Lung Cancer

[offbrat56]

My dad was just diagnosed with a billiard ball-sized squamos cell tumor in the left lung. Today he begins radiotherapy and chemotherapy for 7 weeks. No metastasis to brain or lower abdomen yet. Some lung lymph nodes were found to be affected. I do not know any of the specifics of his staging, but after reading on this site, I would say he is either Stage IIb or Stage IIIa. They would not offer surgery unless it was the removal of the entire lung. Since my dad has COPD/emphasema, this was not considered an option. I do not know why they refuse to remove only the tumor--if it is due to the particulars of his condition or they don't have a thorasic surgeon capable of the procedure. This is very frustrating to deal with since my inclination is to remove it----get the thing out of him before it does spread.

Since he has chosen to remain with this particular hospital and doctors and their opinions for treatment, I have questions regarding that treatment. What happens to the cancer cells as they are killed? Does the body assimilate them? Doesn't that carry a risk of its own? Will some break loose and cause respiratory problems of a crisis nature? They live an hour from the medical facility and I worry about possible problems due to this distance.

Please don't advise me to speak with his doctors---he won't let anyone ask the doctors anything. "It's my life, my decision!" If I had any of the doctors' email addresses, I would email my questions and concerns---but I don't. After reading the survival rates for the various lung cancers and stages on this site, it seems to me surgical intervention of the tumor alone (even if he has to travel to an enormous hospital to find the right surgeon) would be the best course of treatment. Time is such a critical factor, though, and I don't know how long it would take him to find a surgeon willing to resection.

Any answers out there to my questions/concerns? Any experienced medical people out there to advise me of facts for the various scenarios? Other factors: The tumor is confined to a small area/compact, does not involve any blood vessels or nerves (yet), it is blocking a brochial tube to his lower lobe, and the lymph nodes involved are the ones right near the tumor--not all over the lung. My dad smoked for 30 years, but has been smoking-free for 25 years. He is in very good shape, otherwise, physically. He went from playing golf every other day to being confined to his chair and then bed with various "lung inflammations/infections" just since early Feb/09. They kept telling him his shortness of breath was due to his COPD/aging. It was the third emergency room trip that caused someone to look for an actual cause to this marked change in breathing and associated pneumonia that was later determined to not be pneumonia He was even told the second time that his own "awareness of his increasing heart rate" would cause him to get more anxious and thereby make it worse. Yes, I am angry at the delay--very! They determined it to be less than 6 months old. I can't dwell on that, though. It was found. It hasn't spread. It is confined. I want him to select and acquire the best treatment with the best possible outcome. He is a retired officer and insurance is not a factor. Any advice? Thank you.

[Davy9]

I will share what I can.

I suspect that it is the location of the tumor that has caused the recurrent pneumonia's and limits the surgical approach. If the tumor is high in the respiratory tract it then sits close to, or among where the major airways branch off to their individual lobes. It would not be easy to resect just the tumor or just a section of the lung in this case. The tumor is too close to all the segmental airways that supply all the lobes of the left lung leaving the sole surgical option of complete removal of the entire left lung. That also dovetails with his recent history of a persistent pneumonia. It was probably a sequestration pneumonia where the tumor mass blocked off one or more major airways leading to their lobes. That shuts down airflow in and out of those affected lobes resulting in atelectasis and infection. Often these are seen as very specific lobar pneumonia's on xrays. Regardless of treatment the lung infection recurs because the tumor precipitates the infections.

The radiation and chemo is intended to shrink the tumor. They are not commonly curative but it does happen. The curative approach would be surgery plus the other therapies. If the tumor is unilateral and has not spread beyond the left lung its resection would offer the best prognosis. Using just the other 2 therapies will likely return the patency to the impacted airways temporarily controlling the recurrent pneumonia's, but historically they more palliative than curative.

I have no understanding of how advanced the emphysema is and have nothing to advise as to how well he would function if the left lung were removed. His prior pulmonary function studies will help define that. They can also do better functional analysis using imaging studies so they can get some understanding of how well that right lung would support him.

You know your dad. Perhaps if he clearly understood what his level of activity could be after the surgery he would be more willing to accept it. But, maybe he does already understand this and it is not good enough for him. The surgery itself is major but not as horrific as it sounds. They have been removing lungs for a long time so the procedure and its post-op care is well practised. He will have a significant rehab effort but he sounds regimented enough to tackle anything that challenging.

