stage 3a lung cancer...what treatment if any?

hanksta · New User Joined: 22 Aug 2008 Posts: 2

my mom, 78, is just diagnosed with stage 3a non operable non small cell lung cancer and is in excellent health and very strong. Diagnosis was a complete shock. The doctors talk of a 1/3 shrinking tumors, 1/3 staying stagnant and a 1/3 of these tumors will grow if she takes chemo of carboplatin and gemcitibin together. I am afraid of the side effects being a catalyst to making her very ill. They do not say the time in months or years that she has to live and even talk of curing the cancer. Am I being told the truth or not. I need the truth because all the research I am reading is that stage 3a lung cancer should be palliative and not for cure?

I need help from those of you who have experienced this kind of cancer and what they were told from their practitioners....

Does everyone fight the cancer? Or do people choose not to and still have quality of their life?

Is cancer treatment for this lung cancer still being experimented? Radiation was recommended by one doctor in addition and not by another...where do I turn for an honest answer?

onecoyote · Experienced user Joined: 15 Jul 2008 Posts: 66

Hi Hanksta,
First off, if your mom is in good health why do they say it is non operable? Many 3a staged people's cancer can be resected after a course of chemo and/or radiation. All depends on the location and size of the primary tumor, type of cancer and location of lymph nodes involved.
My husband is straddling a 2b/3a stage, next week we should know the pathology of biopsied lymph nodes they took from a mediastinoscopy. We were told by the surgeon that if a 2b, surgery would be the only treatment, no chemo. If it turns out a 3a, then a course of chemo/radiation will hopefully "downsize" the stage to a 2b thus making surgery possible.
My opinion(only an opinion), after extensive research and talks with oncologists, is that a 3a stage is far from "pallative". Options do exist if the patient has no other underlying medical problems that prevent them from being performed.
Everyone's scenario is a bit different, that is why there is no "one size fits all" answer as far as treatment goes. You should educate yourself as much as possible(knowledge is power) and then write down all your questions and concerns to have the doctors address.
I am sure others from this site can fill you in further.
Good luck
Onecoyote
Goodluck

dano

Hello Hanksta;
When you get a chance, get a second opinion on her condition.
I found that for me the second opinion gave me more understanding of my condition and more confidence in my doctors.
God Bless
Dan
_________________
54 year old male in Hawaii
Diagnosed Nov. 9,2007 with NSCLC IV
with Mets to the lymphs and brain
Had full brain radiation treatment in Jan 08
Currently on chemo treatments every 3 weeks
with Alimta
and taking Lovenox for blood clots
Now back to work full time
http://cancerforums.net/viewtopic.php?t=9993

hanksta · New User Joined: 22 Aug 2008 Posts: 2

thx to all of you. The surgery was not recommended because of where it lies in her lung. while researching the two chemo drugs on the internet there was strong suggestion that these two drugs are used in palliative - the doctor will not say anything about her condition other than her chances to live 5 years are definitely not going to happen. here in Quebec decisions are made by a tumour team of doctors with regards to her therapy and not just by one - however I did manage a second opinion but we will be getting that apointment after she has started treatment. The waits here are impossible however, if a patient is in trouble, as my mother, then the system works quickly: except getting second opinions becomes hard.

My personal fear is that 'it isn't the cancer that kills you - it's the treatment' that most people seem to say is the hardest part. We also were never told that treatment could shrink it to size for surgery - that is something i am going to bring up with the doctor.

dano

Hi Hanksta;
I see you are doing the best you can under the circumstance of living in Canada. Here my insurance allowed me to go from Hawaii to Seattle, Washington for a 2nd opinion. Your on a ride no one wants to be on but come here and share it and we can walk along side you through it.
God Bless
Dan
_________________
54 year old male in Hawaii
Diagnosed Nov. 9,2007 with NSCLC IV
with Mets to the lymphs and brain
Had full brain radiation treatment in Jan 08
Currently on chemo treatments every 3 weeks
with Alimta
and taking Lovenox for blood clots
Now back to work full time
http://cancerforums.net/viewtopic.php?t=9993

sgodshall · Regular Joined: 06 Jun 2008 Posts: 44 Location: Tennessee

Bill had a mask for WBR and stereotactic radiation. Hope you get some answers soon.
_________________
As long as there is Life, there is Hope.

