 7/20. Everyone in our area says "go out of town - do not stay here" and they did make me feel rushed, especially with the major confusion on the dx. The Doctors in our area that have cancer go to Sloan Kettering and that is where the 2nd opinion is. I have read about your success and think that it is wonderful. I wish you well and I know that you have given me some hope, just hearing your story. Thanks again.

Kim

HeartofSoul's picture
HeartofSoul
Posts: 730
Joined: Dec 2009

so you have had 2 opinions, one by Med onc and one by Pulmonary DR, and your dad has had one biopsy which are indicating two different types of lung cell cancers. I would get another opinion by the second med onc on 7/20. Because there is a differnece in how the two types of lung cancers are treated (SCLC and NLCLC), you want the applicable treatment plan from the start. The difference from 7/8 and 7/20 is less than 2 weeks which is not a significant margin of time. Also request a tumor board to review your dads med data, path report, and scans if there is confusion or uncertainty by your DR findings.
Tumor board is made up of med onc, rad onc, pathologists, radiologists, perhaps pulmonary DR, and surgeon onc (Thorasic )

NSCLC spreads more slowly than small cell lung cancer. Consequently small cell treatment can be more aggressive in the early stages and more palliative in the late stages, because the cancer must be stopped in the early stages to have more hope of eradication. By the time small cell lung cancer gets into the later stages of disease, it is much more difficult to eliminate.

Treatment

Before the appropriate treatment can be defined a careful staging of the disease must be made. The principles of therapy of NSCLC and SCLC are different. SCLC is very seldom surgically resectable, usually widespread at presentation and is generally both more chemosensitive and radiosensitive.

NSCLC: Treatment is based on the stage of the disease at presentation (which may be assessed by thoracic CT, PET scan, brain MRI). Stage I-II are usually resected (adjuvant chemotherapy can be discussed with the patient) and locally advanced stages (III) are treated by combined modality treatments (neoadjuvant chemotherapy, resection if stage IIIA or radiotherapy). If overt distant metastases are detected, therapy is palliative and chemotherapy has been shown to improve median survival and quality of life.

NSCLC is further divided histologically into three main disease subtypes of:
•squamous cell carcinoma,
•adenocarcinoma and
•large cell carcinoma.

Small Cell:
Small cell carcinomas account for 20% of lung cancers. They mostly arise centrally in a large bronchus and are highly invasive and highly metastatic.

SCLC: If the tumour is confined to one hemithorax (limited disease), a combined modality therapy (chemo- and radiotherapy) is indicated: in more advanced disease (overt distant metastases in brain, liver, bones, surrenal glands or other organs) chemotherapy will be palliative though an excellent remission might be obtained in more than half of the patients.

What causes small cell lung cancer?
Approximately 13% of lung cancers are small cell lung cancers. Small cell lung cancer is primarily caused by smoking. Tobacco smoke has actually been shown to alter the content of a patient's DNA, leading to a greater likelihood that the cells will grow abnormally and become cancerous.

What causes non-small cell lung cancer (NSCLC)?
Approximately 87% of lung cancers are non-small cell. There are three sub-types of NSCLC: squamous cell carcinoma, large cell carcinoma, and adenocarcinoma. Each sub-type relates to the specific type of cell affected. NSCLC is closely associated with smoking, as well as asbestos or radon inhalation; the majority of NSCLC cases smoked at some point during their life. Thus, fewer people smoking should unilaterally lower the prevalence and incidence of NSCLC in the United States and worldwide. Secondhand smoke can also contribute to development of NSCLC later in life.

http://atlasgeneticsoncology.org/Tumors/LungTumOverviewID5030.html

kimbee1218
Posts: 29
Joined: Jun 2010

Thank you for the info...it is very helpful. The Drs are saying that they go by the patholgy report which says NSCLC, not the naked eye of the Pulmonary Dr. My only fear is that the report somehow got mixed up or done wrong. This very experienced Pulmonary Dr was so sure of what he saw, that he gave us the dx the day of the bronchoscopy. Also the Rad onoclogists says NSCLC Stage IV because of spread to the lymph nodes in chest and neck, but the chemo onocolgists says NSCLC stage IIIB, because they did not have the brain scan done yet. I am talking with 2nd opinion, because I had slides sent to them to do there own patholgy report, which is not back yet. I guess I have to assume that they received slides of my Dads tumor and not somebody else. I am waiting to hear from them and I think I am going to ask for the review that you mention. This is a life on the line and we need to be sure. As is this is not confusing enough without Drs making more confusion, who to beleive. I appreciate the information on the NSCLC, as I had only researched the SCLC. Once again, thanks.

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