As for the initial diagnosis there is not much to offer. He had a spate of recurrent pneumonia's during the winter and that is not uncommon nor always related to a neoplasm. When the treatments did not work they explored why and found the answer.... and they are offering some solutions. You would probably be in exactly the same boat in any medical institution. Lungs cancers are frequently diagnosed at more advanced stages than this one for a number of reasons.

Is his earlier history of smoking the cause of this? Most certainly it is. Even though he quit long ago he initiated the sequence of cellular events that ultimately resulted in this sort of cancer. Lung cancer was once a very rare disease. You can neatly track the incidence of lung cancer directly with the initiation of industrially mass manufactured cigarettes. Look up the lung cancer statistics for women and you can see exactly when they became a smoking liberated gender.

I am sorry that he and his family must face this battle. Best to you all.

[offbrat56]

Thank you, Davy9. My dad has been receiving the treatments for 4 days, so far, and is already breathing better. He has no pain, still. He has only suffered a little nausea one morning, so far. His breathing capacity was at 50% before this all began. The doctors estimate the tumor to be approximately 6 months old. I do appreciate your insights, but I still wonder what happens to the dead tumor cells. Will he cough them up, will the body assimilate them, will there be toxins released into the body from the dead cells? I am curious about that and no one has told my dad what happens to them, so he can't tell me. Any idea on that? His radiation therapy will be for 7 weeks, approximately, (daily) with a once a week low-dose chemotherapy session each Monday for at least 9 weeks. We are all, naturally, very hopeful and thankful for the treatment.

I am very thankful that income and insurance are not issues for him. I can't imagine what the same situation would be like for someone without insurance or adequate family support. My dad's frame of mind is fantastic, at present. He has found a new zest for life and renewed Spiritual fervor.

Thank you, again.

[EffieJo]

I registered this morning and immediately read your post about your Dad's cancer. My Dad was diagnosed last Thursday with a Squamous Cell Carcinoma in his right lung that has spread to the lymph nodes in his neck. His Doctors said his cancer was at stage 3b. The compression of the cancer mass has caused a blood clot in a vein under his clavical bone. He was on IV heparin for 4 days before being released from the hospital to continue heparin injections twice a day for the next 2 weeks. At that time he begins 7 chemo treatments, one a week for 7 weeks as well as 35 radiation treatments, every day Monday thru Friday for the 7 week period. My Dad is active and had no symptoms other than some shortness of breath and minor swelling in his neck prior to going in to see his Doctors. He is 76 years old but doesn't look or act a day over 60 and we thought he was in fairly good health. Your Father's illness sounds much like what the Drs have told me about Dad. They also told us that surgery was not an option due to the location of the tumor and the fact it has already spread to his lymph nodes. How is your Father doing now? Did he respond well to his treatments? Did they make him really sick? I am terrified for my Dad and can't wrap my mind around this diagnosis. I would appreciate any response from you and will keep you and your Dad in my prayers. God Bless.

[offbrat56]

Greetings! I was saddened to hear of your dad's condition. My dad just completed a shortened number of chemo treatments and shortened amount of radiation treatments. Caution and be forewarned--my dad's throat got so inflamed/sore/raw from the path of the radiation that he could not eat or drink. He ended up dehydrated and having low blood pressure by end of week 3. He also had to get 2 pints of blood transfused to improve his rbc's and wbc's at the same time. He spent over a week in the hospital. He continued radiation, but only ended up having one more chemo treatment. He was sent home and upon returning the following Monday for one of 4 last radiation treatments, they suspended treatment until further notice. He has a very large radiation burn on his back that we are treating. He had a tube (PEG) put in while in the hospital and receives all his nourishment and water via the tube. He is eager for his esophagus to heal so he can eat something, again. All in all, the tumor shrinkage/removal has been successful, but we won't have an accurate picture until he returns to the doctors on the 25th. Be sure and let your dad know about these types of possible problems--to be prepared for them and ready to accommodate them. Keep in touch!

[EffieJo]

Thank you so much for the information on your Dad's treatment and progression thus far. Honestly, I have been so worried about the chemo effects that I hadn't given much thought to how the radiation treatments could effect him as well and am so thankful for your insight. For the time being Dad is feeling good and eating well. I realize this will no doubt change drastically once the treatments begin. I am praying for your Dad (and for you) as you await news on the 25th. Please let me know how it is going and I will update you as we begin the fight. Your family is in my thoughts and prayers daily. Good luck and God bless.