Husband (44) with LC, mets to brain, lymph nodes and bones. Received Carbo/Taxol, currently in a clinical trail. Had WBR, stereotactic radiation to brain

simplyklb

My mom has stage III or IV NSCLC. She has a nodule in her left lung alone with one or two lymph nodes possibly involved (I have seen her original CT scan.). She does not want to know the actual staging. The onc said he would not recommend surgery because it would diminish her lung capacity. My mom has had some aggressive therapy. She's had four rounds of Carboplatin/Taxol/avastin. She is getting ready to have anothr CTscan on Sept. 8th. The onc is thinking continuing with the Avastin only and possibly doing some radiation. We will discuss after the scan on the 8th.

Kristi
_________________
Dad - Andy, 70, diagnosed with SCLC in May 2008
2/20/38 - 10/15/08 Fly high, Dad!
Mom - Jackie, 67, diagnosed with NSCLC in May 2008

maryaz

Hi hanksta, You should learn as much as you can so that you can make an educated decision.. My husband was staged 3B and had surgery NSCLC Squamous Cell Carcinoma. The link is at the bottom of my post to read about his treatment and surgery. I just posted part of this under another thread where it was applicable and so just copying part for here.

He had very aggressive chemo and radiation. Personally, I felt, afterward that it was why he had the opportunity to have the surgery. Surgery in the beginning was not a definite option. We feel the radiation was the biggy for shrinking the tumor.

His cancer was determined by a needle biopsy done January 10th. They insert this thru the back. In doing the bronchoscope, they could not get enough for a biopsy. His treatments started February 25th and then the last was first part of April. Surgery was May 16th.

I believe the tumor had to shrink to a certain point and cancer limited as shown on Pet Scan before surgery could happen. Afterward surgeon had got the tumor and all the lymph nodes that were removed had dead cancer cells except one. We just hope the one is all the further it went. 2 CTscans have so far shown no cancer. Without surgery, he would still have had the cancer growing.

Everyone is different in some ways. That applies to many diseases. Numbers are not always the primary thing to go by. I was told right up front on another board that Stage 3B does not get surgery and that once staged, a stage cannot be changed. Right or wrong, that became an unimportant issue with me when I saw what my husband got for treatment.

I would want to sit down and find out exactly what the doctors think. I have learned that we have to be aggressive sometimes in getting answers. Healthcare all over is lacking nowdays.

I found it very difficult to make decisions on things when your life is in a turmoil and also you are not well versed on what is being discussed. I can look back now and I know so much more than I did in even April. In the beginning, you just don't realize what all is happening.

Best of luck to you. One more thing, the doctor that indicated she would not live for 5 years really doesn't know that. No one really knows for sure. Mad

_________________
Mary

Husband is 67 year old Male
NSCLC - Squamous Cell Carcinoma
Chemo and Radiation Treatments together
Allergic reactions to Taxol and Taxotere.
The Story: http://www.cancerforums.net/about9079.html

Ckim · Experienced user Joined: 15 Aug 2008 Posts: 54

Stage IIIa is a lot different from Stage IIIb.

It means that either the tumor is small enough or that the involvement is only on one side of the lungs and that the lymph nodes are involved.

Once the lymph nodes are involved the chances of the cancer spreading goes up (as opposed to non-lymph node involvement.)

She probably has a really good chance of beating this primary cancer, but as they may have told you, lung cancer is not "curable' past stage III. You can get more time--possibly a lot of time--measured in years, not months.

The chemo will make her very sick. From what I have been able to discern, once it is in the lymph nodes, surgery does not really give you an edge and can disable you more because it is a rough surgery to go through.

Second opinions are great. Best case scenario is that chemo and radiation would put this cancer into remission and she would have many years of quality life ahead of her. Always hope for the best!

maryaz

Ckim: You seem to have more information than I had. I am confused now. This person was told that they definitely would not see 5 years survival. You said if treatment worked would have many years of quality life ahead.

You said “. . also surgery does not really give you an edge . . .” I have to disagree with your surgery statement. On a personal level for me and for some others that I know had the surgery it gave back a life and that is more than ‘an edge’. I really don’t agree with you. I realize my husband’s cancer could show up any day but already we have gained from the surgery. These are the lives of our loved ones. We cannot gamble with them.
_________________
Mary

Husband is 67 year old Male
NSCLC - Squamous Cell Carcinoma
Chemo and Radiation Treatments together
Allergic reactions to Taxol and Taxotere.
The Story: http://www.cancerforums.net/about9079.html

Ckim · Experienced user Joined: 15 Aug 2008 Posts: 54

[quote="maryaz"]Ckim: You seem to have more information than I had. I am confused now. This person was told that they definitely would not see 5 years survival. You said if treatment worked would have many years of quality life ahead.

You said “. . also surgery does not really give you an edge . . .” I have to disagree with your surgery statement. On a personal level for me and for some others that I know had the surgery it gave back a life and that is more than ‘an edge’. I really don’t agree with you. I realize my husband’s cancer could show up any day but already we have gained from the surgery. These are the lives of our loved ones. We cannot gamble with them.[/quote]

With IIIa you have a much better chance that with IIIb because of the bilateral involvement of the lymph nodes. A 78 year old woman may find it very difficult to endure the kind of surgery that may be required whereas your husband may have been better able to tolerate it.

It depends on the age and health of the person--i was going on the age of 78 as far as whether surgery would be a good option. My mom is 74 and in good health but I don't know that she could handle it. I would guess it would also depend on where the tumor is. if it is causing pain in and of itself or if its growth would impeded important systems and can get rid of it, then of course you should.

If my dad had not had the throat cancer, surgery would have been an option for him.

But, once the lymph nodes are involved, its in the bloodstream and cannot be guaranteed to stay dormant or not spread.

Surgery is not a guarantee, nor is chemo for that matter.

But, then again I wouldn't trust anyone to say that they would definitely not see five year survival. the 5 year survival statistics are over 5 years old. Today's chemos are more effective wtih fewer side effects, in essence making cancer in some cases more of a chronic rather than a fatal disease.

My dad survived Stage IV throat cancer which was considered a death sentence at the time (2004). In fact, it was so rare for people at the time to survive it that they had few strategies for dealing with the after effects of what the radiation did to their saliva glands.

Now, more and more people are surviving it and to 5 years. Now, in the condition my dad is in now, i don't know that you would put much stock in it being called "survival.'

That is why I don't know what to think--is he just sick or is he dying?

He was dx'd with Stage IIIa in December of '06. By the statistics, he shouldn't still be alive today. After the mets to the brain in December of '07, he really, really shouldn't be alive. (save for the Cyber knife, he would have an active tumor in his brain.)

And after the Alimta, there are apparently at least 3 other drugs that he could try if he still wanted to try and fight it. If a drug works then NED is just around the corner.

He is lucky so far in that he does not have any heart or high bp problems. but, now we have this pain med problem.

Now, surgery for Stage II is practically a given. Without lymph node involvement, getting rid of the primary tumor and then maybe using chemo to get rid of any residual cells that haven't gotten rooted yet, the chance of survival is very good. With Stage I even better and surgery is the best option.

IIIa and IIIb have some very divergent prospects. wtih b since it is already bilateral involvement of the nodes, surgery will not help things. With IIIa it can go either way depending on other factors. But, chemo can kill a tumor with out the rigors of surgery so there is a decision to be made there. the jury is still out on it though. A lot depends on the individual.

As far as surgery goes though--it is generally considered a good option up to Stage II but is not a given at Stage IIIa and generally useless in terms of survival rates for IIIb.

I remember being very happy that my dad had IIIa instead of b!