[offbrat56]

Dad saw 3 of his doctors today, and praise from all 3! He feels very weak and suffers from heartburn almost continuously. They prescribed an additional medication for the heartburn. They found him to be slightly anemic and gave him a "blood booster" shot--whatever that is--to stimulate rbc and wbc production. His back is healing well. We still don't know when his esophagus will be healed well enough for him to try and eat real food, nor do we know how long he will need to keep his tube to be fed through. He returns on Sept. 23rd, I believe, for a CT scan to see where he is at with any remaining cancer cells, lung damage, etc. I'll be glad to see him eat, walk across the room without being worn out, and for his mood to improve. I know it has to be very hard on a person who is used to golfing every other day to just sit all day, every day, with no energy to do anything, and wishing he could enjoy a meal. I will keep you updated and we do appreciate your prayers. Your needs are in my prayers, as well. My dad was also feeling good and eating well the first couple of weeks of treatment. It all went "south" very quickly that third week. Just be aware and keep in good touch with his doctors. Peace be unto both of you.

[EffieJo]

Hi..I am glad your Dad received some good reports at his last Doctors visit! I embrace any good news received at this point as I am sure do you. Dad met with the oncologist who is responsible for his chemo today. Treatments have been suspended until after a current PET scan is completed. He is scheduled for the scan on Sept 2nd. His last CT scan showed a lesion on his liver and until it is viewed on the PET scan they aren't sure how to proceed with his treatment. If cancer is found anywhere else in his body, they aren't going to give him any radiation...only chemo. Rather than one low dose treatment every week for 7 weeks he will receive high dose chemo treatments one a week, every three weeks for an undetermined time. I know the radiation treatments are so hard for patients but am very concerned that he may not get the opportunity to see if they can help. The Dr said that if the cancer has spread to other locations that it would be classified as Stage IV and radiation wouldn't help him...Is this standard? It is so hard to believe that this vital man is so ill. He walked rings around me today at the hospital...never gets out of breath..or has any symptoms of this deadly disease. I know all that will change dramatically once the treatments begin and am savoring every moment of "today". I continue to hold you and your Dad up in my prayers. Please remember us in yours as well. Keep in touch..God Bless.

[offbrat56]

So sorry to hear about the lesion on the liver. This Oncology Channel site has pretty good information so I would refer you to it regarding usual treatments for Stage IV. They also checked my dad for any other cancer sites prior to treatment---but they didn't tell us there would be no radiation if they found any. They did say they needed to know exactly what they were dealing with before discussing options, so, that may be what they were going to tell us. There is still a chance the lesion has nothing to do with the cancer in the lung--right?

My dad is so depressed at this stage, he is really hard to deal with. My mom and I are so thrilled to be done with the treatments, for now, and to know that he can get all the nourishment he needs, and to watch his burned back slowly heal. We are so thankful and yet his mood is so morbid----he has become convinced he will never get to feeling better, every little twinge or setback is surely more cancer that has spread, and that no one knows what he is going through. It is very, very trying to remain upbeat with someone so determined to be wallowing in pity. We know he feels bad although he is NOT in pain, at all. We know he is extremely tired and has no appetite for food or drink. We know he can't get out and enjoy this beautiful summer we have had. We can't seem to encourage him, at all. We do pray about it, and with him. I am so anxious for any improvement in mood. I don't anticipate this until we see the doctors in Sept. for that CT scan and they declare things to be better. No one has told us that depression is a side effect of the treatments, so I don't know that this is "normal" for those in his position. I suspect it is a common side effect, though, for someone who has been "through the wringer" of cancer treatments.

I will remember you and yours in my prayers and thank you, again, for your prayers for us. God bless.

[EffieJo]

Thanks so much for your reply. I hope your Dad's mood is better. I can relate to what you are going through. My Dad's treatment hasn't even started but he is so down and seems to be focused on dying. I don't know how to help him and it seems no matter what I say, its the wrong thing. He has an appointment today to find out the results of the PET scan with the radiation doctor. Needless to say, I am a nervous wreck. Your insight into what your family is experiencing has been so welcomed and helpful to me. I have two siblings, who both have RP and are blind. We lost our Mom in 2001 to a stroke so I don't have anyone to help me with Dad during this journey. Dad feels my brother and sister have enough to deal with in their life struggles and worries constantly about how his illness is effecting them. I do too...I am worried about everybody! About the lesion on his liver..it could be unrelated to the cancer and I am praying that is the case. Dad, however, is convinced that the cancer has spread there and into his brain as well. I know I am rambling on this morning and we will know this afternoon just what we are dealing with and what is in store for us. But I am really scared to find out...I guess I just needed to vent. I am holding your Dad and your family up in prayer and hope that today is easier for you all. I will let you know what we find out today. Please remember us in prayer..
Thank you for your kindness,
Jo