The sad part is that we saw the tumor on an old x-ray from 18 months before. It wasn't caught. Likely it would have been considered I or II at the time and surgery would have taken care of it.

It's just those pesky lymph nodes. Once it gets in there it is indicative of its spread into the body. And even so, the fact that he had had cancer before raised his chances of getting it again anyway.

But, that tumor he had? It's dead. It's still there but dead. Taking it out would not have made a difference. And at his age at the time (67 and already having had cancer) it would have been too rigorous.

All in all, even though there has been so much uncertainty, the fact that new treatments continue to be developed and the fact that my dad has lived far beyond the original projected statistics makes me have hope that we will indeed someday beat this horrible thing for good!

maryaz

Hi Ckim; I have read what you wrote and plan to read it again. I know what you are saying and cannot disagree. However, my husband for sure would not make it without the surgery. Altho, 2 CTscans show NED at this time, maybe that will not remain.

Everything removed, tumor and lymph nodes were dead cells except live cells in one of the lymph nodes. I would think without the surgery that would have traveled. I wonder if you read my husband's story which is linked under my sig.

I don't want to keep discussing it. I think I see what you are saying. At first it sounded like you were indicating no one has surgery at stage 3B.

I do have another question now. I sure wish the coding worked on this site. You said:
"The sad part is that we saw the tumor on an old x-ray from 18 months before. It wasn't caught. Likely it would have been considered I or II at the time and surgery would have taken care of it."

Did you approach anyone on this? Could you have, if you didn't? Seems someone would be at fault for not disclosing this?? This is why I am adamant anymore about 'GET COPIES OF ALL TESTS'. I would like to see anyone's reply about this part. I have often wondered because mistakes are made in healthcare more than should be nowdays.

Best of luck Ckim. Your Dad has already gone further than expected and so hard to say this time. Doesn't sound good but where there is life, there is hope. I will pray for both of you. I am not one that understands the brain mets. It just comes off to me like a very bad thing and more often than not, bad results.
_________________
Mary

Husband is 67 year old Male
NSCLC - Squamous Cell Carcinoma
Chemo and Radiation Treatments together
Allergic reactions to Taxol and Taxotere.
The Story: http://www.cancerforums.net/about9079.html

pbj11 · Site Admin Joined: 12 May 2007 Posts: 1302

Hanksta,

For a little overall perspective, survival is highly dependent on type of cancer, sub-type, cell differentiation, tumor burden, and stage. IIIB and IV are about the same survival overall. As pointed out, the latest stats which do not reflect newer medicine's like Tarceva, is that only 15% of ALL stages live to 5 years. Lung cancer, on a cellular level is one of the hardest types of cancer to treat. I'll be very honest, I've yet to witness more than a rare handful of people who have surpassed the five year mark with a late stage diagnosis, but there are those few and we always felt that "why couldn't that be my husband?"

Stage IIIb & IV automatically get pegged with the "palliative care" term DUE TO THE STAGING NUMBER. It DOES NOT mean any less aggressive treatment for the patient, unless you opt to do minimal treatment to manage symptoms.

I won't get into the finer points of earlier staging and surgery, except to say that each person is so individual that the final analysis must be done by the oncologists and surgeons in charge. I know plenty of people who had surgery/chemo/radiation for early stage that have had recurrences and are now late stage. If surgery is a possibility, it is always the best, but gives no guarantees that the cancer will not return. As a lay person, I've always looked at it that the conditions that were right for the cancer to develop in the first place still exist throughout the lungs. I could be way off, but that's my own theory after watching how my husband's cancer went down. Stages do not go backward, you are what your initial stage was, with either it termed recurrence or a higher numbered stage.

As far as how a person will react to chemo/radiation, it is any one's guess. I've seen tiny women who come through grueling rounds of chemo like champs and big six-foot men who are laid out flat from the same chemo. Each human body is a unique chemical factory and there is no telling how you react unless you try chemo. Response rate is another variable. It appears the less well-differentiated cancer cells are, the better the initial response. That's why you see such wild improvement with first line SCLC treatment, then it typically roars back because it is the most aggressive type. The more agents or lines of treatment that are used, generally the less the tumors will respond, because they are mutating and becoming resistant to treatment. Lung cancer doesn't follow any rules and we witnessed almost miracle like responses on my husband's fourth line of treatment. Go figure. If you are among the lucky numbers who have the EGFR mutation, you can have amazing reduction in tumors or stability for long periods of time with drugs like Tarceva. (Months to 2+ years.)

Many drugs will actually hold the cancer stable and sometimes that can be as good as it gets. Some people, sadly, can be non-responders to most treatments.

Without trying chemo, one doesn't know how it can change all the variables in a given situation. I look at lung cancer as being dealt a hand of cards and chemo reshuffles the whole deck. Our take was, if my husband didn't like how it made him feel, he would stop doing it. Please see the link at the bottom of my post to see how much chemo he did tolerate and had a fairly decent quality of life. His survival was out of the park for the tumor burden and poor cell differentiation he had at diagnosis. You walk this path in the dark and keep hoping for the best. Some day it MAY be considered a chronic condition and I hope that day comes quickly for all the good people here.

As to the question of why some cancers weren't caught -- we have to live in the present and deal with what it is. No amount of Monday morning quarterbacking is going to change where either us or our loved ones are sitting. Ha! Learned that from my husband actually. He was much better at acceptance than I ever was. Confused

Mary, you are right in that you've learned the importance of being an advocate, but it's not a lesson learned right at the beginning for most folks. It is an important part of our forums to help others to know the power of vigilance for themselves or loved ones. I'd still say that our experience with the health care system was top flight, with no second opinions and no big cancer centers involved.

PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

UneasyRider · Regular Joined: 21 Aug 2008 Posts: 16

Good info, pbj. I'll just add that any recurrence makes it stage 3, and not curable, even if it was stage 1 or 2 when first found.

I had the same thing happen on my chest x-ray. When they spotted the shadow, they went back to a 10 month old x-ray taken before my umbilical hernia surgery, and sure enough, the spot was there. It was explained to me that the spot was so small and faint, it was not seen as anything more than an x-ray glitch until it showed up on another x-ray, which made doctors sure it was more than a glitch, so that may be what happened this time, too.
_________________
57 year old male in Texas diagnosed with Stage II NSCLC in November, 2007
Treated with upper left lobectomy and 3 rounds of adjuvant chemotherapy
6 month CT scan shows lungs clear
My story is in this thread: http://cancerforums.net/viewtopic.php?p=39609#39609

maryaz

PBJ, that was a very good post. I am keeping it for reference for myself. I appreciate the time taken to post it.

I agree with your statement as far as just asking ourselves, why was it not discovered earlier. Part of your post stated:
"As to the question of why some cancers weren't caught -- we have to live in the present and deal with what it is. No amount of Monday morning quarterbacking is going to change where either us or our loved ones are sitting."

I am not sure if you just were referring to someone saying 'why didn't they. . .'. The question I had posted was in response to where Ckim said:
"The sad part is that we saw the tumor on an old x-ray from 18 months before. It wasn't caught. Likely it would have been considered I or II at the time and surgery would have taken care of it."

That was why I posted the following paragraph which still I would like to see a reply if anyone has ever experienced this. I am referring to a test that 'actually' showed it but was possibly never read or told to the patient, for whatever reason, which whether so or not, is what it sounded like Ckim posted:

"Did you approach anyone on this? Could you have, if you didn't? Seems someone would be at fault for not disclosing this?? This is why I am adamant anymore about 'GET COPIES OF ALL TESTS'. I would like to see anyone's reply about this part. I have often wondered because mistakes are made in healthcare more than should be nowdays."

Hope I didn't confuse you. None of you need confusion at this point, there is enough of that just having cancer. Smile

_________________
Mary

Husband is 67 year old Male
NSCLC - Squamous Cell Carcinoma
Chemo and Radiation Treatments together
Allergic reactions to Taxol and Taxotere.
The Story: http://www.cancerforums.net/about9079.html

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